To all "medical coverage is a privilege" folks: - Page 4

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  1. Mar 31, '12 by
    The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.

    Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.

    My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.
    wooh likes this.
  2. Mar 31, '12 by
    Quote from tntrn
    The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.

    Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.

    My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.
    There's no doubt that healthcare delivery in rural areas is different than in urban areas, but is the delivery of rural healthcare in Texas completely different than rural healthcare in Oklahoma?
    Not_A_Hat_Person, tewdles, and wooh like this.
  3. Mar 31, '12 by
    Should the access to rural health care be completely dependent upon your ability to pay? That rural farmer (insert other self employed person) does NOT have the same access to health insurance as does the person working for the factory or hospital or other company with group benefits. So, you add the round trip expenses to the very expensive care (which may or may not be covered by the individual insurance policy) and "boom" you are on the pathway to financial devastation or perhaps the pathway to complete absence of care because you cannot even afford to get to the care AND pay for it too.
  4. Mar 31, '12 by
    You're right of course. The PPACA was something intended for all Americans (except those exempted by HHS... which puzzles me, but oh, well.) At the same time, there is a huge amount of pandering going on. The middle class people who are dubious about it are told they are heartless and bigoted since this legislation is going to provide coverage for the 35 million folks who have none. Read the posts here and you'll see the issues of the poor do get mixed in with the "working poor" as well as the "I want that new pickup therefore can't afford insurance" crowd.

    Looking to DC for a solution to something this complex is manifest foolishness. Same can be said about many state capitals. But some States will be innovative and raise the bar for the rest. If we keep talking about the helpless asthmatic child dying in the street for lack of medical care (or "breathalizer" as our splendid leader calls it) we will only be mud-slinging and denigrating each other. Let there be thought and innovation.

    You ask what NV's version of reform would look like. Well, first of all, we are the hardest hit state in the union. Big headline in our paper today was celebrating the fact that our unemployment rate is all the way down to 12.9% (Whoo hoo! Break out the bubbly!) Let me tell you about my city. The poor get seen in ER's of course. But there are also clinics supported in part by the county, and in part by the largest hospital in town. There is also a pregnancy center where patients pay on a sliding scale. No baby need be born here without prenatal care. There is also a Blue Cross plan advertised for the uncovered family members of the working poor. It isn't free, but it is more than just catastrophic coverage. Medicaid reimburses the hospitals for folks that can't pay.

    We're getting by. It isn't great but I haven't stumbled over dead people in the streets, yet.
  5. Apr 1, '12 by
    Representative Ryan sells the idea of medicaid block grants as a way of allowing states to administer medicaid funds in the way that works best for them, which sounds great as a general idea. This would seem to imply that currently medicaid is rigid and only works in a single demographic, such as urban areas. Although medicaid already has mechanisms to serve the unique needs of various areas such as rural areas; transport outside of the patients community for care can qualify under medicaid, there are special programs to supplement reimbursements in rural areas that don't have the benefit of patient volume to adequately cover costs for things like doctors and CT scanners.

    What Rep. Ryan means when he says that block grants would allow states to administer medicaid in a way that works for them is that it would allow states to drastically cut coverage. In Nevada for instance, Ryan's block grant proposal would force 136,000 Nevadans off of medicaid. Mississippi governor Barber loves the idea, even though it would boot 247,000 out of medicaid in Mississippi by 2021. By "do what works best for them" Rep Ryan appears to be referring to drastically increasing the number of poor who lack health care coverage.

    This is bad not just in terms of a bleeding heart sympathy for the poor, but because it actually costs us a lot more money. At some point everyone ends up on medicare, either due to old age or disability. Just like private insurers, the goal of states is to keep as much of the costs of care out of their budget as possible, which unfortunately often means suboptimal or even non-existent care for common, relatively easily treatable conditions such as diabetes and hypertension. So we avoid the cost of $50 worth of meds a month and then the patient has a stroke and ends up in a Nursing home for the rest of their lives which puts on the medicare budget, or they need 3x week dialysis, which again moves them into medicare coverage. The problem is that while states save the $50 without having to pay for the exponentially more expensive consequences, wherever the money gets filtered through it all comes from us in one way or another.

    That should be the goal, spend a little now to save a lot later, even if that means medicare and those responsible for it (the Federal government) needs to take a more proactive role in making the changes needed so that medicare inherits patients with reasonably well maintained health when they graduate from insurers, medicaid, etc, and enter into medicare, rather than inheriting a neglected and very expensive to care for population.
    rnfostermom, tewdles, and brainkandy87 like this.
  6. Apr 1, '12 by
    i for one would like to know what all the healthcare dollars are paying for and why nurses and doctors are being laid off, wethe hospitals in america are so understaffed with nurses, doctors and ancillary employees? $4 million dollar salaries to pay for this crap, while 50 million americans are uninsured, under-insured and cannot access healthcare, have to file bankrupcy, forclosure and the healthcare benefits of working class america are being cut to the bone or removed. but some lout can finance and 'access' his mistress anytime he wants.
    and to make matters worse- this story made it across "the pond" to england.

    " the british tabloid the daily mail, has more details and pix of those involved. three's a crowd: top health insurance ceo fired from $4million salary job after fight with girlfriend's husband | mail online "


    posted: sun, apr. 1, 2012, 2:42 pm
    highmark ceo fired after assault charges
    by darran simon
    inquirer staff writer

    ceo of pa. insurer highmark charged with assault


    highmark inc.'s kenneth r. melani, ceo of pennsylvania's largest health insurer who was supposed to take over that same post at independence blue cross under terms of a merger that never happened, has been fired, highmark announced sunday.
    melani 58, had been on unpaid leave from the pittsburgh insurance company, where he was also president, following his arrest on charges stemming from a fist fight with his mistress' estranged husband last week.
    his termination followed a meeting sunday of highmark's board of directors, the company said in a statement.
    melani was charged with simple assault and criminal trespass, both misdemeanor offenses, after the alleged attack last sunday at his mistress' home in oakmont, a pittsburgh suburb. according to authorities, melani said that if the police had not been there, he would have killed melissa myler and her husband, mark.
    "the board has reviewed this situation thoroughly and has taken decisive action to address the matter," said highmark's board chairman j. robert baum, who was named acting ceo when melani was placed on leave four days after trading punches with mark myler.
    melani is "deeply disappointed and upset" by the board's move, according to a statement by his attorney, robert g. del greco, jr.
    "we will be reviewing the legal propriety of dr. melani's dismissal and will act accordingly," del greco said.
    melani had led highmark since 2003.
    during that time, he "grew to become one of the most respected and successful healthcare organizations in the nation," del greco said.
    the board, however, is "moving forward to identify a long-term successor to the ceo position," baum said in the company's statement.
    under the merger proposed in 2007, melani was to become independence blue cross's new chief executive and joseph frick, who headed that company, was to assume the number-two spot.
    but in one tense hearing on the merger plan, melani appeared angered when then-u.s. sen. arlen specter raised questions about his compensation. after stiff resistance, the two insurers withdrew their proposal in 2009.
    melissa myler, 28, told oakmont police that melani had hired her last october. three weeks later, they started a romantic relationship. the two moved in together after melani's wife, tracy, told mark tyler about the affair in january, according to a copy of the police report.
    two months later, melissa myler said she learned that melani was having her investigated by a private detective, the report said.
    last sunday, melani showed up at the myler house, the police report said, and accused melissa myler of cheating.
    "it's all about my money," he said, according to the report. then, he refused to leave.
    mark myler took melani by the arm and got him outside on the front porch. that's where the fight broke out.
    both men "had some swelling about the face and also had some minor bleeding," the police report said.
    on sunday, liz williams, a spokeswoman for independence blue cross, cited the company's "strong, productive relationship with highmark." she added: "we continue to have confidence in the talent and
  7. Apr 2, '12 by
    I'm having difficulty following you on the Ryan plan. It seems you're conflating Medicare and Medicaid. I'm not that familiar with the way Ryan's plan deals with Medicaid so... you may be right, I don't know.

    With regard to Medicare... something has got to give. No matter who wins this debate, Medicare is not going to be recognizable within a generation, or maybe less. If Ryan loses, and nothing changes... Medicare will fizzle out. There is no way my kids and grandkids are going to have full coverage when they retire. And this is for a simple reason:

    WE ARE OUT OF MONEY!

    All the economists (actuarialists?) who check the numbers come to the same conclusion. They may quibble about when the program crashes and burns, but they all acknowledge that it will.

    Does the Ryan plan change the way we do Medicare? Yes. (Not for people my age, perhaps... but for my kids and their kids.) Is his a good alternative to the death of Medicare? Maybe... maybe not. We could have a robust national debate on the merits of the Ryan plan... except that opponents keep demonizing anyone who proposes a solution. (You've seen the ad where "Ryan" dumps "granny" off the cliff, right?)

    Speaking personally... I would like to retire. My husband and I have busted our humps for approaching 40 years, have paid off the house, have no debt, have some savings and yes, we've been blessed much more than we deserve. But I saw the President and Congress strip 500 BILLION dollars out of Medicare to finance the ACA. There's no way we can trust the existing leadership. Between that and the panel of experts who will decide if care is cost-effective... um... the Ryan plan is looking pretty good to me.

    But since we can't trust DC, we'll keep working.
  8. Guide
    Apr 3, '12 by
    Quote from jmqphd
    You're right of course. The PPACA was something intended for all Americans (except those exempted by HHS... which puzzles me, but oh, well.) At the same time, there is a huge amount of pandering going on. The middle class people who are dubious about it are told they are heartless and bigoted since this legislation is going to provide coverage for the 35 million folks who have none. Read the posts here and you'll see the issues of the poor do get mixed in with the "working poor" as well as the "I want that new pickup therefore can't afford insurance" crowd.

    Looking to DC for a solution to something this complex is manifest foolishness. Same can be said about many state capitals. But some States will be innovative and raise the bar for the rest. If we keep talking about the helpless asthmatic child dying in the street for lack of medical care (or "breathalizer" as our splendid leader calls it) we will only be mud-slinging and denigrating each other. Let there be thought and innovation.

    You ask what NV's version of reform would look like. Well, first of all, we are the hardest hit state in the union. Big headline in our paper today was celebrating the fact that our unemployment rate is all the way down to 12.9% (Whoo hoo! Break out the bubbly!) Let me tell you about my city. The poor get seen in ER's of course. But there are also clinics supported in part by the county, and in part by the largest hospital in town. There is also a pregnancy center where patients pay on a sliding scale. No baby need be born here without prenatal care. There is also a Blue Cross plan advertised for the uncovered family members of the working poor. It isn't free, but it is more than just catastrophic coverage. Medicaid reimburses the hospitals for folks that can't pay.

    We're getting by. It isn't great but I haven't stumbled over dead people in the streets, yet.
    Currently in NV also, but I'm starting to see a different picture. I'm seeing more and more pregnant women coming in for delivery (some with serious complications) with no prenatal care as the closest place which will see them with no (significant) upfront payment if uninsured is more than 150 miles away. For the working poor with gas at $4.00/gal and a round trip requiring a day off from their minimum wage job they are in a no-win situation.
    Not impressed with NV's solution for healthcare access.
  9. Apr 3, '12 by
    Quote from jmqphd
    I'm having difficulty following you on the Ryan plan. It seems you're conflating Medicare and Medicaid. I'm not that familiar with the way Ryan's plan deals with Medicaid so... you may be right, I don't know.

    With regard to Medicare... something has got to give. No matter who wins this debate, Medicare is not going to be recognizable within a generation, or maybe less. If Ryan loses, and nothing changes... Medicare will fizzle out. There is no way my kids and grandkids are going to have full coverage when they retire. And this is for a simple reason:

    WE ARE OUT OF MONEY!

    All the economists (actuarialists?) who check the numbers come to the same conclusion. They may quibble about when the program crashes and burns, but they all acknowledge that it will.

    Does the Ryan plan change the way we do Medicare? Yes. (Not for people my age, perhaps... but for my kids and their kids.) Is his a good alternative to the death of Medicare? Maybe... maybe not. We could have a robust national debate on the merits of the Ryan plan... except that opponents keep demonizing anyone who proposes a solution. (You've seen the ad where "Ryan" dumps "granny" off the cliff, right?)

    Speaking personally... I would like to retire. My husband and I have busted our humps for approaching 40 years, have paid off the house, have no debt, have some savings and yes, we've been blessed much more than we deserve. But I saw the President and Congress strip 500 BILLION dollars out of Medicare to finance the ACA. There's no way we can trust the existing leadership. Between that and the panel of experts who will decide if care is cost-effective... um... the Ryan plan is looking pretty good to me.

    But since we can't trust DC, we'll keep working.
    I completely agree that we are headed for disaster with out current system, which is why need to figure out to make the entire system cheaper, something even Republicans admit the Ryan doesn't attempt to, the Ryan plan only alters the order of collapse, and probably even accelerates it.

    The Ryan plan on medicaid block grants came up with the topic of shifting healthcare responsibilities to states. Ryan's plan contains proposals for both medicaid and medicare, the main theme for both is to cut beneficiaries without cutting the costs of care, which does nothing more than shift costs to other payers and does nothing to extend the longevity of our health care system as whole. Currently we are on a path where medicare/medicaid will collapse first which will result in the collapse of the rest of the healthcare system shortly thereafter and our economy shortly after that. Ryan's plan just delays the collapse of medicare/medicaid while accelerating the collapse of hospitals, changing that order to Hospitals and private insurers collapsing first, followed by Medicare, followed by medicaid, followed by the rest of our economy. It's also quite possible that Ryan's plan would accelerate the whole process by making huge cuts to preventative care through medicaid cuts, which means that we'll save on the relatively cheap costs of diabetes and hypertension control for instance, only leave medicare to deal with the heavy costs of dealing with uncontrolled diabetes and hypertension (ESRD, strokes, CABG's, etc), in other words the $millions we save today will cost us $billions down the road.

    Although some conservatives like to phrase it that way, PPACA doesn't actually strip $500 billion from medicare. It does do away with the "medicare advantage" program, something both democrats and republicans agree on - Medicare advantage was intended to provide cheaper coverage by privatizing it, although as it turned out it costs 14% more to provide the same care under medicare advantage than it does under "regular" medicare. That accounts for $180 billion of the savings to medicare, the remainder of "cuts" are not actually cuts at all, it comes from doing away with waste and fraud, a way of saving medicare dollars that's hard to argue against.
    lindarn likes this.
  10. Apr 17, '12 by
    I'd say bill the family and they can pay it off like they are suppose to over time. Maybe if they are good people and have paid their bills before, they will be given a discount for their situation (this happened to me before).

    Healthcare is comprised of services and goods. Isn't it considered unethical to *force* one person or group of people to pay for services used by another person or group of people? If you want a service, shouldn't you have to pay for it yourself?

    I've been poor. I've done that. I don't want someone else to have to pay for something I alone am using. If I want my life saved, my thumb stitched, my heart restarted... then I should be the one who pays for it. That's the most logical answer imho.
    TonyaM73 and Peri's Progeny like this.