Healthcare going forward

[Kulindahr]

In fact however a few Republicans and all the democrats will block the GOP bill and Obamacare will collapse for want of a rescue.

For want of a rescue from the clutches of a manipulative president, to be accurate. If Trump would stop trying to make it fail, we'd get a better understanding of what its problems are.

 

[Kulindahr]

They probably will not include mental health....

Of course the GOP don't want to cover mental health -- that might actually help enough people that maybe the number of mass shootings would drop, which would throw a wrench in the gears of continuing to build a police state.

 

[Kulindahr]

If you are between the age of 50 and 64, expect your premiums to increase by as much as 66%. After age 65, Medicare cuts in. But, if Trumpcare takes affect, it will eventually eliminate Medicare

http://americablog.com/2017/06/66-premium-increase-age-50-senate-gop-health-care-bill.html

I don't think it's appropriate to call it "Trumpcare", because he doesn't seem to have a clue what's in it, any more than he did what was in the House version. It would be far more accurate to call it "Watch us put one over on Trump"-care, because the GOP congresscritters figure he'll sign whatever they put in front of him.

 

[KaraBulut]

For want of a rescue from the clutches of a manipulative president, to be accurate. If Trump would stop trying to make it fail, we'd get a better understanding of what its problems are.

Nah- if they bailout the private insurers, it just delays implementation of a public option.

We've seen from Medicare Advantage that paying a for-profit insurance company to provide heavily-subsidized insurance plans is costly. Private insurers can't negotiate with large healthcare organizations, nor can they match Medicare's 3% overhead/admin cost rate.

The way to actually get costs under control is to put the same Prospective Payment System in place for all Americans. This also lays the groundwork to lower costs and rein in abuse in the pharmaceutical sector.

Of course the GOP don't want to cover mental health -- that might actually help enough people that maybe the number of mass shootings would drop, which would throw a wrench in the gears of continuing to build a police state.

It's substance abuse treatment that will suffer, specifically inpatient treatment for opiate addiction. There were reports that one county in Ohio- Montgomery County- is on track to have 800 deaths for opiate overdoes by the end of 2017. The State of Ohio expects about 10,000 overdose deaths for 2017. For most of these users, Medicaid (and the criminal justice system) are the only option for detox and treatment for their addiction.

 

[Kulindahr]

Nah- if they bailout the private insurers, it just delays implementation of a public option.

I don't want them to bail anyone out, I just want them to let the law work the way it is supposed to so any flaws seen will be real ones.

We've seen from Medicare Advantage that paying a for-profit insurance company to provide heavily-subsidized insurance plans is costly. Private insurers can't negotiate with large healthcare organizations, nor can they match Medicare's 3% overhead/admin cost rate.

They can't even match not-for-profit 7-8% overhead/admin.

The way to actually get costs under control is to put the same Prospective Payment System in place for all Americans. This also lays the groundwork to lower costs and rein in abuse in the pharmaceutical sector.

I keep thinking there ought to be a plan where if someone loses a job that gave coverage, or if an employer stops coverage, they automatically switch to getting the same coverage (or better) via Medicare or something like it (which would allow small companies to phase out of having to provide coverage).

It's substance abuse treatment that will suffer, specifically inpatient treatment for opiate addiction. There were reports that one county in Ohio- Montgomery County- is on track to have 800 deaths for opiate overdoes by the end of 2017. The State of Ohio expects about 10,000 overdose deaths for 2017. For most of these users, Medicaid (and the criminal justice system) are the only option for detox and treatment for their addiction.

The three largest facilities providing treatment to the mentally ill in the U.S. are county jails.

 

[Kulindahr]

The system as it stands is insane. Trying to get help for my mom, I have to go to three or more different agencies, and essentially serve as their babysitter because none of them stay on the job unless they're constantly reminded to do their jobs. So programs that supposedly kick in immediately have yet to do anything for us after seven weeks of spinning wheels and watching my mom suffer because the assistance she was promised is in limbo. They keep trying to put her on Medicaid, which she refuses because the moment she died they'd take the house and leave me homeless... unless the fact that I'm disabled protects the house, but no one will commit on that except to quibble over whether I count as disabled because I'm not on stupid Social Security "low grade torture" (as my former psych-doc describes it) but get payments due to private insurance (not-for-profit through a church). Anyway, she's suffered two falls because the doctor's order for a raised toilet seat for rails that was promised two months ago has yet to appear, and we can't afford the thing unless a doctor orders it... and I'm just a hair from calling the doctor and telling him he bloody well ought to pay her medical bills resulting from his neglect!

 

[ballcaphair]

The system as it stands is insane. ... Anyway, she's suffered two falls because the doctor's order for a raised toilet seat for rails that was promised two months ago has yet to appear, and we can't afford the thing unless a doctor orders it... and I'm just a hair from calling the doctor and telling him he bloody well ought to pay her medical bills resulting from his neglect!

Even with a doctor's order, Medicare and Medicaid will allow physical therapy for an arbitrary number of days. Rehab often ceases at my clinic regardless of progress. Stopping care that a patient cannot afford is beyond neglect. It is abuse.

 

[Benvolio]

The system as it stands is insane. Trying to get help for my mom, I have to go to three or more different agencies, and essentially serve as their babysitter because none of them stay on the job unless they're constantly reminded to do their jobs. So programs that supposedly kick in immediately have yet to do anything for us after seven weeks of spinning wheels and watching my mom suffer because the assistance she was promised is in limbo. They keep trying to put her on Medicaid, which she refuses because the moment she died they'd take the house and leave me homeless... unless the fact that I'm disabled protects the house, but no one will commit on that except to quibble over whether I count as disabled because I'm not on stupid Social Security "low grade torture" (as my former psych-doc describes it) but get payments due to private insurance (not-for-profit through a church). Anyway, she's suffered two falls because the doctor's order for a raised toilet seat for rails that was promised two months ago has yet to appear, and we can't afford the thing unless a doctor orders it... and I'm just a hair from calling the doctor and telling him he bloody well ought to pay her medical bills resulting from his neglect!

Have you considered having her transfer the home to you. The law varies but some states will not question it. Ask a lawyer.

 

[Benvolio]

Even with a doctor's order, Medicare and Medicaid will allow physical therapy for an arbitrary number of days. Rehab often ceases at my clinic regardless of progress. Stopping care that a patient cannot afford is beyond neglect. It is abuse.

Therapy and rehab can go on for a lifetime, and allowing the therapist to determine how long the sinecure continues is both subjective and unworkable.

 

[Kulindahr]

Have you considered having her transfer the home to you. The law varies but some states will not question it. Ask a lawyer.

Done that. Five-year limitation: if it's transferred within the last five years of her life, it's considered to be a dodge to keep the government from seizing the home.


That they would do so in the first place to me is a condemnation of Medicaid; it seems like one more excuse to confiscate from people in order to get "help". The ACA used 400% of the poverty level as a cutoff; I think that's high but 200% of the poverty level as a cutoff for the Medicaid help would be sensible... or average the two and make it 300% for both programs.

 

[Kulindahr]

Therapy and rehab can go on for a lifetime, and allowing the therapist to determine how long the sinecure continues is both subjective and unworkable.

But allowing bureaucrats to decide it is unconscionable. Besides that, a sudden arbitrary cutoff is a recipe for suicides, something two of my former therapists have noted. Bureaucrats don't care about citizens' lives, as demonstrated by the fact that even with life-threatening conditions they deny and deny and deny Social Security disability -- and those same therapists have told me that they lost six and five patients, respectively, to suicide over the agony and inhumanity of the bureaucratic process.

I was part of a local health cooperative type organization where there was a system that would make sense: six months of treatment and then review from a different doctor who would then consult with the primary doctor.

Of course in that system both doctors were on straight salary, so there was no incentive to drag out treatment. Pay-per-case corrupts the system and encourages higher medical costs. My doctor agrees, even using the comparison with an electronics engineer: the units may be sold per item, but the engineer gets a set salary to do his best, so why isn't the medical profession run that way?

 

[ballcaphair]

Therapy and rehab can go on for a lifetime, and allowing the therapist to determine how long the sinecure continues is both subjective and unworkable.

As a physical therapist, rehab does not go on for a lifetime! The point of rehab is to get clients strong enough to prevent falls and the pure fear of falling. It is about quality of life. It is about helping people be whole and confident. It is about helping clients getting as healthy and independent as possible. You don't throw people off a cliff. You teach them how to safely climb down and in a few cases, you help them to fly. Being able to stand up and walk across the room is sometimes a miracle. It is not subjective.

 

[KaraBulut]

As a physical therapist, rehab does not go on for a lifetime!

A modification - rehab goes on for a lifetime. Good rehab teaches patients how to continue self-rehab after the therapy appointments end.

Being able to stand up and walk across the room is sometimes a miracle. It is not subjective.

For knee injuries, strokes and closed head injuries, rehabilitation makes the world of difference in function.

It's one of the reasons that while Medicare caps the number of visits, there are exceptions that are made based upon medical necessity. Medicare will push a patient from inpatient to outpatient based upon FIM scores but there's a lot of latitude that Medicare allows between "going on for a lifetime" and the standard number of allowable visits. Therapists do a good job of justifying their services with Medicare.

 

[thewiz]

A former employee of mine, who is retired, said the health care strangulation now under way should come with a prescription for aspirin since it's giving her one hell of a headache!

The Republican plan is not just to go back to the failing system we had before the Affordable Care Act (ACA) -- it also phases out Medicaid protection and spending in favor of granting tax cuts to the most wealthy individuals and corporations. It also cuts the taxes paid by pharmaceutical companies and insurers -- like they already don't make enough. The result is that LESS people would be covered under the latest plan than before ACA (by about 22 million estimated), rates will go up substantially for those who are pre-Medicaid (of course if they reach Medicaid age in 2021, they'll find it gone so let's start the death panels), women will be able to be charged more than men, insurance companies can again write the worthless policies with various caps and omissions that flooded the market before ACA (and covered virtually nothing when the fine print was reviewed), insurance companies will be once again free to spend whatever they like on everything unrelated to actual care, CEO's will reap a windfall, and all will be well in the world.

Part of me wants to say, "let's do it" because so many people are ignorant that the gains made in the last four years were largely because of ACA (until people like Marco Rubio and fellow Republicans eliminated reimbursements for pre-existing conditions that caused a portion of the market to collapse). Kentuckians will see nearly 600,000 more people uninsured if ACA is gutted because (and I've talked to people) they think their state plan has nothing to do with that "damn Obamacare."

But another part of me is worried about people like my niece who just had a mass removed from her abdomen along with a hysterectomy. She is now tagged with two strikes and would likely be without insurance -- at least affordable. Or my sister who has had two heart attacks and is only 51 years old, so far from Medicaid. She's self employed and who is going to write a policy for her? While my company pays for my health insurance, it is likely to increase substantially over the $800 I pay now for a platinum plan with low deductibles and coverage for pretty much everything (and which is $400 per month cheaper than what I was provided by my former employer with less coverage and before ACA).

 

[smokeshadow]

I don't think it's appropriate to call it "Trumpcare", because he doesn't seem to have a clue what's in it, any more than he did what was in the House version. It would be far more accurate to call it "Watch us put one over on Trump"-care, because the GOP congresscritters figure he'll sign whatever they put in front of him.

Sorry - I called it "trumpcare" because I couldn't remember it's actual name or the acronym it has gone by. Besides, regardless of what it's called, it is and will be a disaster in the same vein as our current occupier of the White House

 

[frankfrank]

^ It becomes Trumpcare as soon as he signs it, though - and, comments about "mean" notwithstanding, he WILL sign any finalized Republican bill.

 

[frankfrank]

New NBC/WSJ poll:

Which political party would do better with health care policy?

DEMOCRATS: 43%
REPUBLICANS: 26%

Democrats should be far, far higher in the polls, but THEY - GOT - NOTHIN'. How can they do better than Republicans, if they don't even have a plan that gives the slightest tweak to...anything?

I mean - and yes I know this isn't "Obamacare"/ACA - they can't even do something as simple as suggesting that Medicare actually be allowed to negotiate bulk pricing with Big Pharma. Right now, that is **ILLEGAL**.

If the Democrats actually had a plan, such as "repeal Obamacare only after a seamless transition to Single Payer is passed and signed," their percentage would go way up...and the Republican number would sink even farther.

 

[Kulindahr]

New NBC/WSJ poll:

Which political party would do better with health care policy?

DEMOCRATS: 43%
REPUBLICANS: 26%

Democrats should be far, far higher in the polls, but THEY - GOT - NOTHIN'. How can they do better than Republicans, if they don't even have a plan that gives the slightest tweak to...anything?

I mean - and yes I know this isn't "Obamacare"/ACA - they can't even do something as simple as suggesting that Medicare actually be allowed to negotiate bulk pricing with Big Pharma. Right now, that is **ILLEGAL**.

If the Democrats actually had a plan, such as "repeal Obamacare only after a seamless transition to Single Payer is passed and signed," their percentage would go way up...and the Republican number would sink even farther.

It would go up even more if the Democrats stopped playing games with/for the insurance companies.

If the Democrats wanted to be really creative, they could push for a slow buy-up of insurance company shares by a new National Healthcare Foundation or some such thing, and bit by bit turn the system into a single-payer one. If insurance company shareholders were getting money for their shares, I think some of the opposition would die.

 

[Benvolio]

Done that. Five-year limitation: if it's transferred within the last five years of her life, it's considered to be a dodge to keep the government from seizing the home.


That they would do so in the first place to me is a condemnation of Medicaid; it seems like one more excuse to confiscate from people in order to get "help". The ACA used 400% of the poverty level as a cutoff; I think that's high but 200% of the poverty level as a cutoff for the Medicaid help would be sensible... or average the two and make it 300% for both programs.

One the other hand, they are confiscating the earnings of other people to help you. Why should you keep the house while others lose their earnings for you?

 

[rareboy]