Can someone "dumb down" what Obamacare really means? - page 8

I don't have time to watch the news or read articles so I don't understand much of what is being talked about. Can someone explain to me how it changes for citizens and what it will do to the future of our healthcare system?... Read More

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    This is why those of us who are not strongly political have such a hard time making informed decisions. There is never a clear cut, if you believe this will work vote this way or if you believe this is better vote that way. Trying to read through the information from our government is difficult. It is wordy, legal jargon that is difficult for the average non-legal citizen to understand. When we try to look to other sources to decipher the information for us we get several different opinions that, in all honesty, often seem to each make valid points! Several different people can interpret the same legal mumbo jumbo and come up with very different interpretations that depending on how you see it might make sense!
    I am not focused on politics. I have a career, a family and a rich life. I don't want to run for office or be on the city council. I do however want to participate in making informed decisions. I would like to at least try to be part of the solution to what I view as a huge problem with our medical system. I have read every one of these posts and still feel unqualified to make an informed decision. SAD.
    ticklemern and eleectrosaurus like this.

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    RN-Cardiac, I get where you are coming from. The problem is that we can't get the full truth from either side. Both left-wing and right-wing will tell you their interpretation, and what THEY want you to know about it so you vote for their side. You can't trust the media, because they have all lost sight of the neutrality they are supposed to represent. You can't trust the government, because they are all a bunch of lying D-bags. So what do you do? End up on AN boards where we all end up arguing and being political lol.
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    Quote from cdsga
    Since trust has been shaken over agencies or companies that have been entrusted to safeguard the people, I for one am interested to know how many people's medical condition will deteriorate while waiting for a procedure to be green-lit? That concerns me.
    It concerns me that people now are deteriorating and dying waiting on their insurance to green light. Or deteriorating and dying because they don't have access to affordable healthcare.
    Susie2310 and Fuzzy like this.
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    Quote from SC_RNDude
    Although I have seen various opinions to exactly what extent, IPAB's actions are at least somewhat immune from judicial review. Here is text from the law:
    ‘‘(5) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the implementation by the Secretary under this subsection of the recommendations contained in a proposal.”
    Like many similar boards, the IPAB is an independent group, which is what this is saying; While the IPAB falls under HHS, it is not controlled by the secretary of HHS. This helps provide a 'check and balance' against any potential political bias of the Secretary.
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    Quote from SC_RNDude
    Your example of what is "very different from rationing", to me, clearly is rationing. Which is another problem with the law as it describes what IPAB is prevented from doing. That is, it does not define what rationing is.

    And when they do ration, it will be more indirect than what I described. They will not say "people over 80 will not get a knee replacement". Instead, they will simply cut down reimbursement rates for knee replacements for people over 80.

    So, you believe that if EBP says that people over 80 can not benefit from a knee replacement, that NO ONE over 80 should get one? You believe that a gov't committee should determine this instead of a physician and patient working together?


    Substitute "heart valve replacement" for "knee replacement", and you sound like one of those conservatives who supposedly "want to throw grandma over a cliff."
    Rationing healthcare is putting a limit on services regardless of need. For instance, if Medicare was changed to block grants, where once the money ran out for that year no services would be reimbursed (the basis of the Ryan plan), then that would be rationing. Not paying for a service because it is not needed is not rationing. If a patient comes to the ER and demands a head MRI because they stubbed their toe, refusing to pay for that is not rationing. Do you think we should be paying in these situations?

    Doctors certainly should be involved, which is why the committee includes Doctors as well as other Health care delivery and evidence experts. Decisions should absolutely be between the patient and their Doctor, although if they decide to do something clearly wasteful (a head MRI for a stubbed toe, etc), that's fine, but I'm not going to financially support their ignorance.

    More on the IPAB myths:
    FactCheck.org : ‘Death Panels’ Redux
    elkpark likes this.
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    Quote from MunoRN
    Rationing healthcare is putting a limit on services regardless of need. For instance, if Medicare was changed to block grants, where once the money ran out for that year no services would be reimbursed (the basis of the Ryan plan), then that would be rationing. Not paying for a service because it is not needed is not rationing. If a patient comes to the ER and demands a head MRI because they stubbed their toe, refusing to pay for that is not rationing. Do you think we should be paying in these situations?

    Doctors certainly should be involved, which is why the committee includes Doctors as well as other Health care delivery and evidence experts. Decisions should absolutely be between the patient and their Doctor, although if they decide to do something clearly wasteful (a head MRI for a stubbed toe, etc), that's fine, but I'm not going to financially support their ignorance.

    More on the IPAB myths:
    FactCheck.org : ‘Death Panels’ Redux
    You example is obvious. I would agree that would not be rationing and that the gov't should not pay for it. However, most situations are not so black and white.

    How about going back to my hypothetical example: You said earlier that it is ok for a gov't board deciding that no one over the age of 80 will get a knee replacement if EBP says it is wasteful? That is taking decisions out of the hands of patients and doctors.

    Would cutting reimbursements for knee replacements for people over 80 be considered rationing?

    You believe in cookie-cutter medicine...one size fits all. In which case, the ACA will work better for you then for most people.
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    Muno,...I'm going to sort of play devils advocate for a second. I am not affiliated with any particular political party, and to be honest I'm very ill informed about political issues in general,...however I am a nurse and for the last 6 years of my career I've been in a level I Trauma ED. One of my biggest frustrations at work is waste of resources! I understand that your example is an extreme exaggeration,..but what about the not so extreme cases? Who decides what is ignorant waste and what is necessary? How will that decision be made and made in a timely manner? For instance I frequently see people in the ED who have abdominal pain. They have seen their PCP and are scheduled for a CT/HIDA scan/US (whatever) next week,..."but I just can't wait that long!" They have been seen by a doctor who thought they could wait that long. These tests through the ED are very expensive, and take time/resources from true emergencies. How do we decide what gets paid for? What if the ED doc disagrees with the PCP? Better yet,...what happens when we miss a hot appy, AAA etc? I personally think we need fewer lawyers, and and a greater sense of personal responsibility, but as I don't see that happening anytime soon,...how will we make this cost cutting plan work?
    HolisticNurse97 likes this.
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    Medicare and Medicaid to an extent already ration (if that is the proper word) care. Based upon age of the patient and several other factors certain proceedures/treatments are not supposed to happen (colonoscopies, prostrate treatment etc) and or aren't in theory reimbursed. Problem is hospitals and physicans have created a vast and complex coding systems which allow them to bill and get paid regardless. Yes, often an audit will turn up the "over billing" and take correction happens but not nearly enough to stamp out the waste, fraud and abuse.

    On the wider topic of rationing care in general, it is going to happen in one form or another and depending upon one's current age and or health the effects may be felt sooner or later. One does feel that those at or near "senior" status are safe for now, but as for our children, grand and certainly great grandchildren all bets are off.

    The United States spends more on healthcare than any other nation on earth with no better outcomes than most. Much of these costs can be attributed to mismanaged and or over care of those with either terminal illness and or nearing the last stages of life. Posted a link elsewhere in the "news" forum to a NYT story about a young man who after having a heart transplant eventually died but not before earning the distinction of being one of the most expensive Medicare/Medicaid patients to date.

    To read the aforementioned story is a lession in the "normal" for healthcare in much of the United States, that is the practice of always doing "something" even if that something leads to having to do something else to reverse/mitigate the effects of the previous treatment/proceedure. And so it goes until there are so many comorbidities that the treatment results in a balkanised system of care with each department defending their flanks and the poor patient caught in the middle.

    America could slash it's overall healthcare tab if it put more funds and emphasis on preventive care regardless of income. In particular expecting mothers, moms, infants and children. France offers what is widely regarded as one of the best pre-natal, maternity and early child healthcare systems and they do so spending a fraction of the USA and with much better infant mortality rates as well.
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    Being uninsured certainly rations healthcare. My family went bankrupt after my mother died of cancer. She was not insured. Not only did she die, my dad almost died from the bankruptcy process. I saw a proud man almost commit suicide from the bills that he could never pay in his lifetime of working and the bill collectors yelling at him on the phone. A couple of times, I was almost certain that he was going to take a gun to the hospital and the collection agencies and have a shoot out. I know of a few people who have really wanted to do this.

    Our healthcare system is broken. It is not very compassionate to those who cannot pay.


    Fuzzy
    ticklemern, txredheadnurse, laborer, and 6 others like this.
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    Quote from Fuzzy
    Being uninsured certainly rations healthcare. My family went bankrupt after my mother died of cancer. She was not insured. Not only did she die, my dad almost died from the bankruptcy process. I saw a proud man almost commit suicide from the bills that he could never pay in his lifetime of working and the bill collectors yelling at him on the phone. A couple of times, I was almost certain that he was going to take a gun to the hospital and the collection agencies and have a shoot out. I know of a few people who have really wanted to do this.

    Our healthcare system is broken. It is not very compassionate to those who cannot pay.


    Fuzzy
    There are actually two main problems with USA's healthcare system.

    The first is the vast amount of uninsured and the second is the cost of care even for those with excellent insurance.

    Again using France's healthcare system as an example, persons are reimbursed at up to 70% for most care. IIRC, certain costs are fully covered and those suffering from certified disabilities and or mortal illness have a different level of coverage but but and large there you have it.

    Unlike much of Europe hospitals and physicans have no cap on fees they can charge, rather it works other way round, insurance companies and or government programs limit or negotiate what they are willing to pay which often can and does vary widely by geographic location.

    In 2011 the average total hospital and physician costs for coronary artery bypass in the USA averaged $67,583. Applying the French system of coverage (70% covered) that leaves a bill of about $20,000. This does not include meds, follow-up physican visits and other post hospital care. If the patient is readmitted the whole thing starts again.

    Obamacare does have some methods for bringing hospital costs down and proposes various schemes to do more, but so far nothing is really set to tackle the ever rising costs of healthcare in this country.

    Even those with insurance are feeling the pinch as more and more companies are moving employees into high deductible schemes or persons are choosing those options themselves as the only thing they can afford. Problem is many of these plans leave families or persons on the hook for huge bills even though in theory they do have coverage.

    Finally there is the very basic and fundamental social differences between the United States and most other countries that have some sort of socialised healthcare system.

    The French government like others in the EU/world took their cues from the population in their wishes that *all* persons in a country's borders should not fall below a certain economic floor, and this applies to healthcare. This goes along way to explaining why so many Americans having grown used to being literally shaken down by ER's/hospitals in the USA are gobsmacked when they receive emergency or other healthcare abroad and either aren't billed or pay a small amount. The idea that a hospital or some such should exsist to provide healthcare and not act as a profit center is just alien to many of us.
    Susie2310, Sisyphus, and wooh like this.


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