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Jwherb

First Senate Plan to Replace ACA - the 2017 Patient Freedom Act!

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8 minutes ago, youngrebelfan40 said:

Unfortunately your inbred genetic traits and associated diseases will not serve us too well. Now back to work!

Yes massir.  I will have to sneak it with your women on the sides.  It is an american tradition as old as slavery.

'Yikes.  probably should not have said that.:unsure:

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1 minute ago, halfmanhalfbronco said:

Yes massir.  I will have to sneak it with your women on the sides.  It is an american tradition as old as slavery.

'Yikes.  probably should not have said that.:unsure:


You're going to trigger Rozzie.

 

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On 12/1/2016 at 12:26 PM, WyomingCoog said:

I own a vehicle likely worth more than everything you own combined and just flew first class (including a ticket for a 2 1/2 year old), round trip to Las Vegas and I'm not 35 yet. When you accomplish something outside of finishing a book, let me know. When's the last time you saw a 2 year old fly first class in their own seat? Don't tell me about elite.  

28 minutes ago, NorCalCoug said:

I’d happily compare IQ’s with you any day of the week.

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14 minutes ago, jackmormon said:

Everyone knows how to make Medicare solvent indefinitely. No one has the political will to do it.

My family practitioner said he would much rather deal with Medicare than private insurance. 

They aren't bad to deal with.  Lots better than Medicaid, CHIP, and molina and all those ones.  They aren't great to deal with either.  It's hard to get them to let you do things that are necessary, like CT scans, for people who are having severe abdominal pain, for example.  I have to fill out a lot of paperwork and then talk to someone who I significantly outrank in a medical sense on the telephone and they read a script to me. 

It usually goes like this:

Me: "Hi, I need a CT scan for patient XXXXX, and I need to do it today, I have examined them and performed some labwork and there is a good chance they have appendicitis/cholecystitis/diverticulitis etc"

Nurse reading a script on the phone: "Well, have they tried a course of x medication for 2 weeks, as is instructed before getting a CT scan?"

Me: "No, they presented emergently in my department, and are quite ill, this has happened in the last 2 days, so there has not been time to take a course of x medication for 2 weeks."


NRASOTP: "Well, to approve this today, they need to have done that."

Me: "Ok, here's what we're going to do.  We are either going to approve this right now, or I will send the patient to the ER and you will incur a significantly larger bill due to this all occurring in the hospital, because if this patient goes to the ER, they will do exactly what I am saying, and they won't need to ask your permission. Or we can do it at the outpatient clinic where I am for a lot less.  What do you think?  I am trying to save the system money, and save the government around 8-10 thousand dollars by doing everything here.  If it is positive for appendicitis, I will direct admit the patient and you will not incur an ER charge or CT scan charge in the hospital."

At that point, they usually give in to me, because I don't order CT scans wantonly, I actually have quite good yield numbers.  A few times, they've said to just send the patient to the ER.  That's when I ask for their boss.  One time the guy on the phone told me he didn't care if I was trying to save money, that we just have to go by protocol and the patient needs to try their course of medication.  Now, this would be stupid, because the patient had appendicitis, so I sent them to the ER.  If i had tried their medication for 2 weeks, the patient would be dead because they would have a ruptured appendix and in theory would not have received the care they needed. 

That said, these are the types of problems that you will inevitably run in to with single payor.  I just precepted a medical student who is from Canada, and she hates the Canadian system because her grandmother had ovarian cancer in her 70s and they wouldn't remove it.  They let her die.  Here, they will just remove it and treat it, because that's the right thing to do.  That's why everything costs a lot here, because as a whole, we'll do treat this stuff and worry about paying for it later.
 

 

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In the above situation, I can make an effort to play within the rules, and save the system several thousand dollars if I will do the workup outside of the hospital.  If I do the appendicitis workup in my clinic, where we have a CT scanner, and stat labs, I can avoid getting the patient an ER charge, and that will save them and the system/insurance around 5000 dollars, because I can do the whole workup for a cost of 400-600 dollars by keeping them out of the ER.  If the patient needs surgery, they will be direct admitted and avoid an ER charge.  The cost for the hospital stay and operation will still hit the system/insurance, but we will have subverted the ER and overall saved the system money.

Some practitioners will just send the patient to the ER and avoid doing the workup, but I am interested in the system saving money, because that helps all of us. 

In some cases, people can't have things worked up outside of the hospital, but in many you can.  That's why I think an independent company needs to provide triage physicians to the local hospitals in each city, and that individual can decide whether they should be in the ER or not.  That would save the system money, but the hospitals would never agree to it, because the dirty secret is that they want you to go to the ER.

 

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I've dealt with Medicare / CMS on the legal side,  and let me tell you,  fuck that shit.  I'd rather argue with Aslowhiteguy. 

On the other hand,  though,  everything is pro forma so for settlement, subrogation and reimbursement that's often nice (except it takes months to get a response and process the file).  Dealing with your private insurers can often be a complete joke. 

 

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The Party told you to reject the evidence of your eyes and ears; it was their final, most essential command.

 

 

 

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Just now, Jwherb said:

I've dealt with Medicare / CMS on the legal side,  and let me tell you,  fuck that shit.  I'd rather argue with Aslowhiteguy. 

On the other hand,  though,  everything is pro forma so for settlement, subrogation and reimbursement that's often nice (except it takes months to get a response and process the file).  Dealing with your private insurers can often be a complete joke. 

 

That bad?  

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I don't know why we all fight about this stuff.  We all want what is best for society.

I think you can have the best of both worlds where people can get great care, and still have a safety net that takes care of the poor, underinsured, uninsured, and people who are between jobs and stuff.  You would really need Congress to work together to get this, and reach across the aisle and really be interested in doing what is best for the people of this country instead of selfishly hanging on to talking points of an us vs them narrative.

The German system is really a nice, balanced system that has basic coverage for everyone, but people can buy more coverage if they like.

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The biggest problem with the current system is just because people have insurance doesn't mean the medical providers want to take that insurance, so you've "insured" people, but lots of the providers don't like particular plans, so they won't take them.  In particular, specialists are where you run in to a lot of problems with this.

So, the ACA insured more people, at a much greater cost than it had ever cost before.  It didn't necessarily give more access though.

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1 minute ago, Jack Bauer said:

I don't know why we all fight about this stuff.  We all want what is best for society.

I think you can have the best of both worlds where people can get great care, and still have a safety net that takes care of the poor, underinsured, uninsured, and people who are between jobs and stuff.  You would really need Congress to work together to get this, and reach across the aisle and really be interested in doing what is best for the people of this country instead of selfishly hanging on to talking points of an us vs them narrative.

The German system is really a nice, balanced system that has basic coverage for everyone, but people can buy more coverage if they like.

We're in luck! Donnie's a big fan of a lot of old German stuff.

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2 minutes ago, Jack Bauer said:

I don't know why we all fight about this stuff.  We all want what is best for society.

I think you can have the best of both worlds where people can get great care, and still have a safety net that takes care of the poor, underinsured, uninsured, and people who are between jobs and stuff.  You would really need Congress to work together to get this, and reach across the aisle and really be interested in doing what is best for the people of this country instead of selfishly hanging on to talking points of an us vs them narrative.

The German system is really a nice, balanced system that has basic coverage for everyone, but people can buy more coverage if they like.

Germany isn't Scandinavian though and they're actually good at capitalism so you lost the Bernie vote

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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Just now, Jack Bauer said:

I don't know why we all fight about this stuff.  We all want what is best for society.

I think you can have the best of both worlds where people can get great care, and still have a safety net that takes care of the poor, underinsured, uninsured, and people who are between jobs and stuff.  You would really need Congress to work together to get this, and reach across the aisle and really be interested in doing what is best for the people of this country instead of selfishly hanging on to talking points of an us vs them narrative.

The German system is really a nice, balanced system that has basic coverage for everyone, but people can buy more coverage if they like.

 

Just now, Jack Bauer said:

The biggest problem with the current system is just because people have insurance doesn't mean the medical providers want to take that insurance, so you've "insured" people, but lots of the providers don't like particular plans, so they won't take them.  In particular, specialists are where you run in to a lot of problems with this.

So, the ACA insured more people, at a much greater cost than it had ever cost before.  It didn't necessarily give more access though.

I have to think that the ACA, despite all its flaws as a great study for our country.

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Just now, toonkee said:

Sounds to me like your damned if you do, damned if you don't. 

They give you the run around in both systems. No?

 

It is much easier to get a procedure or scan or medication approved by a private insurer.  The government has protocol and nonsense you have to do before they will give in to signing off on certain medications or procedures.  You can bully them sometimes, but a lot of the time they stick to their guns.

I had a guy who had severe acid reflux and needed to be on twice a day omeprazole.  He lapsed on his prescription, so his insurance (government) wanted him to do a trial of once a day for a month before they'd approve it.  It's ridiculous that this guy has to put up with severe acid reflux for a month before they would approve twice a day dosing.  He didn't put up with it, he just bought another rx out of pocket, but that's the nonsense we'll be dealing with more and more when the government is in charge of this stuff.

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Just now, halfmanhalfbronco said:

 

I have to think that the ACA, despite all its flaws as a great study for our country.

There are a lot of really great things about the ACA.  There's a lot of things that have really hurt people financially too.  I still see plenty of uninsured and underinsured at clinic.  I see plenty of people paying more than they ever have for health care.  Someday, I think we'll have some version of single payer.

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31 minutes ago, Jack Bauer said:

Nobody is denied anything under the current model.  It's like some of you guys don't even know how this works.

So someone can walk into the ER and get ongoing cancer treatment? Ongoing physical therapy or long term mental health counseling?

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1 minute ago, Jack Bauer said:

There are a lot of really great things about the ACA.  There's a lot of things that have really hurt people financially too.  I still see plenty of uninsured and underinsured at clinic.  I see plenty of people paying more than they ever have for health care.  Someday, I think we'll have some version of single payer.

The further along we get in medical advancement the more attainable single payer becomes.  I still think we are 20 years or so away from that.  

 

 

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6 minutes ago, halfmanhalfbronco said:

The further along we get in medical advancement the more attainable single payer becomes.  I still think we are 20 years or so away from that.  

 

 

The opposite is true.  The more technology advances, the more old people we have, the more elderly we have, the more unsustainable single payer is.

20 years ago my dad would be dead, now he costs tens of thousands a year in Medicare.  I'm not pretending to know what the answer is, but imo the problem gets more intractable, not less.

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