@oralloy,
Sorry, some statements here I just couldn't let go.
Quote oralloy on Medicaid GP centers:
Quote:I strongly prefer a normal doctor. I think if poor people had an option, they would too.
Maybe yes, maybe no. Point is, you are trying to say that since Medicaid is supposedly entirely useless, it's no big deal that the all the people who make between $9K yearly and $18K yearly, (more for a family), who were made eligible for Medicaid under the ACA expansion and who are going to get thrown off Medicaid under Trumpcare have lost little to nothing. Because, according to you, Medicaid healthcare is worthless. And that is ridiculous, because Medicaid healthcare is modern scientific healthcare complete with MRIs, CAT scans and open heart surgeries covered, it is not nothing or next to nothing.
Quote Blickers:
Quote: Why would a GP try to handle something that belongs to a specialist-if something goes wrong with the treatment, the GP's on the hook.
Quote oralloy:
Quote:Because the HMO refuses to let them make the referral.
So I suppose the people I know on Medicaid who had MRIs, CAT scans and cardiac catheter procedures just walked into specialists' offices and charmed their way into the operating room or lab without a referral? How silly can you get.
Quote oralloy:
Quote:In an HMO, the general practitioner doesn't give referrals unless the HMO agrees to it. If a general practitioner gives too many referrals to expensive specialists, they will be kicked out of that HMO's network in favor of "cheaper" doctors who don't make as many expensive referrals.
That is the case with all HMOs. But as I said, Medicaid is the worst of the HMOs.
A. All conjecture on your part with no proof that this is the case with Medicaid.
B. Even if pressure did exist to cut down on referrals, (which we don't know there is), to avoid malpractice suits the cases would have to be fairly minor cases. If a doctor refused a referral and the patient ends up with a serous problem as a result, there are any number of personal injury lawyers who would love to go after the doctor, the Medicaid funded facility, and anybody else with money. With every patient, the medical people have to make a reasonable case that they followed medical procedure. There might be some "grey areas" of treating with medications vs referring to specialists where, in good faith, some GPs would decide to treat with a prescription and some would refer, but it can't be anything with the potential to be serious or the doctor loses his license.
Quote Blickers:
Quote:You don't hurt your leg and look up an osteopath in the yellow pages. At least for the first time you see them, they expect you to be referred by another doctor.
Quote oralloy:
Quote: I actually could make an appointment with a specialist without a referral so long as I stayed within my PPO's network (and like I said, I selected one with a very broad network).
I probably would start out with my general practitioner if I had a problem. But if things got complicated and I wanted a second opinion I might decide to strike out on my own.
Having to get referral from a doctor to get your leg fixed and being able to look up a specialist on your PPO and make an appointment is not that big a difference. The big difference is having a specialist treat your leg as opposed to "grinning and bearing it". You are trying to say that since Medicaid requires a referral, you might as well not have modern health care at all, therefore the people working who make between $9K and 18K a year who are going to lose their Medicaid under Trumpcare are not going to suffer much.
BTW, if your leg hurts so bad you need to go to the emergency room, (covered by Medicaid), they will treat it and fix you up with a Medicaid approved specialist to see-the emergency room doctor or physician in the hospital, (if you are admitted), will give the referral. The important thing, you are getting treated by the same people who the PPOs have on the list.
Quote oralloy:
Quote:HMOs and PPOs existed before the advent of Obamacare, but no one was forced to have them.
That's not what you said, you said HMOs were created because of the ACA.
Quote oralloy:
Quote:Why should poor people be forced to have cosmetic outcomes from the 1800s when modern procedures produce much better results cheaply?
Because how something looks cosmetically is less important than if the patient is still alive and well? Besides, the cosmetic difference is between "normal" and "deluxe". Under Medicaid, you might get the normal, standard wheelchair that you see commonly. It won't cover the top of the line model with GPS and the built-in-bar.
Quote Blickers:
Quote:I've seen no evidence that Medicaid recipients don't have all generic drugs covered.
Quote oralloy:
Quote:If someone on Medicaid wants one of the cheap generics with few side effects, they'll have to present the HMO with a good reason why the patient can't just deal with the side effects of the older medication.
Quality of life doesn't count as a good reason.
No evidence of that that I could see. I know somebody on Medicaid who was given Abilify when it was not generic. The difference in price you allege between the "expensive" generic drugs and the "cheap" generic drugs are almost nothing when you see the difference in price between brand name drugs and any generics. Brand name drugs can go as high as $2,000 a dose. "Expensive" generics go for maybe $5 or $15 a dose. Remember, Medicaid covers open-heart surgeries and other expensive operations. This type of penny pinching you are talking about I have not seen dealing with people I know on Medicaid. What I do see with them is medical care performed by certified, licensed Mds and specialists who are also on the PPOs you talk about.
Quote oralloy:
Quote:If they had a more difficult problem that might take a second or third opinion before their problem was even diagnosed accurately, they'd be out of luck. Repeated referrals for the same problem doesn't happen with HMO's, and certainly not on a Medicaid HMO.
And unfortunately sometimes people have difficult problems that are only diagnosed correctly after a second or third opinion.
I frankly don't know if Medicaid covers second or third opinions, but such operations are not common. And what you are proposing is to pass a law, Trumpcare, which will cut the people who make between$9K and $18K a year off Medicaid and onto no health care at all. And the tax credits these people will get under Trumpcare will not even come close to allowing them to purchase health insurance. Fact is, Medicaid gives people the chance to see licensed MDs treat their problem, get their meds, and go to see the same specialists the people on PPOs see. That is an enormous difference between having no medical care at all for these people, which is what the Trumpcare you are supporting is going to do to them.
Quote oralloy:
Quote:If you have an obscure or rare illness, if you are in a plan with a narrow network, there will be no specialists with the expertise to treat you at all.
Narrow networks are the kiss of death.
Get these people on the exchanges where they can choose a PPO with a broad network.
A. So you're down to obscure and rare illnesses as a reason to throw people off Medicaid? Egad, the idea is to get them to a doctor and specialists, and a lot of conservatives are trying to deny them that. Fact is, most states have university hospitals-which accept Medicaid-and the rare illness can be studied and treated there. So that's not even a reason.
B. Trumpcare doesn't put the people who make between $9K and $18K yearly on the exchanges. They won't have enough in tax credits to purchase the insurance from the exchanges. The result is they are going straight to no medical care at all. And this business you are pulling about I-don't-want-the-specialists-at-the-local-hospital-to-do-something-I-want-the-best-clinic-in-the-state is perfectly fine for someone with a luxury plan, but we are talking about getting health care to people with little to no money to spend on healthcare. And which present plan for them is being pulled out right from underneath their feet by Trumpcare.
Shame on you.
