Health Care reform...dont want political

mstang67chic

Going Green
I don't watch any of the political shows on tv so maybe someone IS doing this but...

There always seems to be so much mudslinging coming from Washington that there should be a source of FACTS somewhere out there. Be it a website, newspaper article, show...whatever. Just someone/thing to say: This is the topic and these are the facts about it. The pros are this, the cons that. Basically something like what Dazed posted.

Healthcare? This is the plan being discussed.

Economy? Here are the ideas being tossed around.

Social security? Here is the main issue at hand and the possible solutions.


No mudslinging, no partisanship, no opinions. Just straight facts. WHY is it so hard for these people to just do THAT? Honestly, when I DO try to educate myself on a particular political issue, I have to wade through so much propoganda, rumors and falsehoods that I wind up not bothering.
 

DammitJanet

Well-Known Member
LOL Stang...that is kind of why I posted this because I was trying to figure it out after seeing some of the news lately about the Town Halls and watching people being dragged out in handcuffs! Huh? Made me scratch my head.
 

witzend

Well-Known Member
There always seems to be so much mudslinging coming from Washington that there should be a source of FACTS somewhere out there. Be it a website, newspaper article, show...whatever. Just someone/thing to say: This is the topic and these are the facts about it. The pros are this, the cons that. Basically something like what Dazed posted.

Please try this:

http://www.factcheck.org/

This is not the only issue they address. They have been around a long time and do not take sides. They are a very reliable source of information and easy to read.
 

flutterby

Fly away!
Re: death squads: As it stands, if a medicare patient wants to discuss end of life options, they have to pay for it out of their pocket. Medicare doesn't cover it. by the way, it is NOT called death squads. That term was used as a scare tactic.

All this is doing is ensuring that patients can have these discussions with their doctors - I think it's every 5 years - AND have it covered by insurance. A lot of people really don't understand their options and this is vital care, in my humble opinion.

Witz covered it pretty well, as did Dazed and I have to run yet again. Sigh. I'll be back, though.

Heh. Me and Arnold. :tongue:
 

muttmeister

Well-Known Member
Well, I think any sane person can see that something needs to be done with our health care system. We pay more per capita for worse results than any other developed country.
Rich people can afford almost any care they want; poor people are covered by Medicaid (I only wish I had the kind of health care my grandkids get from that); and old people have Medicare - I have to wait another 3 years for that but my mother has had it and, although she does have a supplemental insurance policy, it has been wonderful for her. The rest of us are up the creek without the proverbial paddle.
I think part of the problem with what is going on now is that, even though the opponents are calling it "Obama Care," the Obama administration did not put forth a definite plan; instead, they made a few suggestions and left it up to the Senate and the House to come up with something that would, hopefully, have bi-partisan support. However, instead of that happening, a number of forces (who shall remain nameless) have banded together to try to defeat this reform without offering an alternative of their own. Because it did not start out as a definite plan with all of the nuts and bolts spelled out, there has been room for a lot of misinformation and outright lies to be spread. It has been difficult for those of us who support reform to come up with definite arguments against those lies because the bill still has not been spelled out for us in detail.
I would hope that whatever side you're on, you will use the newspapers, magazines, internet, etc. to try to find out the TRUTH and then contact your senators and representatives and make your wishes known. Right now there is enormous pressure from both sides, especially from the anti's, and we deserve to have our voices heard above the mob. Just because you shout a lie loudly, or repeat it over and over, that does not make it true. This affects every American and I can only hope that the people of this country will take the time to become informed (hopefully not by the Republican Party or the Democratic Party or the insurance companies or the other special interest groups) and make their wishes known.
 

AnnieO

Shooting from the Hip
ARGUMENT - REBUTTAL:
It's not a scare tactic. It's what I have seen with my own eyes. However that's only in one place. Others may be far better. I can only hope, as all prisoners are not horrible people. There are shades of grey in every situation.

However - on the other hand - how do prisoners get free care, and law-abiding citizens pay? For their care as well? Please don't answer this, it's a rhetorical question. It's annoying.

One of my best friends is an EMT. He says it's awful, how people end up having to fill out forms while their loved one is in the ambulance. All insurance driven. Care for the patient, THEN worry about paying for it and who they are. However... If I ever get hurt & he's around, I know who I'm calling.
 

witzend

Well-Known Member
I imagine that any EMT could also tell stories about how people with chronic illnesses end up in the ER because they can't get a regular check-up or medications because either a) they don't have insurance, or b) their insurance took their premium and denied them treatment.

I recently got a letter from the pharmacy arm of our insurance company, which is the only option for insurance that we have. I have a chronic condition that I have dealt with since childhood. What it is and how we treat it is irrelevant to this story, but for the purposes of this post let's call it "hangnail". What is relevant is that after years of trial and error, we found a medication that successfully treats my "hangnail" without the really bad side effects that other medications I took for hangnail had and which gave up on in the past. Those medications did not treat my condition successfully. This medication is fairly new, is a different class of drugs, and has 3 years until it can be made as a generic drug, so no generic is available. We'll call it Nailclipper.

When I was first prescribed Nailclipper, in 2007 it cost $10 for a 90 day supply by mail. The same as every other RX I get. In 2008 it cost $20 for a 90 day supply, like all my other RX's. In 2009, it went up to $40 for a 90 day supply, like all my other RX's.

Last week I got a letter from the insurance company that said that Hangnail has been successfully treated for other people with the medications of a different class which I used before (which did not work for me and had bad side effects), and they will cover those other medications to treat my Hangnail. They will no longer cover Nailclipper. If my doctor and I think that the best medication for me is Nailclipper, my doctor should contact them and they will explain to my doctor why the other medication will work just as well. If my doctor and I still feel that way, I can pay for it totally out of pocket at $487 for a 90 day supply.

Please bear in mind that the president of this insurance company owns $744,232,068 in unexercised stock options, (stock is worth more if the company cuts costs) in addition to his annual salary of $3.2 million a year. That's over $1,500 an hour in wages alone. It doesn't include his jets or limos, or bonus.

I want to know why he thinks that his people know enough about me to overide my doctor's orders? Talk of "Death Squads" and comparisons to "Nazi's" is reprehensible.
 

AnnieO

Shooting from the Hip
Witz, you are so right. They have no right (in my humble opinion) to attempt to override the doctor's opinion. And to be honest - I can see, if there is a generic, requesting that one first, maybe paying more for it, but if not - !!!!!

It's insanity. And yes, he can tell lots of those stories. He tries not to because it's depressing.
 

DammitJanet

Well-Known Member
Witz...I know wherefore you speak! LOL. I read the fine print in the formulary very well each year to see if nailclipper is going to be covered too or I am off to other insurers to find one who will.

I have sat in the parking lot of the drugstore before and fought with the insurance company for approval.
 

witzend

Well-Known Member
I have sat in the parking lot of the drugstore before and fought with the insurance company for approval.

What I neglected to mention in the earlier post was that the letter came with a tri-fold pamphlet of "nailclipper" type medications that they just aren't going to cover anymore. Period. There is no approval process for these medications. They are not on the list until there is a generic available. We're talking heart medications and diabetes medications, stuff that people need every day.

When I got the letter, I tried to get online to see what their proposed cost out of pocket would be, and their site was down all week from too much traffic. I finally had to do it at 2 AM to even get online. You have to know that this is affecting 100's of thousands if not millions of people.
 

DammitJanet

Well-Known Member
That really frightens me because they could realistically do that to me...well...could have, or possibly still could I guess...on some of my medications. I would have to check and see if all of mine are now generic or if at least one is name brand...but for awhile two of mine were only name brand. We had to get prior approval on them constantly. They wanted to tell me that lithium or depakote would work just as well...Uhhhh...NOT!
 

donna723

Well-Known Member
I don't get in to the politics of it much and I haven't studied up on this as much as I should have because I've always had pretty good insurance and haven't had to worry about it like some have. But it seems to me that more and more, the medical decisions are made by the insurance companies, not the doctors or the patients!

And it seems like the doctors and the hospitals are hitting up the ones with insurance to make up for the ones without it! I don't even have a family doctor. But a few months ago I got an insect sting on the back of my knee that got infected under the skin and the red patch just kept spreading and spreading. No big deal but I needed to see a doctor. I was going to hunt someone up the next day but that night I got a call that my son was two counties away, in the ER (long story). This is a small county-run hospital. I rushed over there (he was OK) but we had to wait about three hours for the mental health social worker to get there to see him before they'd let him go. It was past midnight, we were the only ones there, so while I was there, I asked to be seen about my leg. I was seen by a PA who looked at my leg, took my temp and blood pressure, and I got a shot of a garden variety antibiotic and a prescription ($4 at Walmart). I wrote a check for the $75 ER co-pay that my insurance requires. The whole thing cost me $79 and all was well. A few weeks later I got a statement from the hospital (not a bill) of what the charges had been - ALMOST $6,000! They had charged almost $2,000 for me to walk in the door, close to $1,000 for something else (breathing their air?), and the rest of it was for the antibiotic shot - $1,800 for the injection and the rest was a 'pharmacy charge"!!!! Does this mean my insurance paid $5,925 for that little visit? No wonder our premiums go up every year! And if someone with no insurance came in for the same thing, would they send them a bill for $6,000? Refuse to see them till they come up with $6,000? And this is exactly why my son never got medical treatment several times when he really needed it but didn't have medical insurance at the time!

I don't know what the answers are, I don't even have a clue. But something's gotta change! It's just chaos now!
 

flutterby

Fly away!
Donna, to answer your question, no your insurance company did not pay $6,000. Insurance companies have contracted rates with providers. The provider agrees to accept what the insurance pays.

When I had the heart attack, the hospital bill alone was $175,000+ (doesn't count the cardiologist, etc). The insurance company paid around $100,000. I had a $2,000 deductible. I couldn't have replaced the transmission in my car for what the insurance company paid the cardiologist who did the angioplasty that took 2.5 hours and 4 stents. In fact, they paid the medic company that transported me (no lights or sirens) from one hospital to the other more than they paid for my angioplasty. How disgusting is that?
 

witzend

Well-Known Member
Hey, Heather, at least the Doctor who did the angio had a degree in something and knew how to treat your illness. These insurance company execs have good secretaries who cover their behinds, or play golf with the right guys, and that's about it. Ah, to be born with a silver spoon...
 

KTMom91

Well-Known Member
Right now, we have health insurance (knock on wood), but I have been without insurance many times over the past few years. That meant no preventative care, no mammograms, no "yearly checkup", no flu shots, no nothing, unless I was really sick. Then I went to Urgent Care, if I had room on my MasterCard, or the ER, and let the county pay for it in the end. Miss KT had Medi-Cal, most of the time.

What I would like to see from the national health plan is a safety net, to make health care available at an affordable rate to people who do not have insurance. We all know having preventative care available keeps people healthier, and keeps them from going to the ER for non-emergency things. That allows ERs to do what they are designed to do...take care of emergencies.
 

Marguerite

Active Member
Sorry, this will be long. But I feel I'm coming at this from a very different (and hopefully useful) perspective.

There are some good health systems in various countries out there as well as health systems with problems. You could say that ALL health care systems have something wrong with them. Here in Australia we've had some form or other of nationalised heath care, since the early 1970s. I remember the system we had before this, too. So I've lived through a range of systems. Frankly, all of them were as good as, and mostly better than, what you have in the US. I really want to see your country have a GOOD health care system that will make it affordable and within reach of ABSOLUTELY EVERYBODY, as it is for us. Nobody in Australia is outside the health care system, not even the homeless bum sleeping on a cardboard box or in a clothing bin.

What we had when I was a kid - we had the option of private health insurance (at various levels) or the public system, which meant that if you were desperate, you would be treated in hospital as a public patient. However, there were long waiting lists for hospital treatment and ANY aservices remotely private, you got billed for it. If you had private health insurance you immediately got a better level of hospital care but it cost. The health fund paid for most if not all. Most of the time when I was a kid, my mother diagnosed all our childhood illnesses and we were not taken to the doctor unless it was really bad, or unless it was necessary for our childhood immunisations. So I had measles, mumps, chickenpox, rubella, bursitis, dislocated kneecap, various sprains etc, all without being seen by a doctor.

We had private health insurance if we took it out ourselves, paid for it ourselves. It was not part of any employment package.

Then in the 1970s we got Medibank. It was health cover for all. Instead of paying the doctor and then claiming it back from the health fund (or being out of pocket, if you didn't have private health insurance), we simply showed our Medibank card (one provided to every citizen regardless of age). The doctor filled the number in on a large green and white form then sent it in. He would then be paid according to how many numbers he filled in.
Private insurance was still recommended because it meant you had choice of doctor if you went to hospital, plus it covered a lot of frills such as glasses, dental, private rooms etc. Around this time I became independent of my parents and immediately took out my own private health insurance. An important point here - when the public health system (government-funded) pays for GP visits, then private health insurance doesn't have to fork out so much and as a result, premiums are lower and more affordable.

But Medibank was very open to abuse. All a doctor had to do was fill in the numbers. A lot of doctors claimed for services not rendered and the country's health budget blew out to ridiculous levels. Finally someone investigated and found that a lot of doctors were listing so many patients that there was no way they could have provided any sort of service at all, to such a number. "Medibank fraud" became a well-known phrase.

Then we had a change in government and a watering-down of the system. We still had public health cover for the GP and for specialists, but only 85% of it was covered. We had to pay the gap. The idea was to discourage people from over-using the health services. There was a lot of tweaking of the system at this point, all determined to weed out fraud by doctors. The biggest problem we have always had with our health care system, is the blowout in the national budget.

Further down the track we come to the first incarnation of our current system - Medicare. Long ago, Medibank was turned into a private health scheme. Now with Medicare, it became part of our taxation system. We could have simply paid X amount per head, but they decided to means test it. So we pay a Medicare levy. It used to be 1% of your income, but now it's 1.5%. It's sorted out at tax time, on the same paperwork as your tax return.
But there are a couple of other wrinkles.
First, if your income is below a certain level (I think it's about A$20,000) you don't pay any Medicare levy. And if your income is above a certain level and you don't also have private health insurance, you pay an extra 1% - that's 2.5% of your income.

Now, this seems not too bad - 1%. If you earn $20,000 that means you're paying $300 pa for your public health cover. If you earn $100,000 you're paying $1,500 pa. But you can afford it better.

What we get for our levy - we get public hospital cover but no choice of doctor. In most cases this doesn't matter. it's only if we're having a baby and want OUR obstetrician (or similar scenario) that private insurance is of value. There are other issues - if you need a hip replacement and your orthopedic surgeon is someone you really trust, you still often have to wait for a place in public hospital (because there are a lot of people who don't have private health insurance and who need the same operation) and still can't be certain you get YOUR surgeon. Instead, you get the specialist who happens to be on duty when you're admitted.
But for most purposes, Medicare covers it. Need to see the GP - Medicare. It still only pays te doctor 85% of schedule fee, but a lot of doctors are OK with this because they get more patients if they bulk-bill. If doctors don't bulk-bill then the patient pays up-front the full amount then take the receipt to a Medicare office and claim back what they can (up to 85%). Most specialists do NOT bulk-bill, we get back about two thirds because most specialists charge over the schedule fee. Because they can get away with it (not so much competition).
However, people on Health Care card (the elderly, the disabled, the low income earners) get bulk-billed by most specialists.

Private health insurance - it's still an individual choice and an individual responsibility. Again, not connected to employment perks as a rule. It covers choice of doctor in hospital, a better choice of room in hospital - in fact there are a lot of variations on private health insurance packages.

Problems - we still have a very expensive health care system. But we can choose who we see as GP (unlike the British system). So if we have a problem with Dr A, we can go elsewhere. A good thing because you could have a personality clash with a doctor, or you could find someone totally incompetent but be unable to get anything done about the idiot (been there done that). We've also had the local medical practice go through a laerge number of doctors in a short time, some of them total idiots and some of them brilliant. Some patients chose to follow the good doctors to wherever they went next. We chose to find a practice that wasn't changing doctors every five days.

There are other aspecgts to this sytem, a lot of fine detail, but that is it in a nutshell.

Good things about our system -

1) EVERYBODY has their own Medicare number, which opens doors for medical treatment. The lowliest hobo is entitled to the same level of health care as the richest billionaire.

2) You don't get caught out by medical bills likely to bankrupt you. Need a heart transplant? You can get it done free, if you need it.

3) Our medications come into this as well, with subsidised prescriptions. What is more, once you spend more than a certain amount per family per calender year, the cost per prescription drops to about $5 each. And if you begin with a Health Care Card, you get your prescriptions already at that low price and once you reach your annual limit further scripts are free.

Problems -

1) Our national budget still blows out with health care costs. But it's much more manageable now.

2) The biggest disadvantage from a US point of view, is Big Brother. It takes a HUGE amount of red tape to administer this system. Our health bureaucracy has evolved over 40 years. There is a connectedness to it all that is likely to have your civil libertarians screaming blue murder. With some justification, at least. But you can't make an omelette without breaking eggs and it needs to be considered - what is best? Freedom but poor health, or some level of "Big Brother is watching you"?

A lot of Aussies have accepted the Big Brother stuff on the premise that if you're not doing anything wrong, there is no problem. And generally that is the case.

How it's administered - I said each citizen has their own Medicare number. Each kid when it's born, is at first treated under the mother's medicare number. But once the birth is registered, new cards are issued to the family which include the baby. You can opt to have separate cards for each person in the family, or one card which has all family members on it. You can have multiple copies of the card but only ever one Medicare number that is current.
For example, Medibank was in when we began to have kids. husband & I got a card each, but the same stuff was printed on it - his name, my name and easy child's name. There was one big number at the top, then our names underneath with a prefix number. I'm No 1 on our cards (because I saw the doctor the most, back then). husband No 2, easy child No 3. As each kidcame along they were added. When difficult child 3 arrived, we needed a second card to cover all the family because each card only has room for five names and there were six of us.

Then our older kids grew up and became independent. They applied for their own cards, which came with their own unique numbers.

Now they're getting married. Currently, each kid has their own card, their spouse has their own different card (and number). If they choose, they can combine themselves under one number and a different number will be allocated to them for this. The previous number will be deleted.

For us, it's like a social security number. Medicare works for ID as well. When we get our medications at the pharmacy, we have to give our Meeicare number. Once its registered at a pharmacy that is it, we don't need to keep showing it.

How the Big Brother side of it works - it's all administered by the Health Insurance Commission. Their computers are programmed to watch for anomalies. A doctor who apparently sees more patients than he has time for in the day - it gets flagged as needing to be investigated. A doctor who orders more pathology than average - flagged. Patients whose medication pattern and usage is excessive - flagged (as is the prescribing doctor).

Anything flagged gets checked out, usually beginning with the doctor.

A lot of cross-checking goes on, increasingly so. Because Medicare is paid for at taxation time, our tax file numbers are now linked to our Medicare numbers, so the government can make sure we're paying our fair share. And because Medicare numbers are used for ID in so many areas, if you earn money 'under the table' and get paid by cheque or there are any receipts anywhere, you can be sure that at some stage you WILL get caught out.

There has been some talk about microchipping our Medicare cards to carry a copy of our medical history with it. These days when we see a doctor, it all goes on computer. The idea is that the microchip will carry a history of what has been prescribed and when and perhaps what has been diagnosed, when and by whom. So if we go see another doctor (for example, if we're on holidays) it doesn't matter if we can't remember all our medications, or what our doctor last told us. it will be on the chip. It would be useful in my case, for example, with my history of allergies.
The problem would be if a doctor writes something badly wrong or nasty. But if all that is written is what was precribed (or similar) then it shouldn't be a problem. Besides, a doctor using the system to be vindictive ("this patient has only one funcitoning neurone, and even it is nnot synapsing properly") would find another doctor could easily blow the whistle on him and the patient could sue the first doctor.

So there it is, as simply as I can sketch it.

WE can live with this even though it's not perfect, because it is still the best we've had, in my lifetime.

But could YOU live with it? And if not, can you see where your government could improve on it, to give you a health system for your country that is workable, affordable and tolerable?

Marg
 

Marguerite

Active Member
Oh, I forgot. It's also linked to our bank accounts (our choice at the moment) because when we get a refund from Medicare (for specialists' bills we've paid) they pay it straight into our bank account. So technically it is possible for the government to track the pattern of our bank balance, plus our income, plus our health care use ald all its implications.

Again, we're not doing anything we shouldn't, so we're not concerned. But have we Aussies been desensitised to this level of surveillance?

Marg
 
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