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karthun posted:At the same time there is no reason to trust that any future Republican House, Senate or President will ever fully fund any annular funding of a health care program. Any future UHC program needs to have permanent funding to prevent future fuckery. ACA hosed this up with the mandatory vs discretionary funding thing. But in real technical terms there would be no way to prevent a future Congress from rescinding UHC funding. Only the fact that, like ACA, bills that help people tend to get really popular and it would be political suicide to actively oppose them. That's why AHCA/BCRA failed and the GOP only managed to pick off the most unpopular part of ACA, which is the individual mandate.
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Feb 7, 2018 22:46
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Reik posted:It's hard to reach market equilibrium when the alternative good is death. The market works pretty great for purely optional healthcare - cosmetic surgery for vanity reasons, or LASIK, or that sort of thing.
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Feb 8, 2018 16:31
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Goon parents post itt the total cost of your child's day of delivery.
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Feb 8, 2018 16:42
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esquilax posted:The MMA was 2003, and McCain actually had a rough health policy during the 2008 election. The current rot in the Republican party on health policy really started in opposition to the ACA and does not have to be permanent - it's something that other R's can try to fix. Frist (along with Ryan/etc) voted to give seniors drug coverage while making drugs vastly more expensive over time for everyone else in the country, and put in place Medicare Advantage which the government pays a fairly sizable premium for compared to normal coverage. This also royally broke the budget during what was not a terrible time economically, which was then used as a cudgel during the great recession. MMA is a giant disaster, but since it's the right combination of some help for seniors and massive corporate welfare it's politically difficult to fix. That was the whole point of the law.
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Feb 8, 2018 16:43
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esquilax posted:Frist for example voted to expand medicare entitlements to cover prescription drugs for seniors. Giving old white people goodies is a key part of the gop platform.
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Feb 8, 2018 21:56
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i am harry posted:Goon parents post itt the total cost of your child's day of delivery. Think it cost us about 4kish when all was set and done. Real lovely part was the birth was in February so we had to meet our deductible again. We’ll be paying it off for a few years at least. What a loving joke.
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Feb 8, 2018 22:12
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i am harry posted:Goon parents post itt the total cost of your child's day of delivery. 6k out of pocket with ‘good insurance’ and a paid deductible. That was for an uncomplicated vaginal delivery and one additional evening on the floor (for healing). I think total pre-insurance charges were somewhere around 32k.
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Feb 8, 2018 23:09
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If you're gonna have a kid, I can't stress enough that you should find an HMO with per diem admission copays. You'll pay hundreds instead of thousands.
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Feb 8, 2018 23:12
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Total billed for admission for induction on 12/25, leading to c-section on 12/27, and discharge on 12/30 was approximately $60,000. Our out-of-pocket cost was $300.
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Feb 8, 2018 23:14
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Reik posted:If you're gonna have a kid, I can't stress enough that you should find an HMO with per diem admission copays. You'll pay hundreds instead of thousands. It’d be wonderful if my wife had an HMO available through her work. I do where I work (so it wouldn’t have applied) and the family premium is like 600$/mo. I pay ~150/mo for just me and my daughter, but have a much wider network than the HMO—but the preventive coverage for OBGYN is unacceptable w my work plan. It’s a clusterfuck and frankly unacceptable that we have to make so many compromising choices with so few options.
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Feb 8, 2018 23:23
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esquilax posted:The MMA was 2003, and McCain actually had a rough health policy during the 2008 election. The current rot in the Republican party on health policy really started in opposition to the ACA and does not have to be permanent - it's something that other R's can try to fix. Frist also proposed the medicare premium support amendment that would transform medicare into a subsidy that people use to buy private insurance. And the idea that this United States of Care is bipartisan in any substantial way is laughable. It has something like 52 founders and not a single one of those is a M4A advocate. This is bipartisan in the sense that it ranges from super-conservative Republican (like Douglas Holtz Eakin) to private insurance employed ACA advocate (like Slavitt).
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Feb 8, 2018 23:24
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joepinetree posted:Frist also proposed the medicare premium support amendment that would transform medicare into a subsidy that people use to buy private insurance. It's aimed at moderate republicans and moderate democrats, and it's certainly easier for both of them to buy into the conclusions and not get primaried out if they have the cover of "bilateral" or "policy over politics" or whatever. And I haven't checked the ideological purity of all 52 founders but just last page there was an exchange about a bunch of people angry at noted M4A advocate Jon Favreau. I realize that this is somethingawfuldotcom and the inclusion of republicans or any private company ever automatically poisons the well, but there is discussion about health policy in this country that's a little more tactical than "M4A when?" It's becoming more widely recognized that the health system in this country is broken and that's why these workgroups like Unites States of Care and Amazon/Chase/Berkshire and the Health Transformation Alliance are starting up. And getting some republicans on board with actually trying to solve the problems the country is facing - even if we don't agree with their solutions - is a good goal.
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Feb 8, 2018 23:54
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I'd rather have bad legislation that can pass through Congress (like PPACA) that actually helps people instead of screaming bernie sanders would have won into the ether for all eternity while people loving die because these groups don't pass your purity tests.
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Feb 9, 2018 00:04
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esquilax posted:It's aimed at moderate republicans and moderate democrats, and it's certainly easier for both of them to buy into the conclusions and not get primaried out if they have the cover of "bilateral" or "policy over politics" or whatever. hmm. to pull a name out of a hat, I wonder what the opinion of Douglas Holtz-Eakin, proud USofCare founding member, is on how we should address the problems of healthcare going forward what's that, Doug? the only problem with the House's ludicrous grind-the-poor-into-loving-hamburger health care bill was that it didn't kill -enough- poor people? that Medicaid needs to be slashed further, and the funds thus freed up should be spent on tax credits for the wealthy? yes, this is a person with whom bipartisan agreement on how to solve the problems of american health care can be reached. i am 100% confident that he will be convinced by Reasoned Debate that giving health care to poor people is good, actually. if you are serious in advocating for health care reform, step one is making it clear you do not give a poo poo what Douglas Holtz-Eakin has to say. "moderate conservatives." loving lol.
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Feb 9, 2018 00:08
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The Phlegmatist posted:I'd rather have bad legislation that can pass through Congress (like PPACA) that actually helps people instead of screaming bernie sanders would have won into the ether for all eternity while people loving die because these groups don't pass your purity tests. The big issue is that the republicans proved that being "just say no" babies about health policy is an effective strategy that leads to electoral success, if not legislative success. There's a real danger that the democrats will copy them.
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Feb 9, 2018 00:09
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The Phlegmatist posted:I'd rather have bad legislation that can pass through Congress (like PPACA) that actually helps people instead of screaming bernie sanders would have won into the ether for all eternity while people loving die because these groups don't pass your purity tests. remind me: that bad legislation that passed through congress. how many republican votes did democratic concessions to republicans earn it, again
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Feb 9, 2018 00:09
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My out of pocket max is 1500, can I get screwed for more than that having a kid with out of network shenanigans? How can I protect myself from the wandering doctors that "consult" and charge thousands on the way through?
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Feb 9, 2018 00:17
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baquerd posted:My out of pocket max is 1500, can I get screwed for more than that having a kid with out of network shenanigans? How can I protect myself from the wandering doctors that "consult" and charge thousands on the way through? Have your kid in one of the handful of states that has strong consumer protections against "balance billing." eta a link to a fact sheet about balance billing. Willa Rogers fucked around with this message at 00:40 on Feb 9, 2018 |
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Feb 9, 2018 00:35
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esquilax posted:It's aimed at moderate republicans and moderate democrats, and it's certainly easier for both of them to buy into the conclusions and not get primaried out if they have the cover of "bilateral" or "policy over politics" or whatever. Douglas Holtz Eakin is not a moderate in any sense of the word. Bill Frist is not a moderate in any sense of the word. Gail "we need to cap how long people stay on medicaid" Wilensky is not a moderate in any sense of the word. All three are in favor of things that would not get by even today's republican congress. And Jon Favreau is not a M4A advocate. When asked, he says that he supports M4A, but he hasn't done any bit of advocacy in favor of it. As for the snarky last bit that, I am not saying that they need to be on board with M4A. I am saying that they need to be honest about what their goal is. "We want to bring moderate democrats, republicans and insurance executive to come up with an alternative to medicare 4 all because we don't think M4A will pass/is good/ whatever" is fine. "We are totally in favor of medicare for all, which is why we built this group that doesn't include a single person actually working on a M4A proposal" isn't fine. Of course, their reluctance to admit that sort of gives away the actual goal of the organization, which is to kneecap M4A. They want an alternative so that when 2020 rolls around M4A isn't a litmus test on the left. That is the part I have an issue with. The fundamental dishonesty of going "I am totally in favor of M4A, but it's so complicated that we need to discuss it more, which is why we created this organization that doesn't include a single person who is working or has worked on a M4A proposal and 2/3 members who have voiced opposition even in theory to single payer."
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Feb 9, 2018 00:42
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this org is such a blatant bad faith attempt to undermine m4a that I’m shocked anyone is falling for it. its only long term effect will be destroy the credibility of favreau, which.... good
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Feb 9, 2018 00:58
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In case anyone had any doubt that this was an astroturf org trying to derail m4a, marvel at this wonder of consultant speak: https://www.cnn.com/2018/02/08/politics/what-is-united-states-of-care-andy-slavitt/index.html quote:Krieg: Why not then put this energy and these resources behind some of the movements that are already out there? "Medicare for all" obviously now has traction with Senate Democrats, as do other less comprehensive plans. There are a lot of people already out there trying to create a new narrative, in favor of expanding care. Why not put your influence and, maybe, money behind them?
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Feb 9, 2018 05:14
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This bit makes me crazy:quote:Think about big changes that have happened in the country, (like) marriage equality. That didn't start the year before laws were changed. That started decades before laws were changed. There needs to be a movement and effort to establish successful change that occurs beyond just the current year. It's just more bullshit along the lines of "The ACA will pave the way toward single payer," although you aren't hearing many of the elected Dems who once spouted this say it anymore. And you can practically see Slavitt's flop sweat in trying to say something nice about M4A while he and his little group of assholes got together for the express purpose of stopping it. If there's an upside, it's that this group is bound to fail--not only because people immediately saw it for what it was and called it out, but because there's nothing else left to do wrt our healthcare system than either work toward radical reform or continue to prop up the status quo. What in the world is he saying about "medicare is for olds" and thus needs to be changed before moving to a broader population?
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Feb 9, 2018 05:30
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quote:Krieg: Why not then put this energy and these resources behind some of the movements that are already out there? "Medicare for all" obviously now has traction with Senate Democrats, as do other less comprehensive plans. There are a lot of people already out there trying to create a new narrative, in favor of expanding care. Why not put your influence and, maybe, money behind them? we need to sloooow this down. it's not that we're against the concept of medicare for all, it's just that we're against it happening so -fast-, you see. we need to find a solution that doesn't make Doug Holtz-Eakin not mad at us. that, is, after all, how gay marriage got passed, right? we all got Pat Robertson onboard through Reasoned Debate, and then suddenly opposition evaporated? it wasn't that conservatives fought it tooth and nail at every loving point, and continue to fight it today even after the supreme court has made it legal, heavens no. quote:Krieg: To be clear, though, you were speaking to Modern Healthcare about this, and you're quoted as saying, "We believe every single American should have access to basic, affordable care. But we avoid using language like universal coverage that is polarizing. We want to bring people together, and certain words are used by one party or another to create divides." So, asking as directly possible: Do you support or oppose single-payer health care? what a spineless loving toad of a man. quote:Krieg: OK, but how do you feel, not personally now, but as an activist or political actor? we are for everything! we are against nothing! and while we personally have no policy propositions, we outright deny the existence of the outstanding medicare for all bills because they make our "pragmatic" angle transparently bullshit! we will support anything that might hold back a push for single payer. because we are loving petrified of the concept.
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Feb 9, 2018 05:31
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Willa Rogers posted:What in the world is he saying about "medicare is for olds" and thus needs to be changed before moving to a broader population? I'm guessing it might be concern-trolling about how Medicare doesn't cover prenatal care/childbirth? Because seniors don't tend to need that kind of thing? Of course if you wanted to make things so that Medicare did cover that, you could and would.
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Feb 9, 2018 05:59
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Willa Rogers posted:If there's an upside, it's that this group is bound to fail--not only because people immediately saw it for what it was and called it out, but because there's nothing else left to do wrt our healthcare system than either work toward radical reform or continue to prop up the status quo. Radical reform doesn't necessarily mean socialized medicine. As just one example, all payer rate setting is a great cost control method that is budget neutral by design that would maintain private insurance and the current employer cost contributions, and could potentially gather support from parts of the insurance industry and from employers. However it's vulnerable to attacks from both the right and the left and from the provider side, and is too wonkish to gather grassroots support. So it needs a few years in the incubator before it can be rolled out - someone needs to work on the politics of it to see if it's plausible to roll out on a state-by-state or nationwide basis, or even at all, and also find a way to make it palatable to both parties. E.G. to appeal to R's they start talking about the need for price transparency and responsible consumers of healthcare. For D's they can emphasize patient savings and the use of medicare as negotiating leverage against drug companies. Someone needs to actually work at it though. That's the type of fundamental reform that this type of group could be working towards. If all they come up with is more of the same garbage then yeah it's nothing worth going into siege mode over.
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Feb 9, 2018 07:28
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sat on my keys! posted:I'm guessing it might be concern-trolling about how Medicare doesn't cover prenatal care/childbirth? Because seniors don't tend to need that kind of thing? Of course if you wanted to make things so that Medicare did cover that, you could and would. Medicare does actually cover childbirth. You rarely see it billed in Medicare, but you do occasionally. (Likely through someone eligible via ESRD or SSDI). quote:What in the world is he saying about "medicare is for olds" and thus needs to be changed before moving to a broader population? No, more realistically, some of the benefits need to be re-constructed in order to move from a benefit 'for the old' to a more broad benefit (though you could do this after the fact). Part of the issue with Medicare is it has significant payment silos, but beyond that, some of the benefits, as designed, could create additional problems. So for example, if you require therapy (PT/OT/SLP) in a skilled nursing facility (SNF), Medicare covers the first.. 30 days(?) at full charge. After that, the patient is responsible for a 20% coinsurance per day. Sure, that's not all that different from an insurance company, but that kind of goes against the entire point of moving to M4A to make care affordable for everyone. After 100 days per benefit period (which has to do with episode of care), it has 0 coverage. If you stop improving, the coverage stops - Medicare is designed only to cover care that improves your situation, not that maintains it, from a facility standpoint. If you don't spend the right amount of time in the hospital (~3 nights? they call it 3 days but my recollection is that doesn't include the day of admission or discharge) it won't cover care in a facility afterwards for rehab -- my aunt had a hip replacement and was discharged home the next day with home health. The home health wasn't working for rehab and she was not eligible for any inpatient rehab facilities because her hospital stay wasn't long enough, and she couldn't sustain the level of rehab necessary to qualify for care at an inpatient rehab facility (IRF), while not having the stay length requirement for the SNF. Or balance billing. If a doc refuses Medicare assignment (not entirely uncommon) they can balance bill Medicare patients that they see. Again, none of this is so major that it should need to be done as a precursor to M4A, but there are significant changes to benefit design that need to happen for it to function the way people want in the long run and remove loopholes/etc. Zauper fucked around with this message at 14:36 on Feb 9, 2018 |
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Feb 9, 2018 14:33
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baquerd posted:My out of pocket max is 1500, can I get screwed for more than that having a kid with out of network shenanigans? How can I protect myself from the wandering doctors that "consult" and charge thousands on the way through? I think you're less likely to see this for a maternity claim because you won't the normal culprits like radiologists/anesthesiologists/"assistant surgeons" involved unless it's a c-section or there's other complications. If something does happen, you can contact your state department of insurance, they are getting less tolerant of that garbage.
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Feb 9, 2018 16:12
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Guess what an uncomplicated birth costs the NHS? https://www.theguardian.com/society/ng-interactive/2016/feb/08/how-much-have-i-cost-the-nhs Roughly $4,000 for an uncomplicated birth. Cost to mother: $0 (except maybe a few pounds for parking or snacks)
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Feb 9, 2018 16:17
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Reik posted:I think you're less likely to see this for a maternity claim because you won't the normal culprits like radiologists/anesthesiologists/"assistant surgeons" involved unless it's a c-section or there's other complications. If something does happen, you can contact your state department of insurance, they are getting less tolerant of that garbage. but yeah, your insurance company, which should hypothetically be fighting these charges for you, ain't gonna lift a finger sweet setup tbh
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Feb 9, 2018 17:21
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BarbarianElephant posted:Guess what an uncomplicated birth costs the NHS?  Please don’t let your loving conservatives Americanize your wonderful system.
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Feb 9, 2018 17:49
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Ze Pollack posted:but yeah, your insurance company, which should hypothetically be fighting these charges for you, ain't gonna lift a finger They already paid up - their job is done!
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Feb 9, 2018 17:54
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LeeMajors posted:
They are working hard on it!
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Feb 9, 2018 18:06
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Zauper posted:No, more realistically, some of the benefits need to be re-constructed in order to move from a benefit 'for the old' to a more broad benefit (though you could do this after the fact). Part of the issue with Medicare is it has significant payment silos, but beyond that, some of the benefits, as designed, could create additional problems. Medicare was designed in the dark ages when people vanished into the inpatient wing of the hospital for weeks at a time. Modern hospitals simply don't do that anymore -- you'll be discharged as soon as possible. Like you said, this messes with a whole lot of people who don't get SNF coverage when they don't spend three nights inpatient (and don't forget...the ER doesn't count!) And the utiliziation managers know this and will come down hard on you if you try to trick the system by keeping people inpatient for observation so that they can get coverage. People are genuinely confused when I tell them how crappy Medicare is and how many weird pitfalls it has. The benefits are just completely lopsided. Medicare doesn't cover vision or dental but does cover months-long inpatient stays. It really needs to be reworked to fit into the modern healthcare system.
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Feb 9, 2018 18:28
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Zauper posted:Medicare does actually cover childbirth. You rarely see it billed in Medicare, but you do occasionally. (Likely through someone eligible via ESRD or SSDI). Ah, thanks for the correction! Is ESRD here renal disease (dialysis gets you on Medicare, right?)?
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Feb 9, 2018 19:32
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sat on my keys! posted:Ah, thanks for the correction! Is ESRD here renal disease (dialysis gets you on Medicare, right?)? Yes, as long as you or your spouse meet the usual work history requirements.
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Feb 9, 2018 19:36
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sat on my keys! posted:Ah, thanks for the correction! Is ESRD here renal disease (dialysis gets you on Medicare, right?)? That's right. I want to say that Medicare becomes your secondary insurance for 6 months and then you become eligible for it to become your primary. Or something like that. There is a brief wait in some cases, though it's immediate if you get a kidney transplant. My memory of how it works largely pre-dates the rule they released 7 or 8 years ago that added some more protection for Medicare against the insane profit the dialysis centers were making. quote:
But yeah, because the Medicare DRG system encourages shoving you out of the hospital door ASAP as it's payment per stay in the hospital rather than per time period, hospital stays have gotten shorter as they've optimized getting you to the point where they can shove you out. That that makes your overall outcome worse is just a bonus. Then you also have poo poo like LTACHs. LTACHs are where you go to die from vent weaning. Or, alternatively, they're IRFs that get paid significantly more for the same services. Or in some cases, SNFs since IRFs don't have vent units and SNFs do in the states that don't have LTACHs. Zauper fucked around with this message at 23:04 on Feb 9, 2018 |
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Feb 9, 2018 23:01
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Discharging patients into an SNF around here is basically a death sentence. They boomerang back and are readmitted inpatient on day 21 after the utilization manager kicks them out except now they have sepsis somehow. I've seen this happen so many times that I wonder wtf is going on in these facilities.
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Feb 10, 2018 18:24
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The Phlegmatist posted:Discharging patients into an SNF around here is basically a death sentence. They boomerang back and are readmitted inpatient on day 21 after the utilization manager kicks them out except now they have sepsis somehow. Fraud. I snf I used to do IT for (country villa in California) was fined for Medicare fraud when it was found that they were doping patients with phenobarbitol to make them look like they were declining so that they could bill Medicare for more severe cases. You'd go in with a replaced him and come out suffering alzheimers like symptoms and barely functional. Those places are not about treating people. They're Medicare funded meat lockers for the elderly.
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Feb 10, 2018 21:02
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The Phlegmatist posted:Discharging patients into an SNF around here is basically a death sentence. They boomerang back and are readmitted inpatient on day 21 after the utilization manager kicks them out except now they have sepsis somehow. I used to organize CNAs and activity/dietary aides in those facilities and can tell you they are where people go to die basically
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Feb 10, 2018 21:02
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Ze Pollack posted:we need to sloooow this down. it's not that we're against the concept of medicare for all, it's just that we're against it happening so -fast-, you see. we need to find a solution that doesn't make Doug Holtz-Eakin not mad at us. that, is, after all, how gay marriage got passed, right? we all got Pat Robertson onboard through Reasoned Debate, and then suddenly opposition evaporated? it wasn't that conservatives fought it tooth and nail at every loving point, and continue to fight it today even after the supreme court has made it legal, heavens no. Apparently 100+ years of universal healthcare discussion just isn't enough for the man.
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Feb 11, 2018 00:34
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