@oralloy,
Quote oralloy:
Quote:People have been complaining of the ravages of HMOs for decades. It isn't news that they deny referrals. That is why the structure of an HMO mandates referrals to begin with. It's so they can prevent people from being able to go to specialists by denying them a referral.
Yet I've known people on Medicaid who were referred to a cardiologist for a cardiac catheter. I've known some who spent over a week in the hospital when on Medicaid. How much more are you going to try to push this fantasy that if a patient needs a referral, they don't get one?
Quote oralloy:
Quote:Unfortunately no. I don't know the legal details, but HMOs don't seem to be sued for letting people die.
Maybe people sign away their rights to sue over denied referrals or something.
HMOs and PPOs can be sued for the malpractice of a doctor on their network. But the doctor on the network who refuses to refer a case to the appropriate specialist absolutely is on the hook for malpractice if something bad happens as a refult of lack of referral. So your theory goes out the window.
Quote oralloy:
Quote:Yes. And the fact that I can see a specialist without a referral means that I can't be prevented from seeing that specialist.
If I was required to get a referral first, denial of a referral would prevent me from seeing that specialist.
I don't think General Practitioners perform cardiac catheter operations, so my friend on Medicaid must have gotten a referral. You are making stuff up, if a serious problem comes up from the lack of a referral, the doctor for sure is on the hook for malpractice and the HMO or PPO can be. You are struggling to make it seem that Medicaid is not much different from the Doctors Without Borders physicians who do the best they can to bring modern medicine to impoverished residents of places without electricity or roads. Medicaid is a comprehensive modern medical system that works, contrary to what you are claiming.
Quote oralloy:
Quote:Instead of trying to preserve bad health care, why not try to give people good health care?
Actually, Medicaid is pretty good health care from what I can see, but if you have a plan for improvement, let's hear it. However, throwing people who earn between$9K and $18K yearly off Medicaid without providing a comprehensive alternative is obviously not that way. And people who make between $9K and $18K, (more for a family), cannot afford Trumpcare.
Quote:No. What I said was that Obamacare ended traditional insurance (where there were no networks and people could see any doctor without restrictions).
Obamacare forced people who had been on traditional insurance to join either a PPO or HMO and be restricted to a network.
79% of employers offered PPOs in 2010, years before the ACA went into effect.
Quote oralloy:
Quote:The cosmetics that are denied are not expensive.
Cosmetics may be less important than being alive, but that doesn't mean it isn't important. If modern medicine can reach a better cosmetic result cheaply, why force the poor to have cosmetics from the 1800s?
Medicaid does allow necessary cosmetics, it does not allow the deluxe version. Nor do private health care plans, in many cases. And since your alternative is Trumpcare,which the people being thrown off Medicaid by Trumpcare cannot afford, you are downgrading Medicaid, so that the people being thrown off it won't seem to be losing much.
The people I knew on Medicaid had regular visits to the doctor and got referred for various procedures, some of them quite expensive. While everyone knows that all halth care plans prefer generic meds to brand name drugs, I haven't seen any evidence that Medicaid doctors are denying the expensive generic drugs to keep their jobs. And I've known at least one Medicaid patient who got Abilify before it went generic.
Quote oralloy:
Quote:I am saying that people on Medicaid are denied *cheap* generics with no side effects, in favor of older generics with unpleasant side effects.
If you saw someone get a name-brand medicine they had to have presented a good reason why they need it.
Unfortunately "these needless side effects are unpleasant" is not a good reason for Medicaid to give someone a *cheap* generic without side effects.
Most plans, Medicaid or private, require a case to be made by the prescribing doctor for name brand drugs instead of a generic. What I don't see is any evidence that it takes a long process to get slightly more expensive generics. And even if what you said was true, it would still be far better than being thrown off Medicaid and going without treatment because Trumpcare will not be affordable to people who make between $9K and $18K yearly.
Quote oralloy:
Quote:Are you sure those university hospitals are within Medicaid's network? You said it was a pretty narrow network.
Yes, public hospitals and those connected to universities accept Medicaid.
Quote oralloy:
Quote:Increase the tax credits until the poor can afford a "luxury" plan.
How much can you increase tax credits on people who make so little they pay little to no Federal income tax? We're talking about people making $9K to $18K yearly. Even a 100 percent Federal tax rebate won't pay their premiums for health insurance. And in that range, pretty much every penny goes for day to day living expenses with nothing left over.
If you pay more than a 100 percent rebate, you are talking about subsidies, and Trumpcare is supposed to get rid of subsidies. Basically, Trumpcare just throws people who make between $9K and $18K yearly, (more for a family), off a comprehensive health care plan in Medicaid and substitutes nothing.
