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esquilax posted:The last big expansion to Medicare was almost entirely Republican driven, and HIPAA and COBRA were both bipartisan. If a bipartisan work group offers a chance to make the R's behave like adults again then it's a shot worth taking. COBRA was 1985 and HIPAA was 1996. Not exactly modern era Republicans. Letting the current Republican party touch health care policy is inviting the fox into the henhouse.
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Feb 7, 2018 22:02
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Paracaidas posted:It's occasionally a state problem as well: Wait what the gently caress
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Mar 31, 2018 21:29
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Endymion FRS MK1 posted:Wouldn't I be the estate? I'm an only child and he was divorced so either way I'm paying it right? No, you don't automatically owe your parent's debts. The estate is a separate legal entity.
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Aug 30, 2018 21:37
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Lest we forget that Republicans are still trying to murder you by abolishing Medicaid:quote:CMS is developing a rule that could curtail Medicaid transportation access https://www.modernhealthcare.com/article/20181107/NEWS/181109932 This is almost a backdoor abolishment of Medicaid for adults in rural states. If you can't get to your appointments, Medicaid doesn't have to pay for them! Hieronymous Alloy fucked around with this message at 15:18 on Nov 16, 2018 |
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Nov 16, 2018 15:15
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Spacewolf posted:Medicaid is a better program or Medicare? They're overlapping and mutually complementary. Medicaid has a lot of issues (low rates, too much state level discretion, means testing) but it covers things Medicare doesn't and vice versa. For example, Medicaid covers long term care, while Medicare does not.
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Nov 16, 2018 15:16
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Lightning Knight posted:The more I learn about healthcare, the more I am convinced that maybe the command economy people were actually right all along. Health care is an "impure" public good. https://en.wikipedia.org/wiki/Public_good Like the army, the interstate highway system, internet infrastructure, the postal service, etc., it's just better provided by the government. Back in the 1700's all the fire departments were funded by private fire insurance. Eventually we realized that, no, it was better to just have the government subsidize it, because private insurance meant fires got ignored if the wrong people's houses were on fire, and then the fires spread to everyone. Health care insurance now is where fire insurance was in 1750.
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Nov 20, 2018 16:42
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Lightning Knight posted:Oh I'm actually aware of this, I was more so making a joke really. my joke detecting circuits appear to be irretrievably damaged lately I blame capitalism
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Nov 20, 2018 16:48
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Charge anyone who requires excessive payment for insulin with criminal extortion. It's no different from threatening with a gun. "Pay up or die." Like, seriously.quote:836.05 Threats; extortion.—Whoever, either verbally or by a written or printed communication, maliciously threatens to accuse another of any crime or offense, or by such communication maliciously threatens an injury to the person, property or reputation of another, or maliciously threatens to expose another to disgrace, or to expose any secret affecting another, or to impute any deformity or lack of chastity to another, with intent thereby to extort money or any pecuniary advantage whatsoever, or with intent to compel the person so threatened, or any other person, to do any act or refrain from doing any act against his or her will, shall be guilty of a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. https://www.flsenate.gov/Laws/Statutes/2011/836.05 There's a slight difference in that the person is already dying and you're threatening to withhold lifesaving treatment, rather than threatening to commit active harm, but we have similar provisions for price gouging emergency supplies in hurricanes and the like. Hieronymous Alloy fucked around with this message at 16:21 on Nov 21, 2018 |
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Nov 21, 2018 16:16
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If people aren't using a device they need to use, the correct therapeutic approach is to determine why they aren't using it and then address those roadblocks, not assume they don't really need it and then automatically deny further coverage. But that would increase care costs, and you can save money by throwing hurdles under the feet of sick people and cutting their care when they can't make the jumps.
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Nov 22, 2018 03:02
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VitalSigns posted:In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right? You'd think BUT Provider networks and doctors have authority and can afford to hire attorneys. If you just deny individual sick patients, a certain number are going to fail to jump that hurdle -- because they're sick and tired and don't have attorneys -- and then you can claim savings of whatever percentage. Nobody ever went to a doctor and tried to scam themselves extra medical care they didn't believe they needed. (Or rather, anyone who has, probably has some other medical issue going on that needs treatment instead, like Munchausen's). Nobody goes to the trouble of getting a CPAP machine if they don't think it would help them with a real problem. (They might have been fooled or tricked in some way -- the victim of systemic fraudsters who convinced them they needed something they didn't, etc. -- but actual patients are almost universally sincere in believing they have a real need). I've done a lot of work fighting individual-level care denials and they are almost always based on the thinnest of reasons or the most cursory review -- fifteen minutes spent looking at a thirty-pound stack of medical records, "standards of care" lifted from out-of-context, misquoted powerpoint slides that happen to be the top hit on google for the condition, etc. (neither of those examples are hypothetical or exaggerated). A good system would go after actual systemic fraud as a criminal offense. But that doesn't happen in the case of most denials. Why doesn't it happen in the case of most denials? Because most denials are using the system of "fraud" review as a pretext for denying expensive claims (you can tell this by the fact that nobody prosecutes anyone for attempted fraud). Discendo Vox posted:I'm curious if CPAP devices might have been identified as another potential locus of Medicare fraud. That would explain a lot about the circumstances. This was such a goddam headache. There was one wrinkle to this story that really did gently caress over end users and I don't think it really got covered much in the media. See, some people who got wheelchairs through those scams actually *did* in fact need the chairs, they just happened to buy from a scam provider instead of a real one, but they didn't know anyy better. Then a month later, the lovely scam wheelchair would stop working. Medicare doesn't cover maintenance on wheelchairs for the first year, it's supposed to be under warranty from the manufacturer then, and it only covers one wheelchair purchase every five years. But of course the scam companies wouldn't honor their warranties, or would go bankrupt, or have their assets seized . . . then the poor sick victims would have no functioning wheelchair, no way to get one, and no way to get the broken one they had repaired. Good times! Some crimes make me want to bring back the stocks. Hieronymous Alloy fucked around with this message at 21:42 on Nov 27, 2018 |
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Nov 27, 2018 21:34
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Spacewolf posted:Similar to what everybody else says - remember how hearing aids aren't covered under Medicare (or, IIRC, any *other* federally-funded insurance plan). For kids at least, you can pursue coverage of hearing devices either through Medicaid under the EPSDT mandate or through the public schools under IDEA as assistive technology.
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Nov 27, 2018 22:08
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Willa Rogers posted:
Yeah, that's how this shuffle works. Insurer networks set their policies as aggressively as they can, knowing that a vanishingly small percentage of people will be able to contest the policies effectively. It'd be a good area to expand legal liability, honestly. Make attorneys able to recover triple fees and damages for improper denials of care and that poo poo would stop.
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Nov 29, 2018 20:53
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Malcolm XML posted:Medicare fraud is real lol but it's usually collusion between patients and doctors or possibly providers creatively billing or lying Yeah I also want to get in on how wrong this post is, sorry dude Patients almost definitionally lack the ability to commit (intentional) medicare/medicaid fraud. Unless they are professionals themselves, they lack the ability and knowledge to know whether or not they actually need the services their providers are telling them they need. Think about it: if a doctor and a physical therapist told you you should stop walking and use a wheelchair because ~ medical reasons~, would you listen to them and order the wheelchair? Addictive medications are really the only exception to that rule and even there it's an exception that proves the rule because an addict definitionally has a medical issue that is making it impossible for the addict to understand their own condition. They believe they need it. Yeowch!!! My Balls!!! posted:the answer that some people have tried to make work is consolidating insurers and providers under one roof. Kaiser out on the West Coast is the biggest example, an insurance company that also owns a shitton of hospitals. they still run into the perennial problem with this model: provider-owned insurers lose money on insurance, and insurer-owned providers lose money on providing. Yeah the problem with capitation models is that it fucks over the end recipients because there are no institutional players with a consistent incentive to protect them. Instead, everyone gets an incentive to deny care. Everyone hates me when I say this but you can almost always translate "cost savings" in American health care policy rhetoric into the phrase "denials of needed care" without much change in the underlying meaning. All the actual ways that would save money in American health care don't work under American capitalism: American corporations don't *do* long term investment, as private corporations they *can't* do long-term social policy (i.e., Nudge-type laws designed to encourage healthy behavior), and they can't, won't, and don't want to do anything that would actually lower costs and payments systematically (i.e., full public disclosure of all hospital charge sheets; cap payment for medications to international standards; etc.) So instead when (private) insurers want to save money the best way to do that is to make it very difficult for end-users to actually access needed care, either by throwing procedural hurdles at them (prior authorization) or by setting standards in such a way that they are prohibitively difficult to challenge ("we use a set of professionally developed criteria to determine medical necessity. Those criteria are proprietary trade secrets and not subject to review.") There really isn't an answer that isn't some form of socialized medicine. Fundamentally, insurers are middlemen who profit by promising to provide coverage and then not doing so. Fee-for-service Medicaid has the lowest cost-per-patient of any American system, and the reason is because it's single-payer and that is just an inherently more efficient model. Hieronymous Alloy fucked around with this message at 16:44 on Nov 30, 2018 |
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Nov 30, 2018 15:27
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Willa Rogers posted:I agree with the rest of your post but wanted to point out that the vast majority of state Medicaid programs are now bucketing people into managed-care plans. And as someone upthread mentioned, the state-based Medicaid MCOs are usually way better than the ultra-narrow-network MCOs that come with bronze plans in the individual market. Yeah, that's why I specified "fee for service Medicaid." From what I've seen, the Medicaid MCO's are better than the private options -- mostly because of the residual strength of the Medicaid system as a whole -- but they still ultimately have an incentive to deny needed care, and they pursue that incentive. I have had a lot of clients who were a lot happier once they shifted away from MCO medicaid and back onto standard, traditional, fee for service medicaid. I have never had a client who was happy they switched from FFS Medicaid to an MCO. This is why states are making the switch to the MCO model mandatory -- if they don't force people to make the switch, it won't happen in a free market, because patients universally prefer FFS. If I had a magic wish wand I'd just mandate expanding fee for service Medicaid coverage to all Americans, boom, done. Willa Rogers posted:
Absolutely, it's the worst kind of Lucky Ducky bullshit. Nobody seeks out medical care they don't genuinely believe they need. It doesn't happen, ever. It's too much goddam hassle. On the rare occasions when it does occur, there's some other medical reason causing it (addiction, Munchausen's). Hieronymous Alloy fucked around with this message at 18:01 on Nov 30, 2018 |
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Nov 30, 2018 17:56
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tetrapyloctomy posted:If you're that well-acquainted with healthcare finance, then you know full well that many primary care offices and hospital systems cannot operate solely on Medicare-level reimbursement. I can't focus on healthcare if my department doesn't have funds for staffing. Like I said, there are places to trim costs substantially, but they will involve firing a ton of people or enraging regularly-voting boomers who still think.Obama was creating death panels. A lot of health care admin people are going to lose jobs, yeah. Also health insurance industry people. Unfortunately those jobs are not sustainable anyway. When a limb has gangrene, "you're gonna lose that foot" isn't good news but it also isn't avoidable.
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Nov 7, 2019 12:46
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