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

[Simon Dog]

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.

[cariad]

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....

[jeannea]

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.

[Simon Dog]

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).

[cariad]

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!

[Bill Peckham]

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

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.