@Cycloptichorn,
It's not good enough for me either. I hate the fact that if I lose my job I basically lose my health insurance. I hate that I'm stuck working for a 'large' company so that I can make sure I have benefits. I hate that I cannot easily strike out on my own business ventures, because I need to worry about paying for my health insurance.
I think our current structure harms our competitiveness. It stifles innovation. It handicaps our businesses.
I don't like Obama's bill though.
@maporsche,
maporsche wrote:
It's not good enough for me either. I hate the fact that if I lose my job I basically lose my health insurance. I hate that I'm stuck working for a 'large' company so that I can make sure I have benefits. I hate that I cannot easily strike out on my own business ventures, because I need to worry about paying for my health insurance.
I think our current structure harms our competitiveness. It stifles innovation. It handicaps our businesses.
I don't like Obama's bill though.
As a conservative, you don't give a damn how our failed HC system affects others. It adversely affects you, so you are opposed to it. That is the trouble with the right. It is also unpatriotic.
@maporsche,
Well then Ad-you're a discredit to the right. I'm on the right but any system that abandons millions of poor people is a dead loss in this day and age.
The right here is fully supportive of our NHS. It would be a political dead duck if it wasn't. Wiped out I mean. Opening the door for the left and waving them through.
Consider that people working for insurance companies who have no medical training are more apt to make drug prescription decisions than doctors based on what the salesmen from the drug companies tell the insurance pencil pushers. Does that sound like sarah palin's death panels?
I'm wavering in my opposition to this HC bill...slightly.
@maporsche,
maporsche wrote:
I'm wavering in my opposition to this HC bill...slightly.
It really would help a lot of people - and act as a first step, not a final answer, to the reforms we need to fix the system.
Cycloptichorn
Here's a copy of a letter regarding health care that I read today -
Quote:Dear Rep. ___________
Imagine being sentenced to two weeks in enough pain that you could not sit comfortably at the dinner table.
I’m not talking about being sentenced for a crime " at least not one that I have committed. I am talking about being forced to endure pain needlessly because of my health insurance company’s greed.
On Sunday, Jan. 24, I experienced what I thought was muscle pain due to tightness or a muscle spasm. The following day it was worse. I took twice the recommended dosage of over-the-counter pain relievers just so I could function at my part-time job at a newspaper. By Tuesday, Jan. 26, I could not stand it and made an appointment with my family doctor, who said it appears I had either a pinched disc or perhaps a herniated disc on my cervical spine (that’s the neck area), probably between discs 6 and 7. He prescribed an MRI, which I scheduled for Fri., Jan. 29 at 2 p.m.
My insurance company, Aetna, requires a referral for any such procedure. I called my doctor’s office within 30 minutes of their opening on the morning of Wed., Jan. 27, to get the referral. They sent it through to Aetna that same morning, according to ___ who works in my doctor’s office.
Friday, I arrived for my appointment for the MRI only to be told there was a problem with my insurance. My MRI was not denied " but as of 1:30 p.m. " 30 minutes before my scheduled appointment " Aetna had not yet made up its mind whether it would authorize and cover the procedure.
A supervisor at the MRI place made several phone calls on my behalf, while I waited, wondering if I would get authorization for the procedure in time for my 2 p.m. appointment. Aetna told the MRI office supervisor that they had "until 8 p.m." to decide whether to authorize the procedure. I have no idea who decided they had until 8 p.m. but if common courtesy were their guideline, they would have had a decision before my appointment time. To make a long story somewhat shorter, I went home that afternoon without an MRI and proceeded to make phone calls to Aetna, who insisted they required 24 hours to review a request like mine. Aetna representative _______ insisted they did not receive the request until Thursday morning despite the fact that I requested the referral from my doctor on Wednesday and, according to my doctor’s office, it was processed immediately that morning. In other words, Aetna had more than 48 hours prior to the appointment to review the request.
They did not officially deny the request until Monday, Feb. 1. They told me the reason was that I had spent eight weeks under a doctor’s care trying alternative treatments such as physical therapy. What is most ridiculous about their so-called reason is I did, in fact, go to physical therapy! They paid the bill " or part of it anyway, as my copay was $440 " but not until after making various excuses in an attempt to avoid paying. They knew I had gone to physical therapy specifically for neck and shoulder pain and yet, they claimed I didn’t in an attempt to avoid paying for a portion of an MRI. I say "a portion" because my copay for an MRI is $100. Believe me, I won’t fork out $100 out of pocket for something that’s unnecessary.
I received notice of the denial at 8:30 a.m. Mon., Feb. 1, when I received a phone call at home from Med Solutions, a firm which contracts with Aetna to review claims. They told me they would fax the denial to my doctor’s office and the doctor could appeal if he wished. Interestingly, the doctor did not receive the denial for another two hours.
Meanwhile I was taking Darvocet, a mid-level prescription pain reliever. My job as a writer/editor requires extensive use of the computer, which is extremely difficult because the pain and numbness extends from the spinal column all the way down my right side and all the way down my right arm. To make matters worse, I am right handed.
However, I work part-time which means I don’t have any sick or vacation time. I cannot afford to take unpaid time off due in no small part to my medical bills. In addition to the $440 copay for physical therapy, $20 primary doctor visit copay, $40 specialist visit copay and $80 copays for pain prescriptions, I will owe another $100 for an MRI " should Aetna decide to authorize it. That sum " which adds up to $680 " does not include any additional copays which will be required for the procedures needed to actually treat the condition. Nor does it take into consideration routine out-of-pocket medical costs including but not limited to the $250 a month I pay out of pocket for prescriptions and supplies to treat my diabetes and other long-term chronic but manageable (with treatment) conditions. And I pay that much out of pocket despite having prescription "coverage."
So I doped up and went to work. I had no choice.
That Monday " Feb. 1 " my doctor decided the best way to get me the treatment and testing I needed was to send me to a specialist, who prescribed Vicodin for pain. Although this drug is more potent than Darvocet, it does not take away the pain entirely. It simply dulls it to the point where I can function. If I want no pain, I would have to take something like Oxycodone, which would probably leave me unable to drive safely or function properly at work.
It comes as no surprise that the specialist said I have either a pinched nerve or a herniated disc and I need " get this " an MRI! In all probability, the treatment will be an epidural injection, which cannot be given until after an MRI is done.
I currently have an appointment for an MRI for Thurs., Feb. 11, assuming Aetna does not try to fight the specialist over his diagnosis. My doctor seems to think Aetna will be less prone to fight the specialist, but who knows. If I do get the MRI Feb. 11, it means my pain was drawn out needlessly for two weeks. If I don’t get the MRI, it will mean my pain will continue indefinitely.
This is not the first time Aetna has fought me or tried to block my access to basic health care. I suffer from allergies, which leads to a chronic cough which in turn aggravates the neck and muscle pain described above. My doctor prescribed Allegra. Aetna fought me, claiming I need to try over-the-counter alternatives first. When I said I did, they finally approved the prescription, though that approval means little. The full retail cost of the drug is $88 a month. I pay $78. Aetna pays a whole $10. I just learned I can get the prescription cheaper using a county sponsored discount program and not going through Aetna at all. The same is true for blood pressure medication I take. In these cases, it is cheaper to go as an uninsured party through this discount program than to use the insurance for which I pay $2600 a year out of pocket. (This figure does not count the additional premium paid by my husband’s employer). And I am sure that is just how Aetna likes it.
Incidentally, for the calendar year 2009, I paid $8600 out of pocket for health care. And although I have diabetes, I do not have any serious health conditions such as cancer or MS. I can only hope I never contract a serious illness because I am sure that would leave me bankrupt, assuming I don’t end up dead first.
I am sure you are aware that a health care reform debate is currently raging in this country. I urge you to work towards real reform that reins in the powerful insurance companies because what is happening to me and countless others across this country is absolutely criminal. Companies such as Aetna should not be allowed to put their profits above the health of their customers " the very people they are being paid to protect. And they are making a profit. A Feb. 7, 2008 press release issued by Aetna itself listed the health insurance company’s profits at $1.8 billion.
I realize the health care debate has caused lines to be drawn between the two major political parties. But this is not a Republican issue or a Democratic issue. It’s an issue of fairness and decency for the everyday American people " and by that I mean those of us not covered by the excellent health care insurance plan members of Congress enjoy, and those of us not benefitting from massive health insurance company profits. Americans are supposed to have the right to life, liberty and the pursuit of happiness. But we cannot live when we cannot afford basic health care. And we certainly cannot pursue happiness when we are in too much pain to even sit at the dinner table.
Cycloptichorn
@Cycloptichorn,
You don't have to convince me that health insurance companies stink. Part of the reason I don't like this current bill very much. No public option, no alternative solution.
@maporsche,
maporsche wrote:
You don't have to convince me that health insurance companies stink. Part of the reason I don't like this current bill very much. No public option, no alternative solution.
Yup - but incremental change works, and passing the bill makes a public option/medicare expansion more likely to pass in the future, then not passing the bill does.
Basically if the bill doesn't pass, there's no second chance. The Dems aren't going to go through this whole thing again and the Republicans don't give a **** about reforming the market at all. I agree that the situation isn't close to perfect, but it's the best chance we have right now of getting some necessary changes made - and keeping the ball rolling.
Cycloptichorn
Article from msnbc today.
updated 6:25 p.m. ET March 16, 2010
Click Here!
Health
NYT: With Medicaid cuts, docs and patients drop out
Patients face difficulties finding doctors who will accept their coverage
Stephen McGee for The New York Times
Rebecca and Jeoffrey Curtis searched for care for their son. In the process, they felt like “second-class citizens,” Ms. Curtis said.
The New York Times
FLINT, Mich. - Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.
As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.
She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid .
Dr. Sahouri said that his reimbursements from Medicaid were so low " often no more than $25 per office visit " that he was losing money every time a patient walked in his exam room.
The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.
“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”
It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid , the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.
Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”
The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.
In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare , which are themselves typically well below those of commercial insurers, according to the Urban Institute , a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.
In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.
If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.
As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.
The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.
Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.
When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.
A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.
This year, Gov. Jennifer M. Granholm , a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.
In Flint, the birthplace of General Motors , the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.
But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.
“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”
As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.
At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.
“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.
New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.
Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.
Medicaid enrollees in Michigan’s midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.
Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids . “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”
This article, "With Medicaid Cuts, Doctors and Patients Drop Out," first appeared in The New York Times.
Copyright © 2010 The New York Times
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@maporsche,
maporsche wrote:
Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.
When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.
A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.
This is a problem of a different sort. When I was working, I payed about $136/month for insurance. Total was a scoosh over $500 including the employer's contribution. It was good insurance. It did not cover any sort of hearing aids, nor anything involving dental. That poor suffering devil may think it cruel, but there is something between root canal/crowns and suffering along with tylenol. It's called extraction, and most of us have had it done several times over the years.
@roger,
To add insult to injury, when I needed a hearing aid, the $2600 price tag included sales tax.
@Cycloptichorn,
Cycloptichorn wrote:
the Republicans don't give a **** about reforming the market at all. I agree that the situation isn't close to perfect, but it's the best chance we have right now of getting some necessary changes made - and keeping the ball rolling.
Cycloptichorn
I disagree with this. Republicans have the same constituency that the Dems have. People DO want reform, but not all at once, not all encompassing and not this one.
It was a mistake to try this now and especially the way they are doing it. Should have been done in small bits.
@maporsche,
maporsche wrote:
It's not good enough for me either. I hate the fact that if I lose my job I basically lose my health insurance. I hate that I'm stuck working for a 'large' company so that I can make sure I have benefits. I hate that I cannot easily strike out on my own business ventures, because I need to worry about paying for my health insurance.
I think our current structure harms our competitiveness. It stifles innovation. It handicaps our businesses.
I don't like Obama's bill though.
We have been trying to tell you that when private industry can't do something important, the government has to step in and do it. Moreover, the latter will do it right.
@McGentrix,
McGentrix wrote:
Cycloptichorn wrote:
the Republicans don't give a **** about reforming the market at all. I agree that the situation isn't close to perfect, but it's the best chance we have right now of getting some necessary changes made - and keeping the ball rolling.
Cycloptichorn
I disagree with this. Republicans have the same constituency that the Dems have. People DO want reform, but not all at once, not all encompassing and not this one.
It was a mistake to try this now and especially the way they are doing it. Should have been done in small bits.
It doesn't work in small bits. You can't accomplish the things you need without paying for them, and when you are paying for things economies of scale make it expensive to do small things.
Like, what small things do you think they should have done in isolation? And how would you pay for the money it costs? And please, don't be a cliche and say 'sell insurance across state lines' and 'tort reform.' Give a seri0us answer.
Two related points:
1, The Republicans had ample opportunity to do something - anything - about HC reform for a decade and did nothing (except pass Medicare part D, haha). There's no reason to expect that they would do anything at all if they got in charge to solve the problems.
2, I think you and I know that the Republicans would have fought and likely filibustered any bill the Dems put forward this term. In fact, that's exactly what they've done - there are many examples of individual Republicans voting against measures they previously had a long history of supporting. The idea that the Dems would have had any easier of a time from your side if they had just done things differently is a farce.
Cycloptichorn
The right's hypocrisy never ends.
Hypocrisy: A Parliamentary Procedure
By Norman J. Ornstein
March 16, 2010, 4:24 pm
Any veteran observer of Congress is used to the rampant hypocrisy over the use of parliamentary procedures that shifts totally from one side to the other as a majority moves to minority status, and vice versa. But I can’t recall a level of feigned indignation nearly as great as what we are seeing now from congressional Republicans and their acolytes at the Wall Street Journal, and on blogs, talk radio, and cable news. It reached a ridiculous level of misinformation and disinformation over the use of reconciliation, and now threatens to top that level over the projected use of a self-executing rule by House Speaker Nancy Pelosi. In the last Congress that Republicans controlled, from 2005 to 2006, Rules Committee Chairman David Dreier used the self-executing rule more than 35 times, and was no stranger to the concept of “deem and pass.” That strategy, then decried by the House Democrats who are now using it, and now being called unconstitutional by WSJ editorialists, was defended by House Republicans in court (and upheld). Dreier used it for a $40 billion deficit reduction package so that his fellow GOPers could avoid an embarrassing vote on immigration. I don’t like self-executing rules by either party"I prefer the “regular order”"so I am not going to say this is a great idea by the Democrats. But even so"is there no shame anymore?
Hard to find politicians that aren't hypocrites these days.
Steny Hoyer now says that it's "within the rules", but he didn't feel that way in 2003 when he was ranting that it was "demeaning of democracy".
@Irishk,
Irishk wrote:
Hard to find politicians that aren't hypocrites these days.
Steny Hoyer now says that it's "within the rules", but he didn't feel that way in 2003 when he was ranting that it was "demeaning of democracy".
Same thing as Dreier and other Republicans calling it 'unprecedented' despite the fact they regularly used the technique in the past.
Hoyer even has a much stronger position: the Dems took the Bush admin to court to try and invalidate a bill passed under this law in 2004 - and lost. Hoyer can at least truthfully say that - now that it's been deemed legal - there's no reason not to use the tool in the toolkit.
On the other hand, Republicans who are complaining about this and calling it 'unprecedented' are simply lying.
Cycloptichorn
