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

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  1. Aug 16, '12 by
    Quote from wooh
    I don't think "fallacious" means what you think it means if you're calling the fact that countries with socialized medicine have lower infant mortality rates and higher life expectancies "fallacious."

    But good warning. You don't have to be a nurse. The Koch brothers certainly have the money to pay people to spread lies like calling the ACA "socialized medicine." Quite a few people in this thread that could be right wing plants trying to scare nurses into thinking we're going to make less money and all wait in line for pap smears because of ACA. When most of us (the vagina owning ones) already had our pay threatened by Paul Ryan voting against the equal pay for women act. Which I guess is good for small business, if they only have to pay their penis owning employees a fair wage, they can afford the goods and services whose prices have skyrocketed thanks to the Republican deregulation of the financial industry... Which apparently Barack Obama was supposed to wave a magic wand to fix our economy overnight even though those bankers had a few years to screw it up? Maybe he should have taken a page out of Mitt Romney's business model and sent the job of fixing our economy overseas?
    LMBO!!! Right wing plants? I could say the same about you, you sound like you could definitely be some illogical left-winger so far! You speak about the right-wing spreading lies? What about the current lies coming out of the mouths of the Obama administration, including the president himself? All the things they are saying to demonize the right are about as funny as they are insulting! I am no 'plant'. I am in fact a Canadian RN who LEFT the country because I was SICK AND TIRED of paying more than half of my very hard earned salary for people who dont want to work and use the ER as a primary care physician. And they have to, that is the sad part. Why you ask? Because of socialized medicine. Less money going into healthcare means lower salaries, which means less people wanting to stay in this work force. Sure, I love my job. I love taking care of people, making them better, helping them lead healthier lives. But I have a family to support, on top of supporting millions of others with my tax dollars.
    If you really dont think the ACA (There, you happy?) will change things in regards to your taxes (and yes, it WILL be the middle class who will feel the hardest sting to their pocket books, not the rich, like Obama would like you to think. Again, I speak from experience), then you are sadly mistaken. Salaries will decrease. Might not be overnight, but it WILL happen. When the hospital has less money to spend, who do you think will suffer from it? They will hire less staff. They will spend less on equipment. They will stop giving pay raises. Just wait and see.
    And by the way, having a penis or a vagina has NOTHING to do with ANYTHING, other than the fact that the president is trying to make the mindless masses believe that republicans hate women. Once again, I LMBO.
    HolisticNurse97 and SC_RNDude like this.
  2. Aug 16, '12 by
    Oh, and telling people to stop watching Fox news because of its right-wing affiliations? Please. Maybe you should add it to your repertoire after you watch ALL of the other left-wing news networks to at least get two sides of the story, and make your informed decisions from there...
  3. Aug 16, '12 by
    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.
  4. Aug 16, '12 by
    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.
    ticklemern, Despareux, HolisticNurse97, and 4 others like this.
  5. Aug 16, '12 by
    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.
  6. Aug 16, '12 by
    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.
  7. Aug 16, '12 by
    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.
  8. Aug 16, '12 by
    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.
  9. Aug 16, '12 by
    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.
  10. Aug 16, '12 by
    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.
    elkpark, eleectrosaurus, and libbyliberal like this.