Can someone "dumb down" what Obamacare really means?

wooh, BSN, RN · Aug 16, 2012

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.

MunoRN, RN · Aug 16, 2012

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.

MunoRN, RN · Aug 16, 2012

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

SC_RNDude · Aug 16, 2012

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.

BrnEyedGirl, BSN, MSN, RN, APRN · Aug 16, 2012

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?

DoGoodThenGo · Aug 16, 2012

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.

Fuzzy · Aug 16, 2012

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

DoGoodThenGo · Aug 17, 2012

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 · Aug 17, 2012

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 member or a lady parts 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.

I am in fact an English RN who firmly believes that paying taxes to fund a health service is a good thing to do. It's called sharing. It's called making sure medical care is available for everyone when they need it. Yes, people who are working contribute and their contribution helps people who are unable to contribute financially to their care. If those people who are working become unable to contribute financially to the health service, then the health service is there for them to use too. This situation makes the former workers parasites in your view. Not everyone who needs help is a worthless layabout. Do you know the actual percentage of people who are "undeserving" of care? You can't penalize deserving people simply because you have decided that everyone who isn't working is a bum. What is wrong with helping people who are weaker? Not everyone grows up with family support or a strong body or mind, or abilities that allow them to be self sufficient. Should people who are weaker have no health care; should we as a society just let weaker people suffer and die from lack of preventive care, and lack of care when they are sick? The doctors in the UK are paid well, with good government pensions. Put yourself in the place of people who are weak and vulnerable, without a support system, in need of medical care. I'm sure you wouldn't like to be told that since you can't pay you are a deadbeat.

uRNmyway, ASN, RN · Aug 17, 2012

Yes, I agree that not everyone who gets government healthcare is a layabout or deadbeat. However, there ARE a lot of them. Or maybe its just where I am located. Maybe its also where I grew up. Dont get me wrong, I am far from having grown up to a wealthy family. We were lower middle class at best. But my mother taught me to work hard and make something of myself. Yes, she taught me to share. And I do, for those who help themselves. How many people sell their foodstamps to buy things they shouldnt? How many people on welfare have under the table jobs and net more money than I do? How many people who are completely ABLE to work just stay home having more babies to get a bigger check in the mail? How many people who are CURRENTLY receiving medicare benefits completely abuse it? This is all stuff I saw growing up, and I am seeing a lot of it here. And judging from posts Ive seen on here, Im not the only one who has noticed it.

If all people were deserving of welfare and social aid, why would there be such a fuss made about mandatory drug testing and all?

Its just so funny you know. I used to be pretty liberal. Then I opened my eyes and saw it just doesnt work. Now I see how so many liberals treat those who are more conservative. They insult, make assumptions. Mind you, not all of them. Maybe just those Ive been exposed to...

DoGoodThenGo · Aug 17, 2012

More fuel for the fire: http://www.oecd.org/health/healthpoliciesanddata/49084355.pdf

In the Untied States you cannot solve the debate on healthcare until the larger issue of what if any "rights" are owed to those living on it's shores. We see this playing out in the two other large debates currently splitting this country apart; immigration and gay rights.

Would like to consider myself conservative, but not totally blind nor without compassion. Living in Manhattan, NYC as one does (and a pretty upscale area at that might one add), see the inquality first hand daily.

One knows fully well who is preparing,cooking, serving and delivering food in restaurants. Who is cleaning other person's homes, preparing and serving that food, minding children, caring for the elderly and so forth. Need I remind anyone that it was a member of the immigrant serving class, Miss. Marry Mallon (aka Typhoid Mary), that was responsible for one of the worst outbreaks of disease in NYC if not US history?

Am not thrilled with the current state of immigration laws (or lack of of enforcement thereof) in this country, nor does one feel persons should be able to "abuse" the system. However as a society we can and must come together and decide that for the good of all something must be done to provide some sort of basic floor for everyone in the United States.

Time and time again we've seen how those in this country with untreated or poorly treated mental illness have killed, maimed and or otherwise caused harm to innocents. Anyone who has taken bact, or micro knows pathogens respect neither class, race, creed, or gender.

Bringing this back home to nursing/medicine we know both in the United States and much of Europe what happened when around the 1900's governments decided to do something about the appalling health of the poorest amoung the population. Armies of nurses, doctors, social workers were dispatched everywhere from tenements to schools to even taverns in order to get the word out about proper healthcare. Governments, persons of means and or religous insitutions built hospitals/healthcare systems in order that those wanting should be provided with some sort of healthcare. And what happened? Life expectancy began to rise across the board. Major outbreaks of disease were curtailed. Child and infant and even young adult (especially for women) mortality increased.

Sensibility, BSN, RN · Aug 17, 2012

My dad sent this to me today. I thought it said it so well that I would pass it on to my nursing friends.

I have a job.

I work, they pay me.

I pay my taxes and the government distributes my taxes as it sees fit

In order to get that paycheck, in my case,

I am required to pass a random urine test

(with which I have no problem).

What I do have a problem with is the distribution of my taxes

To people who don't have to pass a urine test.

So, here is my question:

Shouldn't one have to pass a urine test to get a welfare check

Because I have to pass one to earn it for them?

Please understand, I have no problem with helping people get back on their feet.

I do, on the other hand, have a problem with helping someone sitting on their BUTT----doing drugs while I work..

Can you imagine how much money each state would save

If people had to pass a urine test to get a public assistance check?

I guess we could call the program "URINE OR YOU'RE OUT"!