Cuts Could Mean Loss Of Dialysis Care For Thousands Of Americans

[jeannea]

I'm not happy with the general characterization of dialysis patients as apathetic or complainers or welfare bums or whatever. When I first started dialysis I spent the first 6 months or so in total shock and still quite ill. I went to dialysis, felt sick for hours, then tried to survive until the next session. It took months until I could think of anything but my own immediate needs.

Then I remember the population at my center. So many were old and wheelchair bound, even some coming in on a stretcher by ambulance, from the local state funded nursing home. I can't imagine some of them could advocate for more coffee at breakfast. Others were slightly younger or more independent. Many of those were poor people from our local very poor inner city. From their speech it seemed they weren't very well educated. Many in my center had other problems like diabetes or heart disease.

At my center to me it seemed like only about 3-4 of us on my shift had the education, energy, and resources to think about advocacy. Then if you have depression like I do, sometimes you have to focus on taking care of yourself. It's really hard to fight against big government. I know every time I contact my rep, I get a letter back basically telling me to get lost because they don't care about us little people. It's discouraging.

[Bill Peckham]

I'm not seeing apathy so much as dialyzors tuning out the providers. Since 2011 the providers received a per treatment payment that was 10% more generous than the payments they received pre-bundle - how was that extra revenue used? Were there improvements in care? Was staffing improved? More/better supplies? Not the I have heard.


What I recall from the last two and half years are complaints about the payments rate; complaints about the sequester cut; complaints about the QIP withhold; complaints about the case mix adjusters. I think the providers are suffering the effects of crying wolf every three months and now that there really is a wolf no one is listening.

[Hemodoc]

Well, we could certainly chew the fat a bit on what apathy is and whether that applies to the dialysis population, but just looking at one dictionary definition, it seems to fit:

ap·a·thy  (p-th)
n.
1. Lack of interest or concern, especially regarding matters of general importance or appeal; indifference.
2. Lack of emotion or feeling; impassiveness.

No doubt, when you are poor, elderly and undergoing dialysis in the usual fashion of in-center rapid ultrafiltration and short dialysis sessions, yes, simply surviving is what most do from session to session. Dialysis patients demographics are just that, mainly poor, elderly and debilitated patients. In addition, the culture of "compliance" within centers and retaliation for even minor exercises of independence does further promote a very passive patient group.

Thankfully, it is indeed a broad over generalization and there are obviously very active and concerned patients who take dialysis advocacy very seriously. Unfortunately, our numbers are few and far between and our financial resources are even more fragile. As a political entity, a dialysis lobby made up of patients is a group largely ignored by those who have the power. We not only have to deal with convincing doctors, nurses and techs of the clinical benefits of optimal dialysis, but in addition, we must lobby congress and CMS to ordain them since dialysis care belongs to the government.

Belding Scribner devoted his last few decades to just such an endeavor and never saw it come to fruition. I personally believe our greatest hope lies in technological breakthroughs  with portable dialysis machines in an open market place competition. Until home hemo becomes a profit center for dialysis corporations promoting their new toys, I see little chance of any major improvements in the American dialysis experience.

[Dman73]

Maybe the government can increase ESRD cost savings by encouraging transplantation utilizing the lifelong immunosuppressive drugs kidney transplant act.

This approach will benefit all parties and create a much healthier and productive group.

[PatDowns]

Maybe the government can increase ESRD cost savings by encouraging transplantation utilizing the lifelong immunosuppressive drugs kidney transplant act.

This approach will benefit all parties and create a much healthier and productive group.

The lifelong immunosuppressive drugs kidney transplant act topic was brought up before with Noahvale asking IHD patients to show support for it.  Seems he didn't make a good enough argument for Bill Peckham, who is against its passage.

http://ihatedialysis.com/forum/index.php?topic=28786.msg454987;boardseen#new

Maybe you would contribute your thoughts.

[Bill Peckham]

There is a lot providers can do to increase the transplant rate among their patients - a unit's transplant rate is reported in DIalysis Facility Reports that are available through the Pro Publica site. THe Northwest Kidney Centers transplant rate is 79% higher than the national average because they work to get their patients transplanted. NKC is coordinating care even though they aren't actually paid to keep in close contact with the transplant hospitals. NKC does it because it is the right thing to do - if more providers did what was right with the excess payments over the last few years maybe they'd be getting more support from patients.

The lifelong immunosuppressive drugs kidney transplant act topic was brought up before with Noahvale asking IHD patients to show support for it.  Seems he didn't make a good enough argument for Bill Peckham, who is against its passage.

http://ihatedialysis.com/forum/index.php?topic=28786.msg454987;boardseen#new

Maybe you would contribute your thoughts.

In April as a result of that thread, I heard from a lobbyist that has worked with the AOPO and ASTS for the last few years, she made her case for Immunosuppression Coverage through Medicare, I was not impressed. The argument she made boiled down to "the Medicare immunosuppressant coverage is still needed as a wrap-around for those not in states where a benchmark plan would cover the drugs" but my point is all the benchmark plans cover immunosuppression meds. That's been my point all along. I really can't understand how one can offer fixes to legislation they haven't bothered to understand. But I suppose that's the root issue - immunosuppression meds through Medicare isn't meant as a fix to the ACA, to the transplant community the ACA never happened.

[jeannea]

I read Bill's argument against the extra drug coverage. While I understand what he's saying, I don't believe we can count on the Affordable Care Act actually being around after the next election. There are too many politicians trying to repeal it. They get great insurance coverage in Congress and think the rest of us don't deserve any help. It must be nice to have everything in your life work so great that you believe you'll never have any problems with illness.

[Hemodoc]

I hope and pray Obamacare is repealed along with the other repressive taxes of this administration. My only taxable income is my social security and now my health care coverage. By next year, with all of the tax bills of the last few years, I will be paying about $5,000 a year. Once again, this is tax to my social security on my health care coverage which is now counted as income.

My current health care coverage has sky rocketed to $35,000 a year for me and my wife through Group Health. I am grateful for the benefits of working for Kaiser, but I am not sure I can "afford" these "benefits" much longer. Of that, I will pay a straight 15% with no deductions in social security tax on my health care. What part of the "Affordable" part of Obamacare is it that we are supposed to cheer? What part of his "income redistribution" should I cheer? Health care costs have risen dramatically under Obamacare, people are losing health care and employers are changing to part time positions with NO benefits. The heart of Obamacare is exactly as Roberts stated, it is a tax and a HUGE tax.

It gets worse, if I live to be 65, then my small retirement from Kaiser will kick in. I truly believe at that time I will have to get a job just to pay my state and Federal taxes. Sorry, I am no fan of this president and what he has done to this country. Soon, all of America will look like Detroit.

[rocker]

What part of his "income redistribution" should I cheer?

Matthew 25: 37-40

[MooseMom]

Hemodoc, why have your healthcare costs gone up so dramatically?  Mine haven't, so why have yours?  Which part of Obamacare had led to your higher costs?  Here is a link to the timeline where one can see what will be implemented when; maybe this can guide you in your explanation as to why your rates have gone up so much.

http://obamacarefacts.com/health-care-reform-timeline.php

[Hemodoc]

What part of his "income redistribution" should I cheer?

Matthew 25: 37-40

Dear Rocker, funny, I just gave $5.00 to a disabled amputee vet in a wheelchair at Costco. Yes, indeed, INDIVIDUALS have a duty to their fellow man. Now, without getting into a huge theological discussion, socialistic and tyrannical taxation is not what Matthew 25:37-40 is talking about. It is instead a call to INDIVIDUAL caring and giving.

Matthew 25:37     Then shall the righteous answer him, saying, Lord, when saw we thee an hungred, and fed thee? or thirsty, and gave thee drink?
38     When saw we thee a stranger, and took thee in? or naked, and clothed thee?
39     Or when saw we thee sick, or in prison, and came unto thee?
40     And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.

Once again, if you wish to discuss biblical finance, I can assure you that America's movement towards a tyrannical government by BOTH parties with their tax and deficit spending is not at all biblical. Send me a pm if you wish me to explain more since a lot of folks don't want to talk about the Bible here in IHD. Please remember, you brought up this topic.

[Hemodoc]

Hemodoc, why have your healthcare costs gone up so dramatically?  Mine haven't, so why have yours?  Which part of Obamacare had led to your higher costs?  Here is a link to the timeline where one can see what will be implemented when; maybe this can guide you in your explanation as to why your rates have gone up so much.

http://obamacarefacts.com/health-care-reform-timeline.php

Sorry, but the dramatic rise in health insurance premiums is quite well documented. So much for the "affordable" part of the bill.

http://online.wsj.com/article/SB10001424127887324063304578522893554786084.html

[MooseMom]

Hmmm...I couldn't access that article for some reason.  I have to either pay for a subscription or open an account, which I am loathe to do as it just adds to those who want to send me e-mails asking me to spend money.  LOL!

I'm truly not trying to get into a debate.  I really am curious as to why Group Health has made your premium skyrocket.  Is it really because of the ACA, or do you suspect they might be using its implementation as an excuse to raise your premium?  What reason did they give you?  Whenever I hear that insurance premiums are going to go up, I just can't shake off this feeling that, once again, Corporate America is doing sneaky things and blaming it all on anything other than their own greed.

 

[BattleScars]

I know this isn't an easy thing to do, especially for a typical dialysis patient, but I think the important lesson here is we need to be as self-sufficient as possible. I'm not going to sit here and say the sky is falling because I've been hearing that my entire life. This is how politics work, they attempt to scare the little people. For example, every time our government is having a budget issue who does our government threaten first? The sick and the poor. The elderly. The people that can't help themselves. They threaten to cut into our social security and our medicare. This scare tactic has been going on for decades and it's a tried and true method, that's why they keep using it. You don't see Obama threaten the rich in his speeches, you don't see him threaten to cut into our overpaid politicians salaries. That would be political suicide for any president.

At the end of the day everything works out for the most part. I mean I don't think we are going to see dialysis units shutting down all over the place. Anything is possible but in the meantime why worry about it? More than likely we will all live to see another day and continue to get the treatment we need. Now I'm not saying the system isn't broken because it clearly is, I'm just saying the sky isn't falling.

I've realized the past few years since I got sick that (A) I have to take care of myself and (B) The government isn't on my side. I get a little morsel of a check every month that doesn't cover jack. It doesn't even pay half of my expenses, maybe not even a quarter. Without my wife I would be homeless or dead. Bottom line I have to protect myself. I'm not going to go rob a bank or hurt anyone to do it, but you better believe I'm going to do whatever I have to do to make sure my family and I are able to meet our needs. Lately I have been looking at income that is under the table. I think every able bodied person should pay their taxes and I think we should all try not to rely on the government, but the sick and the people that can't help themselves should be taken care of by our government. We have enough to deal with than to worry about our medical care not being covered or our already small SSI checks shrinking. In an ideal world the able bodied would take care of the less fortunate and our government would step up to the place and make sure we were OK. The reality is that we have to make sure we are OK. I've started stashing money away in places that are untraceable. If they find out we have any extra money at all they will just take it away. I need that security of knowing if sh*t does hit the fan or the sky does fall I can take care of myself and my family because even in the best of times this government isn't there to save our butts.

I don't know if that made any sense. Sorry for rambling. I didn't get much sleep last night so if what I'm saying seems out there please forgive me.

[BattleScars]

I also want to note that I'm not exactly anti-government. I'm not hiding up in the mountains stashing away guns and joining the militia. I think there is a middle ground where a reasonable person can say our government sucks and try to come up with real ideas how to solve the problems. Our government is completely out of control and is wasting billions on non essential programs yet we have to worry that we might not get the life-saving care we need? I don't think you have to be nuts to see changes need to happen in our government,  NOT "OBama Change" either. Real changes.

[MooseMom]

I can't disagree with you, BattleScars.  I don't think any government is going to save our butts, especially this Congress.  But there are a goodly number of butts out there that probably do need saving.  Maybe this is where local faith groups could step up, but even for them, caring for a dialysis patient and contributing to the costs would break their banks.

Why are we still using this employer-based health insurance paradigm, anyway?  Isn't that a bit outdated?  Also, if employers decide not to insure their employees, it's my understanding that the employees don't "lose their insurance", rather, they can now go to a health exchange so that they purchase a plan that suits their needs.  That seems to offer more choice than having to take the insurance that your employer offers.

The dialysis/renal community will always be in peril as long as our treatment is based on profit.

[Hemodoc]

Hmmm...I couldn't access that article for some reason.  I have to either pay for a subscription or open an account, which I am loathe to do as it just adds to those who want to send me e-mails asking me to spend money.  LOL!

I'm truly not trying to get into a debate.  I really am curious as to why Group Health has made your premium skyrocket.  Is it really because of the ACA, or do you suspect they might be using its implementation as an excuse to raise your premium?  What reason did they give you?  Whenever I hear that insurance premiums are going to go up, I just can't shake off this feeling that, once again, Corporate America is doing sneaky things and blaming it all on anything other than their own greed.

Sorry, I don't have those answers for Group Health. I just recently sold our CA home and now am no longer a Kaiser patient. Kaiser is paying for my Group Health as part of my health care for life benefit in my retirement package with my medical group. The $35,000 is what Kaiser is contracted to pay to Group Health. I have no clue why it has sky rocketed specifically, but the promise that the "Affordable Health Care Act" would reduce premiums has never materialized. Just the opposite in fact. By 2016, I have read that the average premium for a family will be $20,000.

http://www.huffingtonpost.com/2012/05/15/health-care-costs-record_n_1516380.html

I know that when I am 65 if God willing I live that long, I will have to strongly consider giving up my Kaiser lifetime coverage and go with Medicare and Medigap coverage I will purchase if either are still available. Otherwise, I will on paper look like a wealthy retiree, when in fact, the majority of my taxable income will instead by my health care coverage alone. My accountant explained that the ACA will make that common for people who have health care benefits in one state and then move out of state where they will also be taxable income. There is a reason why Obamacare hired thousands of new IRS agents as part of the "health care" deal.

[MooseMom]

I also want to note that I'm not exactly anti-government. I'm not hiding up in the mountains stashing away guns and joining the militia. I think there is a middle ground where a reasonable person can say our government sucks and try to come up with real ideas how to solve the problems. Our government is completely out of control and is wasting billions on non essential programs yet we have to worry that we might not get the life-saving care we need? I don't think you have to be nuts to see changes need to happen in our government,  NOT "OBama Change" either. Real changes.

I absolutely, totally agree.  I wonder how much money was spent in investigating the IRS because some Congresspeople thought it would look good to be chasing what turned out to be non-existent villains?  It's all about getting re-elected, and I don't care which party you're in.

Government no longer serves the people, at least not in the US.

[MooseMom]

Sorry, I don't have those answers for Group Health. I just recently sold our CA home and now am no longer a Kaiser patient. Kaiser is paying for my Group Health as part of my health care for life benefit in my retirement package with my medical group. The $35,000 is what Kaiser is contracted to pay to Group Health. I have no clue why it has sky rocketed specifically, but the promise that the "Affordable Health Care Act" would reduce premiums has never materialized. Just the opposite in fact. By 2016, I have read that the average premium for a family will be $20,000.

http://www.huffingtonpost.com/2012/05/15/health-care-costs-record_n_1516380.html

I know that when I am 65 if God willing I live that long, I will have to strongly consider giving up my Kaiser lifetime coverage and go with Medicare and Medigap coverage I will purchase if either are still available. Otherwise, I will on paper look like a wealthy retiree, when in fact, the majority of my taxable income will instead by my health care coverage alone. My accountant explained that the ACA will make that common for people who have health care benefits in one state and then move out of state where they will also be taxable income. There is a reason why Obamacare hired thousands of new IRS agents as part of the "health care" deal.

I see.  OK, thanks for that explanation.

[Hemodoc]

Dear Moosemom, the average cost in the exchanges for a family will be $20,000. How many folks of modest income can afford that?

http://www.huffingtonpost.com/2012/05/15/health-care-costs-record_n_1516380.html

[Bill Peckham]

By 2016, I have read that the average premium for a family will be $20,000.

http://www.huffingtonpost.com/2012/05/15/health-care-costs-record_n_1516380.html

Did you even read the article you linked to? The 20K is total healthcare spending through an employer group plan and the increase is not as high as in the past but the dollar amount  is higher because a smaller percent of a large number is greater than larger percent of a smaller number. Peter since you are not a young healthy uninsured hipster your healthcare costs are not going to go up but I would wager that after 2014 when the ACA goes into effect the amount Kaiser has to pay Group Health will be considerably less because they will not be able to charge more due to your preexisting condition. Your situation to date has had nothing to do with the ACA but soon enough you will benefit from the ACA's provisions.

The bottom line total healthcare spending increased about 3.5 to 4% a year in 2009 through 2012 as opposed to 7 to 8% in the previous decade. That lower growth rate has made all sorts of issues around healthcare costs and coverage easier to deal with, those saving will continue to compound far into the future. For those of us who rely on Medicare the trust fund, in 2008 was due to go into deficit in 2016. Today it is due to go in to the red in 2028. That is due to Obamacare.

[Hemodoc]

Sorry Bill, we will have to agree to disagree. I don't believe your figures are accurate. Here are some more articles talking of the failed promise of Obamacare to reduce premiums.

http://thehill.com/blogs/healthwatch/health-insurance/272465-study-health-premiums-skyrocketed-compared-to-wages

http://www.svherald.com/content/news/2013/04/05/350620

http://freebeacon.com/obamacare-causing-insurance-premiums-to-skyrocket-in-indiana/

http://online.wsj.com/article/SB10001424127887323936804578227890968100984.html

Lastly, my Group Health coverage is a group rate, not an individual rate. Health care costs are NOT going down under Obamacare, just the opposite. In addition, the taxes are also going through the roof.

[BattleScars]

Does any of this ObamaCare garbage even apply to me? I live in MA where we already have mandated health insurance. The sky hasn't fallen here once it was passed. If anything it may have saved my life. I didn't have insurance at all before I moved here and because of the laws here pre-existing conditions could not be a reason to deny insurance so I was able to jump on my wife's plan. I have read somewhere that once my 30 months is up on dialysis my insurance can make medicare pay for it all. Not sure what that's about. Anyways, I'm on dialysis and our medical costs aren't that expensive. I want to say my wife gets maybe $50 a week taken out of her check at most but I think it's even a lot lower than that. When she added me on it was only an extra $15 a pay check. My Rx copays are what I think are the most expensive. I can't see anyone average family paying $20K a year in premiums. I'm not trying to argue because I know next to nothing about any of this. My gut feeling is these are more scare tactics. What I don't get is if everyone is so against this Obamacare then why did you all vote for the clown? I had other reasons for not voting for him but you can't blame me on this one. I think he's one of the worst presidents in my lifetime. All those "Change" speeches were nothing but a smoke screen.

[MooseMom]

BattleScars, not everyone is against Obamacare.  Why would you think that?  All of those "Change" speeches were based on the assumption that we had a Congress that really wanted to change the way things work in D.C.  That assumption has proven to be false.  Anyone who needs any kind of government support, like those of us with ESRD who rely on Medicare or Medicaid, will be left behind to rot.

[Bill Peckham]

Sorry Bill, we will have to agree to disagree. I don't believe your figures are accurate. Here are some more articles talking of the failed promise of Obamacare to reduce premiums.

http://thehill.com/blogs/healthwatch/health-insurance/272465-study-health-premiums-skyrocketed-compared-to-wages

http://www.svherald.com/content/news/2013/04/05/350620

http://freebeacon.com/obamacare-causing-insurance-premiums-to-skyrocket-in-indiana/

http://online.wsj.com/article/SB10001424127887323936804578227890968100984.html

Lastly, my Group Health coverage is a group rate, not an individual rate. Health care costs are NOT going down under Obamacare, just the opposite. In addition, the taxes are also going through the roof.

I'm talking about total health spending - which is widely reported to being in the fifth year of record slow growth, confirmed for the 2009 - 2011 period and early indications are that it is continuing in 2012 and 2013, to which your response is to Google up some articles about someone's premiums somewhere going up. I think your response suggests you don't have a strong understanding of healthcare economics.

In addition Peter, you seem to be saying Kaiser is paying Group Health 35K a year to insure you as part of a group rate, that would be extraordinary. More likely, based on common sense, since I don't know the details of your particular coverage, is that Kaiser is paying Group Health to cover you based on the fact that you have stage 5 CKD, which after January 1st Kaiser won't have to do that.

The one article you linked to that did have something to do with Obamacare - the freebacon article - references the Indiana numbers that the Republican administration there cooked up as best they could, but a quick google search will reveal why those numbers are suspect.

Obamacare is heere to stay and it is a big win for the American people, particularly Americans living with an illness