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So medicaid is probably getting constricted and exchange plans are going to become more expensive and useless. Well, it sounds like the community health center I work at is going to become even more swarmed with patients in the near future. Patients who will be even less likely to have a primary exchange insurance to reimburse at least some of the costs to our program. Hopefully they can propose even more inane eligibility requirements for the 340B drug program, just to make my work a perfect hell.
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Mar 7, 2017 04:41
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Mokelumne Trekka posted:Sorry if this was asked - any experts want to weigh in on probability of Republicans success with repeal and replace? Pretty low would be my guess. There's already howling from the Koch lobbyists and Freedom Caucus nuts that it doesn't salt the Earth enough. On the flip side a couple moderate Republicans in the senate have already expressed dissatisfaction with anything that will increase number of uninsured. I also would have put the odds of Donald Trump becoming president at "pretty low" though, so God only knows.
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Mar 7, 2017 04:47
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No Butt Stuff posted:Do HSAs have an earnings cap for contributions like 401ks? You're thinking of Roth IRAs not 401k. But no, no earnings cap for HSA. Even the Roth IRA earnings limitation is incredibly easy to circumvent (fund a traditional ira, immediately convert it to a Roth IRA, pay no tax because it has no earnings).
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Mar 7, 2017 16:02
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The only "goal" I can see this succeeding at is increasing choice of available options on the exchange. Unfortunately said increased options are going to be poo poo plans that don't cover much of anything. And I guess dumping more of the federal Medicaid costs onto the states, and likely Medicare. It's amazing how the insurance options for unhealthy low income earners are: get on disability to qualify for Medicare and then never leave it or ????
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Mar 7, 2017 17:27
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Qu Appelle posted:So, what happens in the meantime with the ACA? It chugs along and still operates while this 'solution' is hammered out in Congress? The exchanges will probably continue to offer very few options in certain regions, that's about it though.
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Mar 7, 2017 22:09
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HappyHippo posted:The 30% premium is hilarious. It's basically just a slightly different form of a mandate, except it goes to the insurance companies instead of the government. It also does the exact opposite of what it's supposed to. The current mandate encourages people without insurance to get insurance. This new monstrosity encourages people without insurance to...continue to not have insurance?
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Mar 8, 2017 04:05
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SimonCat posted:They buy into the horror-stories about other country's health care. My dad's favorite talking point is that apparently the British system doesn't cover knee replacements for the elderly. As opposed to our glorious country where your insurance company can also deny you coverage for arbitrary reasons, and even if they do approve and cover it you can enjoy a big deductible and cost sharing. And God have mercy on you if an anesthesiologist who is non affiliated with your plan somehow wanders into your room during a medical procedure. Enjoy paying that providers bill yourself. Somehow every theoretical criticism of "government run" healthcare is actually even worse under the private system.
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Mar 8, 2017 18:08
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Hollismason posted:If they enact the changes your going to see a rise in deaths from HIV complications. Right now a lot of that is funded and subsidized by Medicaid and other programs. AIDS Drug Assistance Programs are in their own world at least. Same with most Ryan white programs, they're payers of last resort even after Medicaid. Helping a recent immigrant get access to hiv meds for no cost from my pharmacy via the ADAP is one of few times I felt non hateful feelings toward our healthcare system this year. It was like a two page application and next day they could get their $4000/month meds for free.
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Mar 8, 2017 23:22
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They really have nothing to stand on to defend this bill. It raises costs, lessens coverage, replaces the mandate with a slightly different thing that functions even worse, and really does leave in place most of Obamacare. They somehow cobbled together a design by committee bill that will benefit seemingly no one. Seemingly all elements of the health care industry are united in declaring it a terrible idea. It's a bill that exists only so they can pretend that Obamacare was "repealed and replaced" just like they promised their voters. And to satisfy Paul Ryan's raging fetish for block grants.
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Mar 9, 2017 06:57
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Rhesus Pieces posted:I thought I remember some conservative op-ed recently advising that the GOP should just be honest and admit that they really don't believe everyone deserves to be covered. Well it depends how much they've deluded themselves regarding the free market. It's a just world fallacy but with unfettered capitalism taking the place of God. If the market doesn't want the poor to die it will provide them with affordable healthcare.
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Mar 9, 2017 23:06
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silence_kit posted:This doesn't make that much sense to me--why are residents a net drain on hospitals? It seems to me that there could be a lot of useful work that they could be doing at hospitals and so they'd be a net benefit to them and not a hindrance. You know how you occasionally have a new guy at work who doesn't know how to do anything so you have to spend a week or two having them follow you around like a helpless puppy just trying to absorb information, and then maybe another couple weeks of them being "trained" but they're so bad at their job it actually results in net work for everyone else fixing their messups and explaining things? Stretch that out over a couple years and you have a medical residency. Also if they gently caress up and you don't catch it people can die.
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Mar 11, 2017 19:56
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Accretionist posted:It's Trump & Co. so, what's the catch? I can't speak for all of them of course, but CHCs seem to be an extremely cost effective use of health care dollars. The CHC I'm employed at not only gives a lot of people healthcare access, but we actually save the healthcare system we partner with a shitload of money (in the form of our patients now being funded by our program instead of their accounts being written off or sent to collections by the system). Legislatures seem to be realizing that it's more efficient to fund CHCs to save what would otherwise be medicaid or unpaid expenses. Also, I guess it's more palatable for conservatives to grant the money to CHCs instead of funding medicaid? Medicaid is a weird beast because it can be so different from state to state, not just in who qualifies for coverage, but also in how smoothly/competently their state medicaid program functions. In my state our medicaid program is wrapped in layers of bureaucratic inefficiencies and seemingly staffed by 90% bitter DMV-stereotype employees drained of all empathy to care for their fellow man. A lot of their coverage and prior authorization rules would have made sense 15 years ago, but now seem pointlessly inefficient. This is probably inefficiency by design since my state has had unified GOP governance for a fair while now.
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Mar 13, 2017 23:41
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It's always a great sign when your teams talking points alternate between 1) The cbo report is completely wrong and inaccurate 2) actually the outcome the cbo describes is a good thing because... I wonder how long until Trump senses the winds have turned and throws Paul Ryan under the bus.
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Mar 14, 2017 15:03
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evilweasel posted:He has also said, repeatedly, "we're doing the democrats a favor by repealing the law before it collapses next year we could easily do nothing but we're just too nice!!!!!" so he's already laying the groundwork to leave Ryan holding the bag. Trump's entire career and "leadership" style is basically this. Always have an underling available to dump full responsibility for failures onto.
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Mar 14, 2017 18:24
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Konstantin posted:Ryan overplayed his hand, pure and simple. He could have crafted a relatively moderate bill that kept the healthcare industry lobbyists happy, called it an Obamacare repeal, used those lobbyists to get some conservative Democrats on board, and told the far right to go gently caress itself. Instead Ryan thought he could use the electoral mandate to get everything he wanted, and he'll probably end up with nothing to show for it. Not a chance. Why would any Democrats participate in even the most minor gutting of Obamacare? The strategy has always been to sit on the sidelines and let the Republicans make asses of themselves as they can't even drum up a majority from their own party. Even trying to get involved in a "compromise" just makes it easier for the GOP to blame the plan's eventual failure on you.
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Mar 17, 2017 02:19
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Peven Stan posted:Why not just repeal the employer mandate and the token tanning bed tax and call it a day GOP? Give them an inch and they'll try and take a mile, the crazy bastards This probably would have been the best possible thing they could have done to have any real chance of successful passage. They also could have scaled back the minimum coverage requirements for plans on the exchange as at least then they could claim greater choice being offered to consumers and lower premiums (on dogshit plans that don't cover anything). Doing that won't satisfy the rabid base though, and it definitely wouldn't do anything to relieve Paul Ryan's raging hate-boner of Medicaid (beyond which everything else in this bill is just window dressing). The greatest mystery to me is the proposed 30% penalty when obtaining coverage if you didn't have it before. It's almost impressive how incredibly stupid this idea was. It does the opposite of what it should do (instead of punishing people for not having coverage, it actually punishes people who don't have coverage but are trying to obtain coverage). After running for years and mounting endless legal challenges on the evils of the Obamacare mandate, they propose to replace it with...a slightly different mandate? Who actually came up with and is actively supporting this thing?
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Mar 17, 2017 05:43
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Zikan posted:You can't just repeal the individual mandate and call it a day because you risk causing a death spiral in the health insurance markets if people drop coverage and only pick it up when they become sick en mass. Yeah, but that's the thing, the current GOP plan already does that! If your plan is already going to kick 25 million people off of coverage and wreck the exchanges, why not at least make it marketable to the public?
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Mar 17, 2017 18:35
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evilweasel posted:I don't really believe there's any way to pass major health reform without either losers or (more likely) people who fear they will be losers, and it's very difficult to get the benefits to people before the next election. Its not like it was unexpected that the delay in the law's effectiveness until 2014 was going to be a problem - the bill was revised to push as many benefits (children on their parent's plan, for example) as early as possible. And even then we all remember the healthcare.gov issues. You just can't reform 20% of our economy on a dime: even if you can wave a magic wand and get your preferred bill through congress you can't implement it immediately without more magic. So there's always going to be a time between when the bill passes (creating, at a minimum, the people who fear they will be losers under the new system) but the benefits aren't really real. Hell, people are really only waking up to how important the benefits are to them now that they're at risk. Agree completely. An even worse curveball that most haven't considered yet (since we're nowhere near getting a majority on board with universal healthcare): a lot of the inefficiencies in our current healthcare system are jobs. Sure there are a lot of corporate profits and waste, but there's a lot of jobs in our current system that likely wouldn't be there in a simplified Medicare for All system. Navigating the mess of public and private insurers and their obscure billing/eligibility rules requires a lot of benefit coordinators, accounting divisions, programmers etc. I'm not in favor of busywork entirely for its own sake, but eventually we do need to acknowledge that bringing down costs in our healthcare system to bring them in line with other nations will mean a lot of those administrative jobs lost. Tie that in with increasing automation in the economy, American's unhealthy obsession of viewing their self-worth in context of the demanding jobs they preform, and the depressing popularity of "welfare shouldn't go to the lazy able but unemployed" rhetoric that is spat out by the GOP to their willing base and the future looks really loving dark. We're a society that finds purpose of life in employment, but it's hard to see a future without decreased need for low to mid level workers.
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Mar 21, 2017 18:23
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Old Kentucky Shark posted:Look at my user name. Guess how many CDL licenses I have in my family. Guess. quote:The research revealed that over two-thirds of respondents were obese (69%), as defined by a body mass index (BMI) of 30 or higher, and 17% were morbidly obese (BMI of 40 or higher). In comparison, only one-third of U.S. working adults were reported to be obese and 7% morbidly obese. Obesity increases the chance for type 2 diabetes, sleep apnea, heart disease, cancer, joint and back pain, and stroke. These health conditions can disqualify a driver from receiving their commercial driver’s license and essentially take away their livelihood. Yeah ok.
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Mar 24, 2017 00:02
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Mantis42 posted:Yea my dad is a truckdriver and he lives out of a car and has to eat mostly truckstop food, which is basically fast food. It's actually really lovely for your health and is an awful job for a lot of reasons. Oh God yeah, I think former and current truck drivers are probably the most unhealthy occupation group I see at my community health center. I've seen way too many truckers who are making their first doctor appointment in 10+ years because they just had their first heart attack or the years of untreated diabetes is now showing up with eye/kidney/nerve-pain issues. It seems like a profession that takes a huge toll on the body long-term.
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Mar 24, 2017 00:15
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Trump should spitefully demand that Congress vote on this. Force those congressman to put down on the record whether they support this toxic waste.
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Mar 24, 2017 18:44
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Xae posted:I'm pretty sure that is Medicaid. No, but it's confusingly similar. It would mostly cover childless non-disabled adults between 133%-200% of the Federal Poverty Level. Under 133% would be covered by Medicaid, along with different FPL cutoffs for children/disabled/parents. I suppose certain non-citizens under 133% also might go on this plan instead of Medicaid.
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Mar 25, 2017 00:08
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I get that this is a troll amendment, but that wouldn't work at all. Your HSA just sees that you spent $x on a prescription and bills the claim, they don't look at all what the prescription is for.
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Mar 25, 2017 00:53
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Kekekela posted:Funding cuts to the program that was providing a ~12k/yr towards my mom's cancer drugs just got cut. After her insurance, she's on the hook for ~22k/yr now just for the one scrip. That doesn't seem right. Rx's are part of your deductible and maximum out of pocket expenses, and with a family plan your maximum yearly out of pocket expenses can't exceed $14,300 (small comfort I know). Is it an outpatient or inpatient administered medication? Is she on medicare, medicaid, or a commercial insurance? Odds are really good that there is a Indigent Drug Program available from the manufacturer of this drug. The drug companies are assholes, but they're also generally aware that people not on Medicaid/Medicare can't afford their products, so usually their IDPs are pretty generous with income requirements. Also look into if there is a federally qualified community health center in your area. At my FQHC we have a technician whose primary job function is to sign people up for IDP medications, and if they don't qualify we can still usually get them the medication for free due to 340b pricing depending on what their income level is.
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Apr 2, 2017 21:35
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Traditional Medicare is actually much worse than any private insurer when it comes to arcane billing loopholes requiring an army of highly trained staff to navigate in my experience. I know "Medicare for all" sounds like a great cure all to simplify everything and lower inefficiencies, but it isn't quite that simple. There's a reason why Medicare Advantage Plans (where people pay a private insurer extra for a plan that offers at minimum everything Traditional Medicare covers) are so popular and have higher patient satisfaction rates. All Medicare Part D Drug Plans are also administered by private insurers. Traditional Medicare itself is a swamp of red tape, weird rules, and bizarre policies that have needed updating for 20 years. So saying "Medicare for All" is quite a different can of worms than "Single Payer". Medicare itself is a highly blended and confusing private/public plan.
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Jun 28, 2017 13:49
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Neurolimal posted:Seems like a pretty insignifant negative compared to "most people never die of neglected cancer again" Atul Gawande is my favorite author on all things healthcare. I can't recommend his article on the dangers of over-testing and over-treatment enough http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande quote:H. Gilbert Welch, a Dartmouth Medical School professor, is an expert on overdiagnosis, and in his excellent new book, “Less Medicine, More Health,” he explains the phenomenon this way: we’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference. No test is perfect. Overtesting leads to false-positive diagnoses, which lead to unnecessary treatment, which can cause real damages to the body.
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Jun 28, 2017 17:50
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Reik posted:There's a reason the US and New Zealand are the only developed countries that allow direct to consumer pharmaceutical ads. Because by spending 20 seconds reading a list of possible side effects the patient is now capable of making an informed decision on if this therapy is right for them. That's seriously the rationale. Don't I feel like a fool for ploughing all that time and accruing all that debt from attending pharmacy school!
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Jun 28, 2017 20:23
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Hieronymous Alloy posted:Americans demand treatment because if you've missed work (unpaid) to see a doctor and are paying a thousand dollars for the privilege, you drat well want a result This is absolutely true. My last set of Continuing Education courses on infectious diseases had back to back chapters on Antimicrobial Stewardship and Influenza respectively. The first chapter was mostly about how to discourage patients from presenting too often/early with cold-like symptoms so they aren't being prescribed antibiotics for diseases that are probably viral in nature. The second chapter was about encouraging patients to get seen within the first 72 hours of flu-like symptoms, since Tamiflu probably isn't worth it at that point. Combine those two impulses with the $100+ bare minimum urgent care bill a patient will receive just for showing up and you've pretty well summarized our healthcare system.
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Jun 28, 2017 23:43
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Lote posted:You're applying statistics to people with a sample size of 1 and also giving examples where the answers are clear cut. Obviously, no surgeon would do that procedure using just your example. I can also make up a scenario where a surgeon would do a procedure most of the time: lets say someone with that tumor of 0.01% chance of death subsequently develops debilitating anxiety and agoraphobia because of that fear. They lose their job and stop eating. All other options have failed and the person begs the surgeon to remove it because they will be less anxious. I imagine most surgeons would do that procedure. No, I don't think preforming surgery that is viewed as not medically necessary to treat clearly somatic complaints would be ethical in any way. Perhaps an SSRI with a benzodiazepine as needed or Cognitive Behavioral Therapy would be a bit more appropriate method of managing a patient's anxiety than random surgery? brb gonna go ask a dermatologist to remove every mole and freckle on my body on the assumption that they could turn cancerous at any moment
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Jun 29, 2017 02:37
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Lote posted:What do you think I meant by saying all options have failed? That you know absolutely nothing at all about healthcare, disease states, treatments or medical ethics?
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Jun 29, 2017 07:51
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There's a lot of that. The brand name drug companies hiking their prices draws the most attention, but generic companies are happily manipulating the market in even more dramatic ways. They've been rapidly buying each other out, and once only 1-3 manufacturers are making a specific product they can set whatever price they please. The last 5 years at my pharmacy have been an endless roller-coaster of drugs repeatedly going on suspicious shortages and prices getting gouged anywhere from double to 10x their original price over the course of a few months as the shortage continues or drugs return to the market with new price tags attached. For decades the inherent assumption was that once drugs went generic and could be produced by multiple manufacturers, the free market would naturally lower prices over time through competition. Whoops! The new favorite trick of drug companies is to just repackage their old stuff with new a NDC (drug product identifier codes that are used in billing). All those years of competitive biddings and contracts with PBMs will generally lower the reimbursement and prices for your product, but often that reimbursement is tied into a product's specific NDC in the billing software. Just let the old stock run dry, put the pills in a new package with a new NDC on the front and now you can set the price of this "new product" to whatever you want. This works especially well for gaming Medicaid rebates/340b price, which would otherwise have punished a company for inflating their prices on a product over time with lower reimbursement, but now don't because it's a new product with a different NDC.
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Aug 27, 2017 00:26
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Crashrat posted:Yeah his argument is that if the pharmacist had to manually count the pills then it wouldn't have happened...which means they've never seen a pharmacy in action. The new rage in pharmacy is "tech check tech". poo poo is being piloted in multiple states and being proposed for both inpatient and outpatient settings. Instead of a pharmacist giving a final verification on dispensed medications one technician would just check the work of another technician to "free up pharmacist time for patient care activities". There's no possible way that a health care system would instead just choose to employ fewer pharmacists now that a technician making slightly over minimum wage can preform final verification on medications.
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Oct 5, 2017 17:55
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