Medicare won't pay!

  1. This is what happens when the government gets involved in health care. Comments?

    http://abcnews.go.com/print?id=3975993
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  2. 101 Comments

  3. by   FireStarterRN
    I've heard insurance companies also limit treatment options for many patients, so I don't think this cost cutting tactic is unique to medicare. Group Health is notorious for denying coverage and giving patients the run around.
  4. by   KyPinkRN
    This is an outrage, and the number one reason that we don't want universal healthcare.
  5. by   Shaggyb2000
    This story proves that health care isn't a right like so many like to trumpet. It has to be provided by someone who has an incentive to provide it and the person receiving it has to be willing to pay. Unless of course health care fairies show up to start providing services like the tooth fairy does.
  6. by   FireStarterRN
    Quote from JennyLR
    This is an outrage, and the number one reason that we don't want universal healthcare.
    Really? Why is it, then, that nations in Europe that have universal medical access have longer life expectancies?
  7. by   Jolie
    Medicare won't cover this treatment, so private pay and/or private insurance patients won't get it either. From the article:

    "Because federal law mandates that a hospital, which doesn't offer a drug to Medicare patients, cannot offer it to patients with private insurance, either, many doctors fear hospitals will discontinue use of the treatment if they lose nearly $14,000 each time the treatment is administered. "Because of that extra issue, this could be a death sentence for & an excellent therapy that needs to be used more," Silver said. "

    Clear evidence that care already is, and will continue to be, rationed and denied in government-sponsored health plans. It is especially chilling that the law prevents patients privately insured and/or private paying patients from obtaining the care, either.
  8. by   SuesquatchRN
    Quote from jlsRN
    Really? Why is it, then, that nations in Europe that have universal medical access have longer life expectancies?
    They walk and bike more, and eat less.

    I have a simple question that I know is going to be very unpopular, but it needs to be asked. At what age do we decide that we are going to withhold treatment? Now, I certainly hope to live past 70, but why as a society do we consider it a right to be supported and medicated right into incontinent senility?

    We have children foregoing immunizations and dental care and hungry and malnourished and cold and someone 70 is mad because they're not getting free tx that would support this hypothetical kid for a year.

    NOT everyone in Canada and Europe gets every available tx. MANY people die before they can get tx because providers are limited - they leave. MANY peopl live a crippled half-life of pain for years before they can get the joint replacement they need.

    The sad truth is the health care has to be rationed because it is, like everything else, a commodity. If this lady has a house she just may have to sell it.

    I dunno. I see a lot of resources spent on the old - which cohort I am rapidly aproaching - and have to wonder when it became gospel that everyone was entitled to - and here, I'll say it - worth every tx they need.
  9. by   morte
    Quote from Suesquatch
    They walk and bike more, and eat less.

    I have a simple question that I know is going to be very unpopular, but it needs to be asked. At what age do we decide that we are going to withhold treatment? Now, I certainly hope to live past 70, but why as a society do we consider it a right to be supported and medicated right into incontinent senility?

    We have children foregoing immunizations and dental care and hungry and malnourished and cold and someone 70 is mad because they're not getting free tx that would support this hypothetical kid for a year.

    NOT everyone in Canada and Europe gets every available tx. MANY people die before they can get tx because providers are limited - they leave. MANY peopl live a crippled half-life of pain for years before they can get the joint replacement they need.

    The sad truth is the health care has to be rationed because it is, like everything else, a commodity. If this lady has a house she just may have to sell it.

    I dunno. I see a lot of resources spent on the old - which cohort I am rapidly aproaching - and have to wonder when it became gospel that everyone was entitled to - and here, I'll say it - worth every tx they need.
    yup, and i am older than ye
  10. by   x_coastie
    But I keep hearing that socialized health care will be "free" and unlimited for everybody because the government has unlimited funds. Is this not so?




    //sarcasm
  11. by   pickledpepperRN
    Let us write our senators and member of Congress.
    And take paper & stamped envelopes to our churches, PTA, hospital cafeteria, and such to get others to write.
    Write a letter to the editor of your local paper.
    That is what I'm doing as soon as I research a bit more. WE CAN change this!

    ...Legislatures in Washington have a small window of time left to intervene before the end of the year. "It is just not right for the government to take away a treatment that is so effective and is life saving," Kaminski said.
    Doctors are hoping legislative action can halt the payment cuts for now so that more accurate calculations can be gathered over the next year to further refine the costs....

    http://abcnews.go.com/print?id=3975993
  12. by   banditrn
    Quote from Suesquatch
    They walk and bike more, and eat less.

    I have a simple question that I know is going to be very unpopular, but it needs to be asked. At what age do we decide that we are going to withhold treatment? Now, I certainly hope to live past 70, but why as a society do we consider it a right to be supported and medicated right into incontinent senility?

    We have children foregoing immunizations and dental care and hungry and malnourished and cold and someone 70 is mad because they're not getting free tx that would support this hypothetical kid for a year.

    NOT everyone in Canada and Europe gets every available tx. MANY people die before they can get tx because providers are limited - they leave. MANY peopl live a crippled half-life of pain for years before they can get the joint replacement they need.

    The sad truth is the health care has to be rationed because it is, like everything else, a commodity. If this lady has a house she just may have to sell it.

    I dunno. I see a lot of resources spent on the old - which cohort I am rapidly aproaching - and have to wonder when it became gospel that everyone was entitled to - and here, I'll say it - worth every tx they need.
    And what if this lady's age had been 57, or 47? Is it still OK to deny treatment?

    I understand what you're trying to say, Sue, but I don't think you should use age as a factor. Over the years I cared for many older people that were greater contributors to society than people half their age.
  13. by   pickledpepperRN
    Why did the cost go up?
    Why do some hospitals pay such varied prices?
    Why won't the Hospital Association respond to the press?

    ...Senior Medicare officials say they are not trying to prevent hospitals from giving Bexxar and Zevalin. They say that $16,000 is a fair price and is based on the actual prices hospitals have paid for the medicines this year....


    http://www.nytimes.com/2007/12/07/business/07drug.html
  14. by   pickledpepperRN
    It is way more complicated than the headline seems to claim.
    Please read the entire article.
    Of course Medicare must not deny payment for treatment.

    ...CMS maintains that the reimbursement changes were based on hospital cost reports for the last three years. According to Don Thompson, acting deputy director of the Hospital and Ambulatory Police Group for CMS, the claims data submitted by hospitals in the past revealed "widely varying reimbursement rates" for radioimmunotherapies. CMS reports that in 2007 the average Medicare payment was $15,400 for Bexxar, and $21,550 for Zevalin. Based on these numbers, Thompson said CMS is "actually increasing payment [for radioimmunotherapies] in 2008."...

    ...However, doctors and drugmakers claim the decision to make these payment changes was based on inaccurate data.
    "What we realized is that somewhere along the line, the methodology that [CMS] was using is way below what the acquisition price [of Bexxar] is," said Dave Moules, vice president of the oncology unit of GlaxoSmithKline. Instead of basing the amount of reimbursement for Bexxar on the average cost of the drug provided by GSK  which Moules said is $26,780  CMS based the reimbursement rate on the cost reports provided by hospitals.
    Moules said he believed the data CMS received from hospitals was skewed, because the claims information CMS received on the acquisition price of Bexxar ranged from a low of $44 to a high of $66,000.
    One of the reasons for this wide range of charges may be that manufacturers sometimes offered the drug to hospitals at discounted prices. ...

    http://abcnews.go.com/print?id=3975993
    Let us write our senators and member of Congress. WE CAN change this!

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