Health Provisions Slipped into Stimulus Package

Published

Specializes in Critical Care.
well, let me throw my cents in on that question.

i used to work in a doctor's office part time a while back. do you know who decides who is "worthy" of receiving treatment? BCBS, United Health Care, Cigna, Aetna, WellPath, Great West and MedCost.

i used to have to call to pre-certify procedures such as nuclear stress tests and colonoscopies. some insurance plans do not even cover preventative care even with family hx or pre-exisiting.

i talked to a guy once who is a PA-C that worked in the intake dept @ an insurance company. he said it is actually cheaper for them to deny the claims for preventative care. he said if they put forward the $$ for screening care vs. the $$ for care after dx of disease/the amount of noncompliance because pts can't afford care, it is much more cost effective for them to deny the claims and pay for a few yrs of treatment post advanced dx. doesn't make much sense to me, but whatever.

for example, i had a pt recently in the hospital who was twenty six years old who was s/p bowel resection for colon CA. admitted with positive GI bleed a week prior with a hgb in the range of 5 or 6. positive family hx, positive heme cards for a few years, MD wanted colonoscopy but he put it off because his insurance company would not pay and he could not afford the out of pocket fee for a colonoscopy (which usually runs upwards of $2000 for the procedure alone, forget the hospital stay, IV supplies, anesthesia, etc). his case, yes, is rare. but because insurance co. denied the claim, his colon CA was much more advanced than it would have been if they had paid up front.

i had a nodule in my lung last year. MD suggested a bronch. however, bc i am in my mid-20's, i paid out of pocket for my bronchoscopy, because someone sitting behind a desk at Medcost said i didn't need the procedure done. there they had in front of them, pretty CT slices with a 3cm blob in the RLL. but they denied my claims. and out of my pocket came over $2,000.... which has put me into debt... i make payments every month but if i did not have a good job, i couldn't afford those payments, i would be on the street.

now, i know a guy who had no insurance who did losts of drugs and was in renal failure. had a transplant. did more drugs. went back into renal failure. got ANOTHER transplant. didn't pay a penny.

go figure?

you guys are jumping off saying that the govt is going to choose how we care for patients and how it's so wrong, etc etc. read the find print on your insurance policies. you may realize the idea is not as bad as it seems.

Unfortunately, there are those of us who think the government has gotten enough things wrong that is doesn't inspire confidence that they could get this right. I definitely think this has no business being in the stimulus or pork package, as some are calling it.

Up Vote Up Vote ×
Specializes in EMS, ER, GI, PCU/Telemetry.
Unfortunately, there are those of us who think the government has gotten enough things wrong that is doesn't inspire confidence that they could get this right. I definitely think this has no business being in the stimulus or pork package, as some are calling it.

well, seeing as how the economic crisis was inherited from the last eight years of making the rich richer and the poor poorer, if you have better ideas, call your local legislators... cause i sure as heck don't have any.

the orignial article was an editorial commentary and was not based on facts.

Up Vote Up Vote ×
Specializes in Critical care, tele, Medical-Surgical.
I already get "guidance" from my health plan: yearly mamography, medication refill reminders, eligible for initial bone density testiing as over 50.... DH got his prostate screening reminder. My PCP has been ahead of the curve using an EMR for about 9 yrs now: he is often ahead of health plan in giving me RX for screening exams....like many Americans due to work delay in getting some tests scheduled.

HOWEVER, being in homecare, I see too many physicians that are carrying huge patient loads and only focus on cheif complaint during vist, never check diabetics HgbA1C, check their feet -- (homecare RN's find many foot ulcers) or recommend that patient get testing done so I see results opposite side of arguement: advanced conditions that could have been minimized/prevented with early testing if PCP had only offered/provided.

When I check patients homecare eligibility, have access to screen where screening tests last paid for listed: ~ 60% are blank for prostate + mamography exams in 60-80 YO.

Any provider signed up for CMS listserve been getting bombarded 2-3x week with CMS message to include screening exams, offer flu/pneumonia vaccine, diabetes tesing supplies covered under Medicare etc so fully expected to see this type language in next healthcare legislation as part of push to reduce long term treatment costs.

All those tests now covered by Medicare/Medicad will being in patients into labs, radiology, outpt depts therefore increasing facilites healthcare activity + keeping healthcare staff employed: find a problem now obligated to treat it.

Doctors and patient always have the last word to accept/reject based on INDIVIDUAL's unique healthcare needs.

PLEASE read this and the next post.

Up Vote Up Vote ×
Specializes in Critical care, tele, Medical-Surgical.
current bill language:

. american recovery and reinvestment act of 2009 (amendment in senate)[h.r.1.as2]

section:title viii--departments of labor, health and human services, and education, and related agencies department of labor

under office of the national coordinator for health information technology

(including transfer of funds)

  • for an additional amount for `office of the national coordinator for health information technology', $3,000,000,000, to carry out title xiii of this act which shall be available until expended: provided, that of this amount, the secretary of health and human services shall transfer $20,000,000 to the director of the national institute of standards and technology in the department of commerce for continued work on advancing health care information enterprise integration through activities such as technical standards analysis and establishment of conformance testing infrastructure so long as such activities are coordinated with the office of the national coordinator for health information technology: provided further, that funds available under this heading shall become available for obligation only upon submission of an annual operating plan by the secretary to the committees on appropriations of the house of representatives and the senate: provided further, that the secretary shall provide to the committees on appropriations of the house of representatives and the senate a report on the actual obligations, expenditures, and unobligated balances for each major set of activities not later than november 1, 2009 and every 6 months thereafter as long as funding under this heading is available for obligation or expenditure.

fyi, this position been in existance for 4yrs created by president bush:

go to thomas (library of congress) , click latest daily digest to locate bills currently being voted on and latest admendment language

then email your congress person regaring your thoughts language tweek or desire to see passage/rejection...

they do listen to you and trust me omeone in the office is keeping scorecard on comments received.

seen if first hand on my trips to us senators office and meetings with state senator/reps in pa's harrisbug capital bldg.

contact info available: 2/4/09: nursing activism primer-- legislation, lobbying/ contacting elected officials

it is important not to think an editorial interpretation is the language of the bill.

Up Vote Up Vote ×

I never knew this was even being discussed and I wonder how many others were ignorant to this being included as well. The President could have mentioned this in the hour he was on tv last night. Interesting how it didn't make the show but not at all surprising. What's covered and what isn't would get people's ante up and rightfully so. I'm disappointed.

Up Vote Up Vote ×

Health care rationing is needed in the US. It seems to me that only in America is it considered a failure when you die--sometimes death is treated as an insult rather than the natural function it is. I have read that more money is spent on healthcare during pts. last 30 days of life than during their entire lifespan. Too many times patients that we know are going to die end up costing the health care systems ever increasing amounts of money in an attempt to save them from dying.

So is it time to change the public's perception of death and encourage palliative care and hospice more? Does the USA need to adopt guidelines as to what care should be provided for certain medical conditions? And that patients, ones that we all know will be DC'd to a nursing home or to a private residence to eventually die but are kept alive with vents, should be treated with hospice instead of medical care? I heard on the news last month that there are 10,000 people that are home ventilator dependent patients here in the USA.

What brought this up was a case...the pt. is 102 years old, has dementia, and fell, sustaining a compound fracture to an extremity. After surgery, a revision to the surgery, then pneumonia, many days in the hospital, an infection of the external fixation site, more pneumonia, several more days in the hospital, now in a nursing home for IV antibiotics...and she is still a full code per family's wishes. When is enough, enough?

Up Vote Up Vote ×
Specializes in NICU Transport/NICU.

Okay, now let me give a different example.

My grandfather is 92 years old, still drives, is active in the community college orchestra, and swims everyday in the summer. He was just diagnosed with Aortic Valve Stenosis and needs to have a heart cath. and valve replacement. Two very intensive surgeries. He carries his own insurance and is no drain on the government as he was wise with his retirement. Under this new Universal Healthcare Plan, not only would he not be allowed to have this surgery because he is certainly too old, but he wouldn't have the choice of paying out of pocket for it either. The only way he could get this surgery would be to go to a different country that does not have universal health care. (sounds eerily familiar to Canada and the UK) My Grandfather may be 92, but he is sharp and healthy and would be lucky to live another year or two without these surgeries. I don't think it is the government's right to decide this and God Help anyone who would tell me that a family member is not allowed to have a certain procedure performed. This plan is yet another way for the Democratic Government to be in control and another part of our transition to a Socialist Government. And for you nurses who think we are immune to this, we will be the second group to receive pay cuts, right after the doctors. You think we're underpayed now, just wait until the government is stroking all of our checks.

Up Vote Up Vote ×
Okay, now let me give a different example.

My grandfather is 92 years old, still drives, is active in the community college orchestra, and swims everyday in the summer. He was just diagnosed with Aortic Valve Stenosis and needs to have a heart cath. and valve replacement. Two very intensive surgeries. He carries his own insurance and is no drain on the government as he was wise with his retirement. Under this new Universal Healthcare Plan, not only would he not be allowed to have this surgery because he is certainly too old, but he wouldn't have the choice of paying out of pocket for it either. The only way he could get this surgery would be to go to a different country that does not have universal health care. (sounds eerily familiar to Canada and the UK) My Grandfather may be 92, but he is sharp and healthy and would be lucky to live another year or two without these surgeries. I don't think it is the government's right to decide this and God Help anyone who would tell me that a family member is not allowed to have a certain procedure performed. This plan is yet another way for the Democratic Government to be in control and another part of our transition to a Socialist Government. And for you nurses who think we are immune to this, we will be the second group to receive pay cuts, right after the doctors. You think we're underpayed now, just wait until the government is stroking all of our checks.

I understand your point of view but we currently have people in their 30's dying in the United States because they can't afford chemotherapy or their asthma meds. We just can't afford to treat everyone with all the advances in medicine today. Health Care Rationing is going to be the only way to treat the maximum number of people with the $$$ available. Since insurance companies are allowed to pick and choose who they want to insure, they have forced the government to pay for everyone else.

Up Vote Up Vote ×
Specializes in ED, MICU/TICU, NICU, PICU, LTAC.
How are you going to "prove" that they are engaging in self-destructive behavior? Follow them around at home? People could simply deny that they smoke or overeat. I mean -- I don't think folks like yourself are thinking this through. There WILL be a way of rationing with this -- and I shudder to think about the methods and who will be the "deciders" of who gets what in health care.

a simple blood test for cotinine, which is the major byproduct of nicotine, confirms tobacco use. Overeating/sedentary lifestyle speaks for itself. And this already occurs with allocation of transplant organs; this is not a new thing.

Up Vote Up Vote ×
Specializes in Critical care, tele, Medical-Surgical.
I never knew this was even being discussed and I wonder how many others were ignorant to this being included as well. The President could have mentioned this in the hour he was on tv last night. Interesting how it didn't make the show but not at all surprising. What's covered and what isn't would get people's ante up and rightfully so. I'm disappointed.

He did mention it.

It is NOT to restrict care.

He is mistaken, in my opinion, because he says electronic medical records will provide jobs, prevent the horros of triplicate papers, and nurses having to read doctors writing.

I'm not for it but it is NOT what the original opinion piece stated.

And it is not in the Senate version.

Up Vote Up Vote ×
Specializes in NICU Transport/NICU.

awsmom8,

You just proved my point. You said "We just can't afford to treat everyone with all the advances in medicine today." Nobody is asking you or us to pay for him, he has been responsible and taken care of himself and doesn't need the system to pay for him. But under this new healthcare plan, we will not have a choice. Everyone will have to be part of this plan unless you want to leave the country.

Hears another example. I'm 28 and had a right thyroid lobectomy performed in Dec. My physician found the mass in November when I was getting my physical for nursing school. Under this new system, I would most likely still be waiting for testing because at the time the mass was found, it was inconclusive whether it was malignant or benign. I wouldn't have been able to get into nursing school and could've waited up to a year for the surgery. All based on the government's decisions. The government isn't the answer to all of our problems. As much as people would like to think they are the smartest and brightest. The majority of them are elected into office because they rubbed the right elbows and most have never run a business of their own.

Let this be your 92 year old Grandfather, or 76 years old for that matter, and we'll see how you feel. I would never expect for you to be able to put yourself in my situation though because liberals are just to close minded.

Don't worry, you all will get what you voted for. And when you lose your freedoms as you know them, your always looking at the other side of the fence mentality will kick in, and you'll be complaining again.

Up Vote Up Vote ×

My aunt went to her MD and asked for a mammogram. Her mother and all her sisters had been diagnosed by that time with breast cancer. My aunt was 30. Insurance CO said she was too young for a mammogram.

Age 35 she is finally old enough to get her mammo. Radiologist read mammo and said "no cancer". Age 36 (now because of fam hx she could get them annually), she has next mammo. Cancer. Metatisized (sp?). Dead at 36.

Reevaluate the first mammo. GEEZ how could they have MISSED that cancer?!?!?! She had it then. Uncle sues hospital and docs. Seven years later...at trial they said that the cancer was so advanced when she was 35 there was nothing they could have done to save her. My uncle got NOTHING. Single father of 3.

This is what happens when MONEY dicatates care.

I dont want to think about the politics of this PORKULUS bill. I wish that Pelosi and Obama would have divine intervention to stop this crap in its tracks. This is a DEMOCRAT FEEDING FRENZY at YOUR wallet. Good luck folks! This bill does LESS for the economy than FDR's unconstitutional plan. If you look at history and want to turn around the economy....you need to look at REAGANs administration.

I don't care whether you are a democrat or a republican. Facts are facts. They are digging us a multi-trillion dollar hole we will not get out of for years. This is what Japan tried. They call the result - Japan's LOST DECADE. Well, folks who voted for him/them....they promised change 2 years ago. They promised change for the pres. You got it.

Hope we survive.

Up Vote Up Vote ×
+ Join the Discussion