What is Obama care really gona do for dialysis and Transplant canidates ?

[cariad]

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.

[noahvale]

^

[PatDowns]

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.

[cariad]

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

[cariad]

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.

[rfranzi]

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.

[Bill Peckham]

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.

[PatDowns]

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.

[PatDowns]

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.

[jeannea]

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.

[Bill Peckham]

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.

[Bill Peckham]

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, or my comment to CMS on the proposed QIP for ESRD, or  my Comment to CMS on the Proposed Physician Fee Schedule for MCP Physicians - 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.

[Bill Peckham]

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?

[cariad]

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.

[cariad]

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.

[noahvale]

*

 

[cariad]

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.        

"Be kind, for everyone you meet is fighting a great battle."   

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?

[lmunchkin]

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

[big777bill]

 Imunchkin you expressed my sentiments on the Obamacare situation exactly. Come what may we will deal with it one way or another.

[Bill Peckham]

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

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.

[YLGuy]

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.

[Simon Dog]

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.

[lmunchkin]

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

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!

[Bill Peckham]

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
(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.

[cariad]

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.)