Healthcare reform

[Texsox]

So I still have not had it explained to me how we are adding 50,000,000 million people to the system, while having, at most, the same number of doctors, nurses, and facilities, without having longer delays, and less care. If you can explain it, I would love to hear it.

 

Are you talking about those that visit emergency rooms for common ailments, and use services without paying? People are still using services. Shall we discuss what will happen with costs when the hospitals and doctors are reimbursed for that care? Discuss what it does for ER rooms when non emergency matters can be handled by a more appropriate doctor visit or "doc in a box"?

[southsider2k5]

Are you talking about those that visit emergency rooms for common ailments, and use services without paying? People are still using services. Shall we discuss what will happen with costs when the hospitals and doctors are reimbursed for that care? Discuss what it does for ER rooms when non emergency matters can be handled by a more appropriate doctor visit or "doc in a box"?

 

There are plenty of people who refuse to go for treatment because they can't afford it. With no disincentive not to make trips, this will only expand. It is an economic truism that the cheaper something is, the more people use of it.

[BigSqwert]

There are plenty of people who refuse to go for treatment because they can't afford it. With no disincentive not to make trips, this will only expand. It is an economic truism that the cheaper something is, the more people use of it.

Can't beat the free emergency room for a stubbed toe!

[Texsox]

There are plenty of people who refuse to go for treatment because they can't afford it. With no disincentive not to make trips, this will only expand. It is an economic truism that the cheaper something is, the more people use of it.

 

No doubt. And perhaps some out of pocket cost component will help curb unnecessary visits.

 

Still, keeping patients with chronic illness out of ERs will be a wonderful help to the system. And preventive medicine and timely treatment is actually cheaper for the system.

 

Are you suggesting too much business will hurt the industry? I believe there may be an initial adjustment period, there will also be a realignment as treatment is pushed and pulled to the most effective avenue. No more "I've been coughing for two weeks" trips to the ER or people with pneumonia not being treated.

[jasonxctf]

So I still have not had it explained to me how we are adding 50,000,000 million people to the system, while having, at most, the same number of doctors, nurses, and facilities, without having longer delays, and less care. If you can explain it, I would love to hear it.

 

there's plenty of capacity out there. I'd say that the last 5-6 times I've been to a doctor's office (regular checkups, mtgs with the wife, etc) the waiting room has been completely empty.

[Texsox]

there's plenty of capacity out there. I'd say that the last 5-6 times I've been to a doctor's office (regular checkups, mtgs with the wife, etc) the waiting room has been completely empty.

 

All the old people are in Florida and Texas in our waiting rooms. I can see my Doc in a day or two if it is summer, but by November or December, he is booked for three months.

[southsider2k5]

there's plenty of capacity out there. I'd say that the last 5-6 times I've been to a doctor's office (regular checkups, mtgs with the wife, etc) the waiting room has been completely empty.

 

Really? It never happens to us, and with two little kids we are in for something at least once a month.

[southsider2k5]

No doubt. And perhaps some out of pocket cost component will help curb unnecessary visits.

 

Still, keeping patients with chronic illness out of ERs will be a wonderful help to the system. And preventive medicine and timely treatment is actually cheaper for the system.

 

Are you suggesting too much business will hurt the industry? I believe there may be an initial adjustment period, there will also be a realignment as treatment is pushed and pulled to the most effective avenue. No more "I've been coughing for two weeks" trips to the ER or people with pneumonia not being treated.

 

I am suggesting the system is on the verge of collapse as it is from lack of capacity. They won't be able to keep up with the crush of 50,000,000 people getting "free" care.

[Balta1701]

I am suggesting the system is on the verge of collapse as it is from lack of capacity. They won't be able to keep up with the crush of 50,000,000 people getting "free" care.

You know, the worldwide Physicians per capita data is actually very interesting, when you consider the total amount we spend on health care. Most industrialized countries have more physicians per capita than us (save the UK, Japan and Canada) and yet we spend more than 2x as much per person on health care as either of those countries. Where's that money going? Either our doctors are making a hell of a lot more than everywhere else, which means that part of the problem is we're not training enough doctors to keep up with demand and push down the costs, or there's something else that is a major money drain.

 

Anywho, if Canada, Japan, and the UK can survive with fewer doctors per capita than us, then the system isn't on the verge of collapse from lack of capacity. It could benefit from more capacity, but that's a different argument. What that data actually says is; those places are more efficient in how they use their capacity.

[jasonxctf]

Really? It never happens to us, and with two little kids we are in for something at least once a month.

 

maybe its a DuPage Co/Kane Co thing? Or maybe my doctors suck and everyone else knows something that i dont?

[Texsox]

I am suggesting the system is on the verge of collapse as it is from lack of capacity. They won't be able to keep up with the crush of 50,000,000 people getting "free" care.

 

There are two versions of free at work here, free to the patient and free to the provider. I would hope their would be some co-pay or some mechanism to prevent the "free to me" so I will see a Doctor every week. There is the positive situation of having those treatments actually being paid for directly instead of indirectly. Part of the capacity issue is people using the resources in an inefficient manner. The ER for example when they need a Doc visit. We should gain as we stop treating people for free at the most expensive option, ERs, and begin treating people in a lower cost and more appropriate facility.

 

It is interesting that you say the health care system is on the verge of collapse. If you truly believe that, then I would think you should want to see changes to prevent that collapse. Having health care providers being compensated for their care seems like a great first step. The only other option I would see would be laws preventing patients from being seen, and that seems like a harsh situation we would not tolerate as a society.

[Texsox]

maybe its a DuPage Co/Kane Co thing? Or maybe my doctors suck and everyone else knows something that i dont?

 

Here it is a seasonal thing which truly cannot be avoided. With the Winter Texans there is a severe shortage for three or four months a year and a severe glut for eight or nine months.

[southsider2k5]

There are two versions of free at work here, free to the patient and free to the provider. I would hope their would be some co-pay or some mechanism to prevent the "free to me" so I will see a Doctor every week. There is the positive situation of having those treatments actually being paid for directly instead of indirectly. Part of the capacity issue is people using the resources in an inefficient manner. The ER for example when they need a Doc visit. We should gain as we stop treating people for free at the most expensive option, ERs, and begin treating people in a lower cost and more appropriate facility.

 

It is interesting that you say the health care system is on the verge of collapse. If you truly believe that, then I would think you should want to see changes to prevent that collapse. Having health care providers being compensated for their care seems like a great first step. The only other option I would see would be laws preventing patients from being seen, and that seems like a harsh situation we would not tolerate as a society.

 

You mean like not adding 50 million people to the system all at once?

[Texsox]

You mean like not adding 50 million people to the system all at once?

 

You mean adding 50 million payments to the system versus 50 million services without full payment. We do not agree on the actual number of people who will now visit Doctors who have not visited before. The impact will be IMHO, less than what you are quoting. IMHO there will be an increase of people visiting Doctors and a decrease in ER and Urgent Care visits. There will also be an increase in routine care and a decrease in care for more serious, and more labor intensive care, from waiting and allowing small problems to become big problems.

 

I have tremendous faith in America opening the clinics and expanding Doctors offices once payments will follow these treatments. The uninsured are an anchor to expanding health care.

[Texsox]

SS, I think your question deserves a fuller response, because in the short term it would be a hurdle. Long term, perhaps not as much.

 

I do believe for any new system to work, there needs to be some gate to keep people from making weekly visits to the Doctor. Currently it is the insurance companies and economics that keep people away. Also the time away from work and other responsibilities. I would like to see some sort of gate left intact. Perhaps it is a co-pay per visit. I'd even accept a sliding scale on that co-pay.

 

Short term, I agree it will be an issue. I also believe, with providers receiving payments, we will see a boom in small clinics. I'd also like to see more Nurse and PA care for common ailments built into the system. That is one area that is underutilized with a better cost. I think there will be a slow down in the building of new emergency rooms as patients are moved to more appropriate treatment venues.

 

I see here some of the clinics that offer free or low cost treatment. They are at capacity based on revenue not on physical size or available volunteers and doctors. They could expand without much effort just by receiving adequate funding for their operations.

 

I am interested in how you envision the short term and long term affects.

[Y2HH]

SS, I think your question deserves a fuller response, because in the short term it would be a hurdle. Long term, perhaps not as much.

 

I do believe for any new system to work, there needs to be some gate to keep people from making weekly visits to the Doctor. Currently it is the insurance companies and economics that keep people away. Also the time away from work and other responsibilities. I would like to see some sort of gate left intact. Perhaps it is a co-pay per visit. I'd even accept a sliding scale on that co-pay.

 

Short term, I agree it will be an issue. I also believe, with providers receiving payments, we will see a boom in small clinics. I'd also like to see more Nurse and PA care for common ailments built into the system. That is one area that is underutilized with a better cost. I think there will be a slow down in the building of new emergency rooms as patients are moved to more appropriate treatment venues.

 

I see here some of the clinics that offer free or low cost treatment. They are at capacity based on revenue not on physical size or available volunteers and doctors. They could expand without much effort just by receiving adequate funding for their operations.

 

I am interested in how you envision the short term and long term affects.

 

That gate is would be called rationing -- in reality -- as it's the only alternative.

 

If demand rises (adding 40M or whatever the officinal number ends up being), and that will raise demand then the available supply MUST rise with it to keep things exactly as they are now in terms of speed, quality of care, etc. But therein lies the problem...we will not suddenly have a supply of experienced doctors and nurses that were kept in Al Gore's lockbox the last few years waiting to be unleashed to bring equality to the flood of new patients.

 

The quality of care would either drop, because you'd be on an assembly line through a doctors office, because the line of patients behind you keeps growing -- or they'd have to start rationing to alleviate the mess they've created.

 

Either way, the focus is once again on those unhappy with the system...thats A MINORITY number no matter what math you choose to futz with to get the answer you're looking for.

 

The population of the US is 320+M, of that 320+M, only 40-50M are uninsured.

 

I'm not one of them.

 

Breaking a system that the majority are happy with because a rather loud minority wants something for nothing annoys the holy f*** out of me.

 

But I'll compromise...and I'll do so clearly and easily.

 

Government care ONLY IF you make less than 40K per year (family) or are unemployed.

 

Boom. Done.

 

And if you b**** enough, maybe you can get me to agree to raise that to 50k a year for a family...but do NOT make it something anyone and everyone can be a part of...I do not want the government more involved in my life than it already is.

 

[southsider2k5]

http://www.bizzyblog.com/2009/08/20/vas-de...ed-under-obama/

 

VA’s Denial-of-Care-Oriented ‘Your Life, Your Choices,’ Quashed Under Bush, Revived Under Obama

Filed under: Health Care, MSM Biz/Other Bias, MSM Biz/Other Ignorance, Taxes & Government — TBlumer @ 2:42 pm

 

VeteranAndFlag

 

If you were a reporter trying to gauge the credibility of Obama administration’s protests that it is really serious when it says that it will honor patient, doctor, and family treatment wishes in serious illness situations if the government takes an exponentially greater role in health care, you might look into how areas of health care already controlled by the government are dealing with these sensitive matters.

 

Apparently either no journalist has cared to look, or if anyone has looked, they haven’t found anything they believe is worth reporting.

 

In today’s Wall Street Journal, Jim Towey, a former director of the Bush White House’s Office of Faith-Based Initiatives and founder of the nonprofit Aging with Dignity, found a troubling, newsworthy, death-encouraging decision that has already been made during Barack Obama’s short term in office.

 

As Towey chronicles and explains, it’s in the Veterans Administration, and it really is appalling. Here are key excerpts from his column (bolds are mine):

 

If President Obama wants to better understand why America’s discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.

 

Last year, bureaucrats at the VA’s National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, “Your Life, Your Choices.” It was first published in 1997 and later promoted as the VA’s preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated “Your Life, Your Choices.”

 

Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

 

“Your Life, Your Choices” presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political “push poll.” For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be “not worth living.”

 

The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to “shake the blues.” There is a section which provocatively asks, “Have you ever heard anyone say, ‘If I’m a vegetable, pull the plug’?” There also are guilt-inducing scenarios such as “I can no longer contribute to my family’s well being,” “I am a severe financial burden on my family” and that the vet’s situation “causes severe emotional burden for my family.”

 

When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?

 

….. only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as “Compassion and Choices”).

 

This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to “Your Life, Your Choices.” Not just those of advanced age and debilitated condition—all patients. America’s 24 million veterans deserve better.

 

Towey wraps by challenging the president “to walk two blocks from the Oval Office and pull the plug on ‘Your Life, Your Choices.’”

 

Don’t hold your breath, Jim — waiting for the president to make that walk, or waiting for anyone else in the press to note a federally-controlled health care system that is realizing the worst fears of those who believe in the dignity of life.

[southsider2k5]

You mean adding 50 million payments to the system versus 50 million services without full payment. We do not agree on the actual number of people who will now visit Doctors who have not visited before. The impact will be IMHO, less than what you are quoting. IMHO there will be an increase of people visiting Doctors and a decrease in ER and Urgent Care visits. There will also be an increase in routine care and a decrease in care for more serious, and more labor intensive care, from waiting and allowing small problems to become big problems.

 

I have tremendous faith in America opening the clinics and expanding Doctors offices once payments will follow these treatments. The uninsured are an anchor to expanding health care.

 

I don't buy that at all. You are talking about adding the people who have been least able to afford care before to the system, and there being no incentive for them to keep care to a small of a level as possible. Once this happens, it becomes like welfare, social security, or any other program that people are "entitled" to. Unless someway that has been publicly discussed happens to discourage people from seeking care, there will be an explosion of people seeking medical attention. Like I said earlier, the cheaper something is, the more people that will buy it. When something is "free" there is nothing to stop you from using it for everything. At least now, people have the fear of their credit being ruined, or being hounded by bill collectors to stop them from seeking care for no reason. After Obama-care, there won't even be that.

[Texsox]

I don't buy that at all. You are talking about adding the people who have been least able to afford care before to the system, and there being no incentive for them to keep care to a small of a level as possible. Once this happens, it becomes like welfare, social security, or any other program that people are "entitled" to. Unless someway that has been publicly discussed happens to discourage people from seeking care, there will be an explosion of people seeking medical attention. Like I said earlier, the cheaper something is, the more people that will buy it. When something is "free" there is nothing to stop you from using it for everything. At least now, people have the fear of their credit being ruined, or being hounded by bill collectors to stop them from seeking care for no reason. After Obama-care, there won't even be that.

 

As I said there should be some co-pay to prevent overuse. With such an obvious problem, I would be amazed if it was not addressed in the program.

 

It is free for those that go to the emergency room intending not to pay.

 

There was an earlier comment by Alpha that the plan allows for the government to draft your bank account to pay for the services, so that would seem to address that there will be a co-pay and there will be strict collections, both would work to help solve your concern.

[Y2HH]

As I said there should be some co-pay to prevent overuse. With such an obvious problem, I would be amazed if it was not addressed in the program.

 

It is free for those that go to the emergency room intending not to pay.

 

There was an earlier comment by Alpha that the plan allows for the government to draft your bank account to pay for the services, so that would seem to address that there will be a co-pay and there will be strict collections, both would work to help solve your concern.

 

I don't like the idea of the government having direct access to peoples bank accounts. That's just a BAD idea and I foresee a lot of accidental overdraws waiting to happen.

 

And how exactly do you/we dub something as "overuse/abuse"? What if they actually NEED to use it that way? Now we have to have a list of special exceptions and what if's? Who determines these exceptions and what if's? Sounds like were adding layers upon layers of administration work here, which would contradict one of the core reasons for reform (to cut overhead and administration/red tape).

 

Sounds like we are going to create a new monster when our intention was to "slay" it by sending in the likes of the Baconator on crack wielding his +4 Louisville.

 

I maintain that we do something for those in need -- but there has to be strict rules as to who is eligible for this "free taxpayer assisted care". I have absolutely no issues with my tax dollars going to help those with medical care that need it and cannot afford it, lord knows where my tax dollars go now, so I'd rather them go there, instead. But the key for me is in helping those that need it, not those that can afford it but would rather not pay for it since they can get it for nothing.

[StrangeSox]

I don't like the idea of the government having direct access to peoples bank accounts. That's just a BAD idea and I foresee a lot of accidental overdraws waiting to happen.

 

You have the option of signing up for a direct-deposit or online bill pay type of program. The horror.

 

 

 

[Y2HH]

You have the option of signing up for a direct-deposit or online bill pay type of program. The horror.

 

How about just send a bill like everyone else, and I'll pay it how I choose. Why the need for added administration?

[StrangeSox]

How about just send a bill like everyone else, and I'll pay it how I choose. Why the need for added administration?

 

You have the option. Just like I have the option for Comcast to not send me a paper statement and take money straight from my account. If you still want to write a check, go ahead.

[Y2HH]

You have the option. Just like I have the option for Comcast to not send me a paper statement and take money straight from my account. If you still want to write a check, go ahead.

 

That aside, my original point had nothing to do with how to pay -- but that it's even an "option" to give the government direct access to a personal bank account. I just don't think it's a good idea, and that's all it was meant to convey.

Edited August 21, 2009 by Y2HH

[ChiSox_Sonix]

That aside, my original point had nothing to do with how to pay -- but that it's even an "option" to give the government direct access to a personal bank account. I just don't think it's a good idea, and that's all it was meant to convey.

 

To be fair, if it truly is just an option, if you're uncomfortable with it then don't suscribe to that plan. I don't like the idea in and of itself, but if it's just one of several options it's fine. I just won't choose it.