I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: gotmoose on November 21, 2012, 04:35:33 PM
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Does anybody really know exactly whats gona happen to Dialysis patients and future Transplant canidates under Obama care? I havent been able to find any offical information requardling this.
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so does that mean we are screwed, should the government will it so?
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They could safely cut the requirement that a dialysis patient must be seen by a Nephrologist once a month. What a waste of tax payer money. The Nephrologist needs to see a patient in his/her office if "needed". Only if the person is having "problems." I could go months without seeing mine.
cut cut cut!
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Every zero-sum game has winners and losers.
One of the immutable requirements for a transplant is a successful finding on the wallet biopsy, and the uninsured are automatically excluded from consideration unless they have a boatload of ca$h. Those who are already insured can expect an even more crowded waiting list as more people are added to the insurance roles and thus able to get past the financial gatekeeper at the xplant center.
So, those who are currently insured are losers, and those who will be able to get insurance as a result of O-care are the winners. Whether this is good or bad is left an an exercise for the reader to figure out.
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There is no winners and losers. It sucks, but they are going to look for ways to cut costs, and those who can not contribute and pay any taxes, will be considered not being candidates. This has been coming for a long time. We all will be affected eventually.
Sharon
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Rerun - I'd add cutting the social worker's pay for visits once a month while on dialysis also. The one I had the last three years was useless. And dietitians, too. No help there at all for me. Maybe the rest of you had better luck.
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Rerun - I'd add cutting the social worker's pay for visits once a month while on dialysis also. The one I had the last three years was useless. And dietitians, too. No help there at all for me. Maybe the rest of you had better luck.
Same here, they do not do anything to help. And my doctor and nurse that come see me every couple of weeks, are in the clinic 10 minutes tops. They stop by and ask "Do you need anything?" and they are gone!
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I have 60 posts looking at heathcare reform through the CKD lens here http://www.billpeckham.com/from_the_sharp_end_of_the/healthcare_reform/ (http://www.billpeckham.com/from_the_sharp_end_of_the/healthcare_reform/)
The short answer is that Obamacare is a huge win for people who have CKD. One reason so many people who use dialysis or a transplant apply for and receive disability is concern about health insurance. For people using dialysis health insurance is a barrier to employment – one person using dialysis (and having their care reimbursed at premium private payer rates) can significantly increase a medium to small business’s per employee health insurance cost – many dialyzors feel pressure from employers to “go on disability”.
For people using a transplant they have to worry how they will pay for a life time of immunosuppressant use. Right now once you are 36 months out from a kidney transplant you have to find your own insurance because unless you qualify due to age or disability you will lose your access to Medicare. With Obamacare people with preexisting conditions will have the same access to health insurance that healthy people have, and for women their costs will be at parity with men.
The exception is in states that don't agree to implement the Medicaid portion of the law, in those states people who earn less than 100% of the poverty level will not have any new benefits, if they are not eligible for Medicaid today, and if they're in a state that opts out of the Medicaid expansion they'll not have Medicaid coverage after 2014.
There is not a line item in the budget for social workers or dietitians, they are paid out of the bundle. All these support staff are competing for the limited resources the bundle provides; the providers would not doubt agree to the idea of ending their involvement in patient care but when used properly they are valuable members of what should be a team.
The IPAB, like any other legislation, can not bind future Congresses, but it could achieve savings that are more targeted than across the board cuts, hopefully it will preform better than expected.
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Where each state stands on ACA's Medicaid expansion
http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap
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Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.
This trend will probably accelerate if the states not participating also enact medical tort reform.
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Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.
This trend will probably accelerate if the states not participating also enact medical tort reform.
I don't men to be "that guy," but I live in Massachusetts and we've seen nothing like that. Do you have any citations to back that up or is this just speculation?
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I think a lot of people worry about health care rationing in the future. Well we've had it for years. I had to deal with it for the 15 years I worked and had "regular" insurance. They have always decided what they will and won't pay for. I don't think that changes will be immediate or abrupt. Beauracracy moves slowly.
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There is no winners and losers.
Are you really say that there will not be a group of people who are better off because of Obama care, as well as a group that are not as well off? That's what I mean by "winner and loser".
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At this point in time, all comments/analysis can be considered speculation. However, what is fact, twenty-something states are not going to participate in the extended Medicaid program and/or develop their own exchanges. It will not be business as usual.
Comparing your state's program to Obamacare is like comparing apples to oranges. I don't believe it involved 2700 pages of regulations and requirements as well as federal level interventions.
This is funny because this is not fact "twenty-something states are not going to participate in the extended Medicaid program and/or develop their own exchanges."
Here is a handy up to date map of what each state has said to date http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/1/ (http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/1/)
As the smoke and dust of the campaign settles I think most states will decide to go with what is in the interest of their citizens; choose to expand Medicaid.
Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.
This trend will probably accelerate if the states not participating also enact medical tort reform.
This is funny too. You're predicting that as patients move out of states, physicians will move in, that is counter to basic economics. In any case if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, no reason to move to a state where people are uninsured to avoid treating them.
In general the several states of the old confederacy that have said they will not expand Medicaid have terrible Medicaid/health insurance now yet I am not aware of a vast migration for health benefits. After 2014 there will still be today's residency requirements for Medicaid.
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Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.
This trend will probably accelerate if the states not participating also enact medical tort reform.
This is funny too. You're predicting that as patients move out of states, physicians will move in, that is counter to basic economics. In any case if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, no reason to move to a state where people are uninsured to avoid treating them.
In general the several states of the old confederacy that have said they will not expand Medicaid have terrible Medicaid/health insurance now yet I am not aware of a vast migration for health benefits. After 2014 there will still be today's residency requirements for Medicaid.
I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements. We already see illegal alien migration away from states with tougher immigration laws. Why expect less in this scenario?
And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.
You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs. One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
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Thanks for reposting the "handy up to date" map that Patdowns posted before you. And, I will stand by my comment of fact that 20 states have decided at this time to either not participate in the extended Medicaid Program and/or develop their own exchanges.
From the map Patdowns posted, 8 states are not participating in the extended Medicaid program w/5 leaning that way. Here's an up to date map from Kaiser Family Foundation showing how states are breaking towards forming their own exchanges (including source of decision). - http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17 (http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17)
16 have decided to default to the feds. Therefore 8+16=24 - I won't even count the 5 leaning states.
As far as going w/the interests of its citizens, these states are. They realize it (extended Medicaid) will cost them huge amounts of money long-term and do not want to tax citizens any further or commit their states to unsustainable financial obligations . Unlike the federal govt., states can't print money. Those are facts.
The main reasons given by most governors who do not want to set up state exchanges? The Obama administration has been slow to release details about how exchanges should operate and complained that the law has proved too inflexible to meet the needs of individual states. Funny, exactly opposite of what you say why they will end up participating. Now, if the administration will make changes the states can live with, of course they will reconsider.
I don't think the nature of the exchanges are an issue, people with CKD will be better served by having access to insurance, whether through a state run exchange or an exchange run by the feds, from the perspective of the insured they're the same. If you need transplant meds for the rest of your life you will be able to maintain health insurance if the state runs your exchange or the feds run your exchange. What was funny is that you preface your comment by warning people about speculation and then you immediately speculate about how many states will choose which ever option.
The meaningful choice is whether to opt into the expansion of Medicaid because the Affordable Care Act does not have a plan B to get insurance to people who earn 100% or less of the federal poverty level (fpl) or whatever the state's Medicaid eligibility requirements are (and I would note that the states that are saying they will opt out of the Medicaid expansion are among the worst Medicaid payers and have some of the tightest eligibility requirements). The Obamacare subsidies kick in at 133% fpl, I'm hearing there may be a way to get that down to 100% fpl but in states that opt out the most needy won't have improved access to insurance. That's the thing that matters to people with CKD using dialysis or using (or wanting to use) a transplant: will they have access to health insurance? In some states it will depend, but for most Americans the answer is yes you will have access to health insurance.
Whether or not expanding Medicaid is a good idea is now going to be tested. We'll see if having millions of people without health insurance (10 million in Texas) is better than having millions of people with kinda crappy health insurance (Medicaid). For people who want to use a transplant the answer is it is better to have crappy insurance rather than no insurance. I think for the country it is also true - crappy is better than none - and I think for each state it is true. Now it could be that I'll look back on my support for this position in the same way you perhaps look back on support for unskewed polls, or it could go the other way and then there'll be no looking back and either way the Republican governors can campaign on it in 2016.
I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements. We already see illegal alien migration away from states with tougher immigration laws. Why expect less in this scenario?
And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.
You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs. One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
To doctors those low income people are patients, so were talking about the same people - right now today, and it has been true my entire life, people can move to a different state and gain access to health insurance that they don't have access to in their home states. This has been true my entire life but I haven't heard about the disenfranchised poor of Mississippi moving to California or New York, why would it suddenly happen after 2014? There will still be residency requirements for Medicaid in 2014, just as there are today. Ask someone who is using dialysis and insured by Medicaid how easy it is to move to a new state.
This idea that physicians will go Galt because of Obamacare is funny because basic economic theory, that even objectivists believe, is supply follows demand. There will be more people with insurance, which means doctors will have a bigger customer base, in every state. And if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, they have no reason to move to another state where people are uninsured. If a doctor doesn't want to treat patients insured under expanded Medicaid then she does not have to treat them, she can choose to treat only those with private insurance. The market will adjust.
What I am describing is what is the current law. I don't think I am making a prediction beyond stating the obvious - Obamacare is a big win for people with CKD.
That said I think Simon Dog has a point that if more people have access to a transplant, there will be more people on the transplant list, and therefor the wait will be longer than it would be otherwise. That is a dynamic that will probably play out but it isn't a good reason to oppose expanding access to health insurance.
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I was listening to a radio program on NPR today. In some states, they said LA, eligibility for Medicaid is 15% of federal poverty level. That's appalling! You can only get Medicaid if you earn less than about $2500/year. We in America treat out poor horribly.
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I was listening to a radio program on NPR today. In some states, they said LA, eligibility for Medicaid is 15% of federal poverty level. That's appalling! You can only get Medicaid if you earn less than about $2500/year. We in America treat out poor horribly.
If you're interested on how the income threshold varies from state to state for nondisabled adults check out Table 3 in this PDF
http://www.kff.org/medicaid/upload/7993-02.pdf (http://www.kff.org/medicaid/upload/7993-02.pdf)
Arkansas wins the race to the bottom with current eligibility set at 17%; according to the chart Louisiana comes in at 25%.
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I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements. We already see illegal alien migration away from states with tougher immigration laws. Why expect less in this scenario?
And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.
You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs. One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
To doctors those low income people are patients, so were talking about the same people - right now today, and it has been true my entire life, people can move to a different state and gain access to health insurance that they don't have access to in their home states. This has been true my entire life but I haven't heard about the disenfranchised poor of Mississippi moving to California or New York, why would it suddenly happen after 2014? There will still be residency requirements for Medicaid in 2014, just as there are today. Ask someone who is using dialysis and insured by Medicaid how easy it is to move to a new state.
This idea that physicians will go Galt because of Obamacare is funny because basic economic theory, that even objectivists believe, is supply follows demand. There will be more people with insurance, which means doctors will have a bigger customer base, in every state. And if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, they have no reason to move to another state where people are uninsured. If a doctor doesn't want to treat patients insured under expanded Medicaid then she does not have to treat them, she can choose to treat only those with private insurance. The market will adjust.
What I am describing is what is the current law. I don't think I am making a prediction beyond stating the obvious - Obamacare is a big win for people with CKD.
That said I think Simon Dog has a point that if more people have access to a transplant, there will be more people on the transplant list, and therefor the wait will be longer than it would be otherwise. That is a dynamic that will probably play out but it isn't a good reason to oppose expanding access to health insurance.
Believe what you want. Below are not just anecdotal stories.
http://www.aapsonline.org/index.php/site/article/the_risks_and_perils_of_obamacare/
http://www.forbes.com/sites/gracemarieturner/2012/08/21/the-real-tragedy-of-obamacare-has-yet-to-be-felt-by-the-poor/
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=0
http://www.humanevents.com/2012/11/01/beaten-by-obamacare-washington-doctor-throws-in-the-towel/
As far as your comment of Obamacare being a "big" win for ESRD patients, did you read OKarol's recent thread posted on the News Articles board about sensipar, Fosrenol and other meds being added to the bundle? If so, please explain how that's going to "help" us? Oh, you'll probably say this is just a "trail balloon" thrown out there. (My take, if true, its a compromise in getting immunosuppressive meds covered for longer than 3 years.)
http://ihatedialysis.com/forum/index.php?topic=27922.0
All Obamacare is going to do is lead to more substandard esrd care.
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My complaint against Obamacare is changing the whole system when 80%-85% of Americans were happy.
Source? I have a strong feeling you are misrepresenting what was actually found. There is no way - no way at all - that 80-85% of Americans were happy with the US health care system. I have yet to meet a single, live adult who did not decry the state of American healthcare when Obama took office. If they are happy with their coverage or their current doctor, they can keep it. Anyone who is not clear on that point by now just doesn't want to be informed.
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
You know, PatDowns, you don't need to be insulting with your responses. Bill has done as much for the CKD community (not just dialysis patients, but all of us!) as anyone I can name. When my transplant was failing and I was trying to get a handle on what the future was going to hold for me, I can credit two sites with providing me with the priceless information that I needed to navigate the system and get where I wanted to go. The first is IHD, and the second is DSEN, Bill's site. I received better medical care from what I learnt from reading Bill's articles and participating on IHD. He has an excellent handle on how the health care maze operates and to suggest that this should somehow translate into everyone with CKD receiving better medical care because of him is ludicrous. As far as I know, Bill is not paid a cent to put in all of those hours maintaining his site, talking to journalists, participating on other CKD sites and everything else he does in the advocacy world. If Bill had never got into advocacy, CKD patients would be all the poorer for it.
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Thanks for the speedy reply, noah. Yes, it's pretty much as I expected. This is not suggesting that people did not want to see reform. Back in 2009 (the year of this poll) I can clearly remember both Democrats and Republicans in Congress agreeing that the system needed to be overhauled, the argument was over how.
There have also been polls (that I don't have time to research right now) showing greatly increased support for the ACA once people were disabused of paranoid rumors such as compulsory death panels.
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My complaint against Obamacare is changing the whole system when 80%-85% of Americans were happy.
Source? I have a strong feeling you are misrepresenting what was actually found. There is no way - no way at all - that 80-85% of Americans were happy with the US health care system. I have yet to meet a single, live adult who did not decry the state of American healthcare when Obama took office. If they are happy with their coverage or their current doctor, they can keep it. Anyone who is not clear on that point by now just doesn't want to be informed.
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
You know, PatDowns, you don't need to be insulting with your responses. Bill has done as much for the CKD community (not just dialysis patients, but all of us!) as anyone I can name. When my transplant was failing and I was trying to get a handle on what the future was going to hold for me, I can credit two sites with providing me with the priceless information that I needed to navigate the system and get where I wanted to go. The first is IHD, and the second is DSEN, Bill's site. I received better medical care from what I learnt from reading Bill's articles and participating on IHD. He has an excellent handle on how the health care maze operates and to suggest that this should somehow translate into everyone with CKD receiving better medical care because of him is ludicrous. As far as I know, Bill is not paid a cent to put in all of those hours maintaining his site, talking to journalists, participating on other CKD sites and everything else he does in the advocacy world. If Bill had never got into advocacy, CKD patients would be all the poorer for it.
Yes, Bill has done much for the renal community in helping folks deal positively with esrd. I greatly respect Bill's renal disease treatment knowledge, especially when it comes to Nxstage, and have referred people with questions on here to his blog (as well as Hemodoc's). However, that does not mean he is the all powerful know all when it comes to policies and potential effects/fallout from them. While, Bill might be a wonderful consumer go-to, he has minimal influence when it comes to policy decision making. That's not a knock on Bill - it's a by product of the system.
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Thanks for the speedy reply, noah. Yes, it's pretty much as I expected. This is not suggesting that people did not want to see reform. Back in 2009 (the year of this poll) I can clearly remember both Democrats and Republicans in Congress agreeing that the system needed to be overhauled, the argument was over how.
There have also been polls (that I don't have time to research right now) showing greatly increased support for the ACA once people were disabused of paranoid rumors such as compulsory death panels.
From June, 2012
Most Americans would be happy if "Obamacare" is overturned.
With the U.S. Supreme Court set to decide on President Obama's health-care law on Thursday, more Americans say they would be pleased if the law is ruled unconstitutional than constitutional, according to a new NBC News/Wall Street Journal poll.
In the survey, 37 percent say they would be pleased if the Supreme Court finds the law unconstitutional, versus 22 percent who say they would be disappointed with that outcome.
On the flip side, 28 percent say they would be pleased if the court rules the law is constitutional, compared with 35 percent who say they would be disappointed.
But pluralities on both questions maintain they would have mixed feelings with either outcome, suggesting that opinion could change depending on how the Supreme Court ultimately decides on Thursday.
What's more, if the law's individual mandate is found to be unconstitutional, 25 percent say that would hurt them and their families; 18 percent say it would help; and 55 percent say it wouldn't make a difference.
http://firstread.nbcnews.com/_news/2012/06/26/12419577-nbcwsj-poll-more-would-be-pleased-if-health-law-ruled-unconstitutional
This is making different points to your first comment which implied that 80% of people liked the healthcare system, which I think is completely untrue. I'm on my second glass of wine tonight so won't do a good job picking this new poll apart right now, but I do think it's a bit of a stretch to say "most Americans" when it turns out the actual percentage is 37. A more appropriate headline might have been Shocking Number of Americans Just Don't Give A Damn About Policy. This article doesn't seem to be telling us much of anything. Back to my :wine;
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Yes, Bill has done much for the renal community in helping folks deal positively with esrd. I greatly respect Bill's renal disease treatment knowledge, especially when it comes to Nxstage, and have referred people with questions on here to his blog (as well as Hemodoc's). However, that does not mean he is the all powerful know all when it comes to policies and potential effects/fallout from them. While, Bill might be a wonderful consumer go-to, he has minimal influence when it comes to policy decision making. That's not a knock on Bill - it's a by product of the system.
Well, I'm glad you recognize Bill's contributions. I have been reading his writings for five years and discussing issues with him on IHD for over 3 years and I have to say that I have never known him to profess to be "the all powerful know all" when it comes to government policy or anything else. My transplant surgeon also has minimal influence on policy decision making, it doesn't mean that he doesn't understand more than most when it comes to the effects of new laws and regulations. (Incidentally, he is pro-Obama and quite vocal about this on Facebook.) It also does not mean that this surgeon has not changed many lives for the better within the world of organ failure patients.
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I was listening to a radio program on NPR today. In some states, they said LA, eligibility for Medicaid is 15% of federal poverty level. That's appalling! You can only get Medicaid if you earn less than about $2500/year. We in America treat out poor horribly.
This is the "hole" some will fall into. What about the working poor? What about numbers that make sense for human beings in the first place? My opinion about dialysis since starting is they don't really care about how we feel anyways, they only want us well enough to work, not to have a quality of life. Care could already be better. I've been fighting that battle since I started. I was just shoved with 8 tubes of iron last month, I felt like my head was going to fly off. I complained and they spread it out a little, but did not decrease the prescribed dose. I was told flat out by my neph that it was over EPO costs. I told him cost should not be a factor in patient care, period. It should not be equated with profit, or we are all screwed. He kept arguing that the money wasn't there and when I said that wasn't a sufficient argument, he threw out the heart attack risks of too much EPO, but my hemo was over 13 with the iron. I asked him, in addition to his numbers, if he would please consider what the patient's body is saying. He said he couldn't base his decisions on that alone. I replied that I didn't ask him to, I just asked him to consider it. He finally seemed to get the point. Geez. I have been appalled at the care I see, and I have changed docs many times. I was told my standards were high. Um, yes, they are. Should I lower them? Apparently so. There, that's enough for today, leg cramp.
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Noah/Pat if you want to debate the over all merits of Obamacare or the over all merits of my volunteer activities feel free to start another thread. I haven't made the case that Obamcare is a huge win for people with CKD based on some sort of special knowledge or access, I'm saying it is a huge win based on paying attention to the issues that are important to people with CKD.
Because I pay attention I know the difference between MIPPA and PPACA. I know MIPPA is what led to the expanded bundled payment for dialysis, and MIPPA is what will lead to the inclusion of binders/calcimimetics in that payment. And I know that PPACA aka Obamacare is what will allow people with CKD, who are not on dialysis or who have a transplant, to access health insurance and receive care that can delay needing dialysis or the care that can keep a transplant healthy. By paying attention I know that Obamacare subsidizes insurance premiums through the exchanges (whether the exchange is run by the feds, the state or as a partnership between the two), Obamacare doesn't use tax credits to support premiums. And I know people who are undocumented aren't allowed to purchase insurance though the exchanges or qualify for Medicaid or Medicare. Most undocumented dialyzors have their care reimbursed because of EMTALA but in some states, for instance GA, that is changing.
For people with CKD Obamacare will help them live the lives they were meant to live but for their bum kidneys.
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Well, I'm glad you recognize Bill's contributions. I have been reading his writings for five years and discussing issues with him on IHD for over 3 years and I have to say that I have never known him to profess to be "the all powerful know all" when it comes to government policy or anything else. My transplant surgeon also has minimal influence on policy decision making, it doesn't mean that he doesn't understand more than most when it comes to the effects of new laws and regulations. (Incidentally, he is pro-Obama and quite vocal about this on Facebook.) It also does not mean that this surgeon has not changed many lives for the better within the world of organ failure patients.
Your transplant surgeon may have minimal influence on policy decision making as an individual, but not as part of the medical establishment collective,especially if he is associated with AST, NKF and UNOS. And, in his realm, yes, he has changed for the better many lives. Just as my transplant nephrologist has, who, by the way, is not a huge supporter of Obamacare.
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Noah/Pat if you want to debate the over all merits of Obamacare or the over all merits of my volunteer activities feel free to start another thread.
Cariad brought up your actvities in a post to me and I responded to her comments. Feel free to chastise your acolyate.
You know, PatDowns, you don't need to be insulting with your responses. Bill has done as much for the CKD community (not just dialysis patients, but all of us!) as anyone I can name. When my transplant was failing and I was trying to get a handle on what the future was going to hold for me, I can credit two sites with providing me with the priceless information that I needed to navigate the system and get where I wanted to go. The first is IHD, and the second is DSEN, Bill's site. I received better medical care from what I learnt from reading Bill's articles and participating on IHD. He has an excellent handle on how the health care maze operates and to suggest that this should somehow translate into everyone with CKD receiving better medical care because of him is ludicrous. As far as I know, Bill is not paid a cent to put in all of those hours maintaining his site, talking to journalists, participating on other CKD sites and everything else he does in the advocacy world. If Bill had never got into advocacy, CKD patients would be all the poorer for it.
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I know this is a touchy subject for people. I had trouble staying on Facebbok before the election because so many viewpoints think that sick people are like that lawyer joke. You know, what do you call 10 lawyers at the bottom of the ocean? A good start. I think many people would rather not think about sick people. Maybe they think dialysis is contagious!
My take is that the system was not perfect before the law change and will not be perfect after. We just have to do our best to stay educated and advocate for what we need. Or else move to Sweden. I've considered that but I don't like winter.
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I know this is a touchy subject for people. I had trouble staying on Facebbok before the election because so many viewpoints think that sick people are like that lawyer joke. You know, what do you call 10 lawyers at the bottom of the ocean? A good start. I think many people would rather not think about sick people. Maybe they think dialysis is contagious!
My take is that the system was not perfect before the law change and will not be perfect after. We just have to do our best to stay educated and advocate for what we need. Or else move to Sweden. I've considered that but I don't like winter.
The terms republican's used to advance their policy preferences - for instance, makers v takers - did create some self loathing among those who have chronic illnesses and see themselves as conservative/republican. It's collateral damage from the whole Obamacare saga.
Having access to health insurance if you have CKD is a good thing, you shouldn't feel bad if you benefit from Obamacare or any other federal policy.
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Noah/Pat if you want to debate the over all merits of Obamacare or the over all merits of my volunteer activities feel free to start another thread.
Cariad brought up your actvities in a post to me and I responded to her comments. Feel free to chastise your acolyate.
You know, PatDowns, you don't need to be insulting with your responses. Bill has done as much for the CKD community (not just dialysis patients, but all of us!) as anyone I can name. When my transplant was failing and I was trying to get a handle on what the future was going to hold for me, I can credit two sites with providing me with the priceless information that I needed to navigate the system and get where I wanted to go. The first is IHD, and the second is DSEN, Bill's site. I received better medical care from what I learnt from reading Bill's articles and participating on IHD. He has an excellent handle on how the health care maze operates and to suggest that this should somehow translate into everyone with CKD receiving better medical care because of him is ludicrous. As far as I know, Bill is not paid a cent to put in all of those hours maintaining his site, talking to journalists, participating on other CKD sites and everything else he does in the advocacy world. If Bill had never got into advocacy, CKD patients would be all the poorer for it.
You left out your proceeding comment
You know, Bill, you don't need to be sarcastic with your responses. I started my post with "don't be surprised if..." You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here. If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.
I took this to mean that if CMS had listened to me - for instance accepted my comments to CMS on the ESRD Prospective Payment System Proposed Rule (http://www.billpeckham.com/from_the_sharp_end_of_the/2009/12/my-comments-to-the-cms-on-esrd-prospective-payment-system-proposed-rule.html), or my comment to CMS on the proposed QIP for ESRD (http://www.billpeckham.com/from_the_sharp_end_of_the/2010/09/my-comment-to-cms-on-the-proposed-qip-for-esrd.html), or my Comment to CMS on the Proposed Physician Fee Schedule for MCP Physicians (http://www.billpeckham.com/from_the_sharp_end_of_the/2010/08/proposed-physician-fee-schedule-for-mcp-physicians.html) - we dialyzors would already be experiencing better medical care. It's flattering to think my ideas would result in we dialyzors benefiting - it is certainly my intention - but be that as it may, and again feel free to start another thread if you'd like to discuss my previous comments to CMS, I did not make the case that Obamacare is a huge win for people with CKD based on some sort of special knowledge or access or previous comments and writings about the provision of dialysis.
And BTW I wasn't being sarcastic, I found it funny. You made an argument on economic grounds: doctors will leave states that expand access to health insurance, that flew in the face of economic theory: supply follows demand.
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So, let's say they do turn to extended medicaid for insurance. Well guess what, lifetime coverage for immunosuppresives isn't included!
Medicaid isn't covering immunosuppression? Do you have a citation?
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Noah/Pat if you want to debate the over all merits of Obamacare or the over all merits of my volunteer activities feel free to start another thread.
Cariad brought up your actvities in a post to me and I responded to her comments. Feel free to chastise your acolyate.
Pat, enough with the insults and condescension. As Bill pointed out, it was you who initially tried to sarcastically minimize Bill's contribution to the renal community, then you backed away from that in a post responding to me but turn around and hypocritically call me names in a reply to Bill. From your very first post on IHD you have spewed anger and venom at the members here - MM, Hemodoc, Bill, Kickstart, me - to name just the ones I can remember off the top of my head. You do not know a thing about me and have zero place implying that I am some sort of groupie and not a highly educated individual with more years of renal replacement therapy behind me than just about any other member here. You stated that Bill couldn't know more than anyone else because he wasn't somehow dictating dialysis policy, but then you agree with me that even my surgeon does not get to do that.
Bill has asked you to stop derailing this conversation by starting a new discussion if you want to pick apart what he has and hasn't done for people with CKD.
On a more general note regarding the ACA and dialysis, I don't see how anyone could not understand that the very free market and lack of regulation that some here admire is responsible for making DaVita the company that it is today and Kent Thiery fabulously wealthy off of human misery.
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My complaint against Obamacare is changing the whole system when 80%-85% of Americans were happy.
Source? I have a strong feeling you are misrepresenting what was actually found. There is no way - no way at all - that 80-85% of Americans were happy with the US health care system. I have yet to meet a single, live adult who did not decry the state of American healthcare when Obama took office. If they are happy with their coverage or their current doctor, they can keep it. Anyone who is not clear on that point by now just doesn't want to be informed.
http://www.gallup.com/poll/123149/Cost-Is-Foremost-Healthcare-Issue-for-Americans.aspx
Examples that "If they are happy with their coverage or their current doctor, they can keep it," is wrong. Not if their MDs leave private practice or retire early, or no longer accept medicaid or medicare. Anyone who is not clear on this by now just doesn't want to be informed.
EDIT: "Millions of Americans may lose their healthcare plans"
One of the major selling points of ObamaCare was the president's oft-repeated promise that if you liked the coverage you have now, you would be able to keep it. As Obama's team drafts the regulations for implementing this massive government takeover of the healthcare industry, it's becoming evident – if not undeniable – that the president and his supporters misled the American people.
As many as 1.5-million Americans may lose their health coverage this year due to ObamaCare regulations. Now, we're learning that new regulations may force tens of millions of people to lose their employer-provided healthcare plans.
Here's what happening: Come 2014, the federal government is going to dictate what kind of coverage you must have. We were told that the federal mandates would apply only to policies sold in the new federal healthcare "exchanges." Polls found that large majorities of Americans (75%) with health insurance were happy with the coverage they currently have. So, Democrats reassured a nervous public that employer-provided plans would be "grandfathered in", or exempted from the new requirements. However, that's not what the latest draft regulations from the Department of Health and Human Services seem to suggest.
James Gelfand, health policy director at the U.S. Chamber of Commerce said, "These rules are extremely strict. Almost no plan is going to be able to maintain grandfathered status." Here's why: According to the New York Times, "An employer would also lose its exempt status if it increased co-payments for doctor's visits to $45, from $30 – a 50 percent increase – while medical inflation was 8 percent."
So, if an employer attempts to offset the increased costs of health insurance by adjusting the co-payments in the policy, it will likely lose its exemption and be forced to cancel the policy entirely. Where's the incentive for employers to continue to offer health insurance if they can't protect their bottom lines? There isn't any. In fact, ObamaCare actually creates a perverse incentive for businesses to drop whatever coverage they do provide, something conservatives repeatedly warned it would do.
What is even more amazing is that Secretary of Health and Human Services, Kathleen Sebelius, had the audacity to claim that this rule is intended to keep the president's promise. As she put it, "If you like your doctor and your plan, you keep it." In reality, these new regulations make it far more likely that you will lose your current coverage.
Well over 100 million Americans are currently insured through their employer. The Wall Street Journal reports, "The law could leave more than half of employers without a grandfathered plan in 2013, the draft estimated. Its worst-case assumption is that 80% of small-employers will lose grandfathered rights by 2013." Senator Charles Grassley (R-IA) said, the rules are "more proof that you actually can't keep what you like. Change is coming for a lot of people, whether they want it or not."
Writing in yesterday's New York Post, Dr. Scott Gottlieb notes that the HHS bureaucrats who are writing these new regulations are "true believers" in a single-payer nationalized healthcare scheme. He adds, "They are massaging the law's vagueness to give themselves the tight federal control over health care that will bring their vision into practice," by forcing more and more Americans into ObamaCare's government-approved plans.
http://goodnewsfl.org/christian-news/millions_of_americans_may_lose_their_healthcare_plans/
noah, rather than fundamentally change a post that I had already replied to before the edit, could you please just create a new post? I am only just seeing this, I note that the link is for some Christian blog and upon skimming it, noticed that the Wall Street Journal is quoted. I am so not in the mood for Murdoch's big bag of bullshit this morning, so I am not going to bother looking at an article that you hid away in an edit. The sources are too far from credible anyhow.
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noah, rather than fundamentally change a post that I had already replied to before the edit, could you please just create a new post? I am only just seeing this, I note that the link is for some Christian blog and upon skimming it, noticed that the Wall Street Journal is quoted. I am so not in the mood for Murdoch's big bag of bullshit this morning, so I am not going to bother looking at an article that you hid away in an edit. The sources are too far from credible anyhow.
An edit done maybe 25 minutes after the original post is hiding?? Hiding would be if I didn't qualify it has an edit. Plus, it wasn't a change. It's called an addition! However, I'm sure you would say the same if done by Peckham or Meinuk, right?
The Wall Street Journal or Christian based reporting source are far from credible? But then again, you do consider anything not found in one of your socialist liberal media sources like MSNBC/HuffPost/The New Republic as BS.
Just shows how truly mean spirited you lefties truly are! Thanks for the laughs. :2thumbsup;
"Be kind, for everyone you meet is fighting a great battle." :sarcasm;
I would have no problem asking Bill or Meinuk to start a new post in this situation - why would I hesitate to do that?
Wow, I asked you nicely if you could please do me the courtesy of not editing a reply to me but instead just start a new post. (Adding to a post isn't changing it? Do you really want to play semantics games with me?) No idea why you are making such a big deal of that request and why you cannot resist insulting me. But apparently I'm the mean-spirited one....
I have not called you any names nor attacked your character. Everything Murdoch touches turns to propaganda, most of us realise this. I am an atheist and don't read more than a handful of blogs anyway, let alone ones from a Christian perspective. Like it or not, I get to decide what I do with my time, and I chose to give your edit a miss. Your response is just about the angriest reply I've ever received - I think you deserve some sort of award for that, I've had some foaming-at-the-mouth ones, goodness knows. Are you especially fond of Rupert Murdoch or something?
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John & I have not seen any changes in his care. Obamacare or not, so what? If it happens, let it! If it don't, then great! Fiscal Cliff or not, so what? We all have different opinions & views. I respect those who have different views than I. So what? Its interesting to read for me, but bottom line, it is what it is.
If some changes are in the making, so be it. I try my best to make it best as possible for my family and all this uproar over who is right and who is wrong, is like watching a "comical movie". Its like watching "tug a war". Both sides pulling & pushing as hard as they can. IT'S FUN TO WATCH. Even John is enjoying the show.
We have always prepared for the worst if it should happen. If it don't, then we are prepared for it too!! If we need help, we know where to go for that. We prefer not to worry about matters that may be beyond our control. All is well for us right now! Subject to change, but taking a wait & see attitude right now.
Just our take on things, not the view of all on this site, as Im fully aware of too! Just my plug.
God Bless & Jesus Is Lord,
lmunchkin :kickstart;
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Imunchkin you expressed my sentiments on the Obamacare situation exactly. Come what may we will deal with it one way or another.
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This is a good recap of where things are in the states with regard to accepting the expansion of Medicaid
http://news.yahoo.com/brinksmanship-obama-medicaid-expansion-poor-094031478--finance.html (http://news.yahoo.com/brinksmanship-obama-medicaid-expansion-poor-094031478--finance.html)
The math is starting to change some minds leaving opponents a very thin reed on which to stand "The concerns we have ... are around federal solvency and the ability of the federal government to meet its commitment." So they are saying rather then provide health coverage that might have to change because of "federal solvency" issues, rather then risk having to scale back benefits at some point in the future, they'd rather never provide the coverage. That is a sad position that will be difficult to explain after the fever breaks.
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I just got this email from Davita:
End-of-Year Medicare Cuts Could Impact Dialysis Patients
Dialysis care is a lifeline for many people and without dialysis or a transplant, these patients would not survive. Medicare cuts being discussed may have a significant and disproportionate impact on dialysis providers and patients nationwide. Currently more than 80 percent of dialysis patients depend on Medicare for life-sustaining treatment.
For these beneficiaries, dialysis providers receive a “bundled” payment for a multitude of services. Specifically, patients receive four-hour dialysis sessions at least three times a week, which includes lab services, nursing care, medications and more. Medicare barely covers the full cost of dialysis treatments, thus many of our facilities lose money on the majority of patients we serve.
As policymakers in Washington discuss cuts to an already stretched “bundled” payment that is still adjusting to changes and approaching a "fiscal cliff" cut in January, we fear dialysis centers could close their doors, leaving patients in a difficult situation – forced to travel long distances to receive care, dialyze at a hospital emergency room that costs the system more money, or forgo some necessary care altogether.
Please take a moment to email your members of Congress today. Ask them not to cut or restructure the vital services Medicare makes available to America's kidney patients.
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On a more general note regarding the ACA and dialysis, I don't see how anyone could not understand that the very free market and lack of regulation that some here admire is responsible for making DaVita the company that it is today and Kent Thiery fabulously wealthy off of human misery.
Actually, the lack of a free market prevents meaningful price competition. Compare the trend in pricing for surgery that is almost always insurance paid (cataract) vs. almost never insurance paid (refractive correction). The later actually has vendors advertising prices; competing based on price; and prices that are now hundreds per eye rather than the thousands per eye common when the procedure was new.
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John reassures me AGAIN, that he will give it up before he allows it to drain us financially. I dont want to think about that right now. Im fully aware that he will do that, as he fears no death. The only reason he lives is for me. Iam not afraid of dying either. We all will someday. I guess that is why Im not worried about all this, because Our Saviors Arms are Wide open.
Fellow believers, you do know that Satan is relaxing, while we do all this worring for him. Im not giving him the Satisfaction. Let him run to and fro, seek whom he wants, but I will not allow him here where my Lord lives. The two do not mix. So spirit of worry, YOU ARE NOT WELCOMED HERE!
There was an article in the Opion section of The Tennessean, that someone said that the government was going to demolish people on dialysis. That is sad, but what can you do?
Jesus Is Lord,
lmunchkin :kickstart;
P.S. Hemodoc, wanted you to know, we got a thing in the mail from NxStage. They showed experiences from several people doing NxStage. All good, by the way. It said that the next issue would show Dr. Peter Laird who has this disease and how he copes with it & Nxstage. Cant wait. I love & learn so much from you, Peter. God Bless!
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On a more general note regarding the ACA and dialysis, I don't see how anyone could not understand that the very free market and lack of regulation that some here admire is responsible for making DaVita the company that it is today and Kent Thiery fabulously wealthy off of human misery.
Actually, the lack of a free market prevents meaningful price competition. Compare the trend in pricing for surgery that is almost always insurance paid (cataract) vs. almost never insurance paid (refractive correction). The later actually has vendors advertising prices; competing based on price; and prices that are now hundreds per eye rather than the thousands per eye common when the procedure was new.
I think you'll be interested in this article
http://www.businessweek.com/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care (http://www.businessweek.com/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care)
(btw it is a multipage article which I find distracting to read but if you click the little "Print" icon at the bottom of the first page you'll be able to read it as one page with no ads)
There is some price competition in dialysis in pursuit of those that have private insurance - the negotiation is to try to pay just four times Medicare's allowed rate instead of ten times the allowed rate. Any healthcare price negotiation is based on the two party's relative market power, Medicare has the most market power they will get the lowest prices. It's like a very large co-op that provides its members with with access to low healthcare prices. The concierge service described in the article could be provided through health insurance too, it is in effect like a medical home or and could be part of an accountable care organization's approach.
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Actually, the lack of a free market prevents meaningful price competition. Compare the trend in pricing for surgery that is almost always insurance paid (cataract) vs. almost never insurance paid (refractive correction). The later actually has vendors advertising prices; competing based on price; and prices that are now hundreds per eye rather than the thousands per eye common when the procedure was new.
Lasik has gone up in price and those adverts for $399 (used to be $299) at a creepy strip mall are 1. borderline malpractice and 2. notorious for their bait and switch tactics and aggressive upselling. My husband had Lasik 8 years ago and it cost roughly $4000. He went to the best he could find, recommended by my aunt who also went to this surgeon. My husband's was a very complicated case and he actually had to come back a different day for the surgery because once they dilated his eyes, they realised they were not prepared to go forward with surgery. The way that those chain shops operate, they basically dilate everyone's eye the same amount and use a press to flatten out the puckering. Had Gwyn had that done, it would not have corrected his problem and probably would have left him with permanent damage. Two people who worked for my husband at the time went to those shops - remarkably, they say they are glad they did it - but they have permanent burns on their pupil (they basically see everything through grill marks now) and they have a starburst effect whenever they look toward anything bright. They went to the people who were focused entirely on money as their adverts suggest. My husband wanted to preserve his vision, he went with the guy who does not advertise based on cost but on his 20 years of obsessing over this one part of the body. Gwyn's procedure would be over $5000 today.
Quote from random internet page that came up when I googled cost of lasik in us
Many experts recommend avoiding discount laser eye surgery centers with aggressive advertising campaigns. Such centers often employ bait-and-switch tactics by bringing customers in with the promise of a low LASIK eye surgery price, then tagging numerous added fees onto the final cost of the surgery. Some surgeons advertise a low price, but patients come to realize this price applies only to patients who need very minimal corrections, and more extensive corrections boost the cost of LASIK eye surgery significantly. Furthermore, some surgeons may charge less for LASIK because they do not have the experience or technology that other, more expensive surgeons may possess.
source: http://www.docshop.com/education/vision/refractive/lasik/cost
This is why I think that dangling money in front of doctors as the primary reward is damaging and it is preferable to do as other countries do and make sure that physicians make a very good living but it is an enjoyable profession and knowing that you've done some good in the world that is the real payoff.
Bill, I am interested in this article - read the first bit and it sounds promising. I have to admit I was a bit creeped out by the doctor saying he wanted to be part of the 1% and naming his practice after one of the most awful books ever written (from a literary standpoint, but also arguably from a human decency standpoint. If anyone wants to discuss this opinion with me further, please make sure you've actually read the book in its entirety, including the radio address. Because I have. And that's 1000+ pages of time I'm never getting back.) Primary care seems that it would be the easiest to fix - I went to a no-frills GP in Milwaukee for years and I had great insurance then, I just thought he was a better doctor than the others. Could this model be applied to, say, brain surgery? Socialized medicine would also do away with having to bill Blue Cross. My doctors here (UK) give the sort of service mentioned in this article and I have not received a single bill. They call me at home to discuss my lab results, they are expediting our case through the system with an issue I'm having with one of my boys. I was expecting to have some complaints by now, but I honestly cannot think of one. The first doctor I met here laughed when I said I was from America. He found what American colleagues believe about the NHS quite amusing.
I read a NYT article several years ago about concierge medicine in New York and not only were they charging more than $50/month, but what they were doing was actually illegal and the reporter had to go undercover. I cannot remember exactly how it was illegal, but I believe it was because they were essentially running two practices - one on insurance, one concierge that took cash - and were treating patients who pay cash better than the insurance patients and they are not allowed to do this. (Yet. I just shudder to think what the future will hold for America.)
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I think the article was about a practice on a corner that had two entrances for mammograms. The self-pay high rate place gave nice robes, fast service, personal meeting with the doc right after the imaging - and the cheap place used paper gowns, longer waits, and the doc sent you a report later. But, the machines used to do the imaging were the same, as were the docs who interpreted the images.
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I think the article was about a practice on a corner that had two entrances for mammograms. The self-pay high rate place gave nice robes, fast service, personal meeting with the doc right after the imaging - and the cheap place used paper gowns, longer waits, and the doc sent you a report later. But, the machines used to do the imaging were the same, as were the docs who interpreted the images.
Yes! I think we read the same article! 2008ish (I was living in LA when I read it.) I remember they had two separate entrances, so the people on insurance were not even aware that on the other side of reception was a whole other world of classical music and chilled bottled water. I wonder if they were ever found out....
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I have read Atlas Shrugged but I know I skipped some of the pages of ranting. I think a lot of people read the book, skip a lot, and don't really know what they're saying is so great. I don't know if it's the worst book ever but it's not one of my favorites.
What bothered me the most about the article on concierge docs is how they said they were interviewing patients rather than the other way. Who would take us? We need too much attention.
When I lost my dental insurance, my mom asked her dentists if he gives discounts for those who pay cash. He said that would be illegal. It would be insurance fraud for billing one guy's insurance company more than he charged me.
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I think the article was about a practice on a corner that had two entrances for mammograms. The self-pay high rate place gave nice robes, fast service, personal meeting with the doc right after the imaging - and the cheap place used paper gowns, longer waits, and the doc sent you a report later. But, the machines used to do the imaging were the same, as were the docs who interpreted the images.
Yes! I think we read the same article! 2008ish (I was living in LA when I read it.) I remember they had two separate entrances, so the people on insurance were not even aware that on the other side of reception was a whole other world of classical music and chilled bottled water. I wonder if they were ever found out....
This was actually an example of cost differentiation "done right". The differences were in frills and service, not the quality of care. Despite the vast differences (robes vs. cheap gowns, etc.), the medical care was the same no matter which entrance you came in. Insurance clients didn't get the royal treatment, but they did get access to the same machines, technology and MDs.
For an example of the other extreme, watch the original MASH movie ... "this one's an officer, make the stiches small".
When I lost my dental insurance, my mom asked her dentists if he gives discounts for those who pay cash. He said that would be illegal. It would be insurance fraud for billing one guy's insurance company more than he charged me.
Insurance fraud is stuff like waiving the co-pay (if the price is reduced, the contract requires the savings to go to the insurance company). It may also be the case that the contract with the insurance company has a "best customer" pricing clause. The real thing is to make sure that you are not being charged a higher rate than would be accepted as "paid in full" by insurance, as the "direct pay" price is often substantially higher than the insurance negotiated rate. I once had a dentist collect the estimated co-pay for her $600 bill ($250), only to find out the "accepted as paid in full insurance price" was $200. I mailed her an invoice for "Charges in excess of insurance contract allowance" (and it was paid).
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I have read Atlas Shrugged but I know I skipped some of the pages of ranting. I think a lot of people read the book, skip a lot, and don't really know what they're saying is so great.
Oh, yes! This is undoubtedly true! I can ferret out a fake most of the time, though. I tend to have a really sharp memory for dialogue and detail in books.
Anyone who has read Atlas Shrugged, all I have to say is, how do you defend the train wreck scene? Conveniently, everyone who died on the train deserved to die because they weren't contributing to the economy with the ruthless, laser-focus of the protagonists.
And Dagny Taggart. Oh, Dagny, I think I hated you most of all. Such a uniquely offensive, self-loathing misogynist. Beware of people who admire this book, they either haven't read it or cannot analyze their way out of a wet paper sack - this book passes judgment on any of us who are not captains of industry, a very small group of people in the scheme of things.
As a work of literature, I will say it had a very promising start, the "Who is John Galt?" expression hinted at a great mystery and provided a nice detail about this fictitious city that this saying had caught on. A character states that the idiom means "don't ask questions that cannot be answered" but that isn't what it meant at all. I remember seeing the ending coming from a thousand paces, and hoping it wouldn't be as cheesy as I suspected it would be, but it was. The Fantastic Four as soap opera, all dropped onto Fantasy Island. In other words, a great big mess!
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I like being right, not that it matters to all the people denied access to healthcare because of resistance to Medicaid expansion. In addition to the people getting preemptive transplant think of the uncounted number of people who never left earlier stages of CKD because of the medical care they could now access.
AND the worries put forward in this thread were all baseless. Which other of worries of "Frank Lee Wong" 's were baseless?
Association between Medicaid Expansion under the Affordable Care Act and Preemptive Listings for Kidney Transplantation (http://cjasn.asnjournals.org/content/early/2018/06/20/CJN.00100118.abstract?sid=bf0cadd6-1402-46c6-a963-7dd05b14f3fb)
Abstract
Background and objectives Before 2014, low-income individuals in the United States with non–dialysis-dependent CKD had fewer options to attain health insurance, limiting their opportunities to be preemptively wait-listed for kidney transplantation. We examined whether expanding Medicaid under the Affordable Care Act was associated with differences in the number of individuals who were pre-emptively wait-listed with Medicaid coverage.
Design, setting, participants, & measurements Using the United Network of Organ Sharing database, we performed a retrospective observational study of adults (age≥18 years) listed for kidney transplantation before dialysis dependence between January 1, 2011–December 31, 2013 (pre-Medicaid expansion) and January 1, 2014–December 31, 2016 (post-Medicaid expansion). In multinomial logistic regression models, we compared trends in insurance types used for pre-emptive wait-listing in states that did and did not expand Medicaid with a difference-in-differences approach.
Results States that fully implemented Medicaid expansion on January 1, 2014 (“expansion states,” n=24 and the District of Columbia) had a 59% relative increase in Medicaid-covered pre-emptive listings from the pre-expansion to postexpansion period (from 1094 to 1737 listings), compared with an 8.8% relative increase (from 330 to 359 listings) among 19 Medicaid nonexpansion states (P<0.001). From the pre- to postexpansion period, the adjusted proportion of listings with Medicaid coverage decreased by 0.3 percentage points among nonexpansion states (from 4.0% to 3.7%, P=0.09), and increased by 3.0 percentage points among expansion states (from 7.0% to 10.0%, P<0.001). Medicaid expansion was associated with absolute increases in Medicaid coverage by 1.4 percentage points among white listings, 4.0 percentage points among black listings, 5.9 percentage points among Hispanic listings, and 5.3 percentage points among other listings (P<0.001 for all comparisons).
Conclusions Medicaid expansion was associated with an increase in the proportion of new pre-emptive listings for kidney transplantation with Medicaid coverage, with larger increases in Medicaid coverage among racial and ethnic minority listings than among white listings.