Obamacare Death Squads
- Thread starter Old_alum
- Start date
No worries, Bobbie: That's all the facts I have or will have ---- being an In-Law and all.
As you know there is language in the law for a panel review ---- often euphemistically referred to by GOP as ''death squads'', choosing who gets treatment or not.
I just found it interesting.
This old woman might have misunderstood, but her doc did not say she had any physical limitations precluding the surgery, but he did tell her Medicare would not pay for it because of her age.
This post was edited on 10/17 5:42 PM by Old_alum
I am sorry to hear about your family member but that is 100% incorrect. There is more to this story that you may not know.
There is no death panel.
There was language in the original bill to pay physicians for advance care planning... That was for doctors to talk to the elderly about their options and offer counseling for end of life decisions. This was ultimately removed from the bill because of the nutjobs claims about it being a death panel.
Since that language was removed, the extreme right had to find other language in the bill to support their nutjob claim so they went with the Medicare advisory board, established to curb the cost of medicare spending which they claimed would recommend rationing and ignored the following.
"The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."
The reality is we have an aging population that requires a disproportionate share of healthcare expenses. Our healthcare system and Medicare is not sustainable if every procedure is approved. We need to face facts and understand healthcare will be rationed and certain procedures will not be covered that might have been in the past. The cost of care will also continue to be shifted to the middle class...check how much your part of the contribution, deductable and out-of-pocket is going up whether its a policy offered by your employer or through an exchange.
I also think the "Death Panel" nonsense is exactly that and its meant to scare people (as most of government works today). That's not what's wrong with the ACA...what's wrong with it is it adds another layer of administration and does nothing to reduce the cost of care. If you haven't noticed lately, the largest employers in a given city (and in many cases highest paid executives ) are non-profit hospitals. Look at the Pittsburgh market and the impact that UPMC has on the economy. Those ACO's or hospital systems are investing incredible amounts of money in acute care infrastructure (private rooms that have woodwork and options that rival a five star hotel) while admissions are declining. They are taking in gobs of money and finding ways to spend it all. They are also over-paying for physician practices (while those docs are looking for a quick pay-out...and getting it). The healthcare expense as a percent of GDP continues to increase, faster than before the ACA.
We have continued to ingnore the real factors (aging population) and confront them, because they are hard. Washington can't make easy decisions...forget about the hard ones. For those that live in Bergen County, why did we just open a brand new state of the art community hospital (Pascack Valley) when you have two outstanding hospitals withing 10 miles of that community (Hackensack and Valley) that both have more than enought capacity??? If you really care about inner-city care, can you explain why there is no new hospital construction in Newark?
A broken system that the ACA has accellerated the breakage.
I also think the "Death Panel" nonsense is exactly that and its meant to scare people (as most of government works today). That's not what's wrong with the ACA...what's wrong with it is it adds another layer of administration and does nothing to reduce the cost of care. If you haven't noticed lately, the largest employers in a given city (and in many cases highest paid executives ) are non-profit hospitals. Look at the Pittsburgh market and the impact that UPMC has on the economy. Those ACO's or hospital systems are investing incredible amounts of money in acute care infrastructure (private rooms that have woodwork and options that rival a five star hotel) while admissions are declining. They are taking in gobs of money and finding ways to spend it all. They are also over-paying for physician practices (while those docs are looking for a quick pay-out...and getting it). The healthcare expense as a percent of GDP continues to increase, faster than before the ACA.
We have continued to ingnore the real factors (aging population) and confront them, because they are hard. Washington can't make easy decisions...forget about the hard ones. For those that live in Bergen County, why did we just open a brand new state of the art community hospital (Pascack Valley) when you have two outstanding hospitals withing 10 miles of that community (Hackensack and Valley) that both have more than enought capacity??? If you really care about inner-city care, can you explain why there is no new hospital construction in Newark?
A broken system that the ACA has accellerated the breakage.
Fwiw the real goal of Omamacare is a single payer system and healthcare like that in au Canada. There is language in the "law" establishing a "review board". The Canadian Supreme Court just affirmed the right of their panel to make life or death decisions. Alas, death panels are not just a scare tactic, in Canada anyway. Before I forget, the VA (Veterans) website used to have a document describing said panel but took it down when the original furor over them occurred. More coincidence? I doubt it.
I think "Death Panel" is over the top. It's essentially a "Coverage Panel". The reality is that we don't have an endless stream of tax dollars to pay for end of life care. I don't want to sound cold and I do work in the healthcare space, but the patient still has the option to pay or find a way to pay for extreme circumstances (i.e. a fourth line chemo treatment that might extend life 30-60 days). I give Canada and many of the Euro countries credit here.
There are extremes at end-of-life. Doctors continue to ''work'' on a relative for four hours after he was dead because they had not been able to contact the next of kin until visiting hours the next morning. That is not just extreme but stupid.
But is a woman's first open heart surgery ''extreme circumstance'' simply because she is 80?
Should there now be clear and simple forewarning to Medicare patients that their life is deemed not worth such expense so that alternative insurance may be arranged?
Old_Alum. I don't profess to say this is an easy problem to solve....especially when it hits you personally. We just went through a similar situation with my Mother-In-Law who is 85 and just went through a quadruple by-pass. Now she and her husband had insurance and the total cost of care would have pretty much emptied their savings.
I'm not a physician, but that would not strike me as an extreme circumstance because that type of surgery on a good surgical candidate can extend a high quality of life considerably. Take the other extreme...my Dad who passed away several years ago was in late stages of Alzeimers 10 years ago and was diagnosed with an Aortic Annurism that was pretty significant. Because of the Alzheimers, he was a terrible candidate for surgery and had a 50% chance of survival just to make it out of surgery. In addition, the surgery and post-op would have like accellerated the Alzheimers. He was unable to make the decision but my Mom opted not to do the surgery (despite the strong recommendations from the Cardiac Surgeon who was looking for a payday..because insurance/Medicare would have covered it). Every situation is different, but he lived another three years and it was the Alzheimers that killed him, not the annurism. BTW, if an annurism blows, death is quick and peaceful...within seconds, which would have a much better end IMO. If that procedure is not covered for mid/late stage Alzheimers, is that so terrible? Once again, no easy answers, but we need to start thinking practically instead of politically.
I'm not a physician, but that would not strike me as an extreme circumstance because that type of surgery on a good surgical candidate can extend a high quality of life considerably. Take the other extreme...my Dad who passed away several years ago was in late stages of Alzeimers 10 years ago and was diagnosed with an Aortic Annurism that was pretty significant. Because of the Alzheimers, he was a terrible candidate for surgery and had a 50% chance of survival just to make it out of surgery. In addition, the surgery and post-op would have like accellerated the Alzheimers. He was unable to make the decision but my Mom opted not to do the surgery (despite the strong recommendations from the Cardiac Surgeon who was looking for a payday..because insurance/Medicare would have covered it). Every situation is different, but he lived another three years and it was the Alzheimers that killed him, not the annurism. BTW, if an annurism blows, death is quick and peaceful...within seconds, which would have a much better end IMO. If that procedure is not covered for mid/late stage Alzheimers, is that so terrible? Once again, no easy answers, but we need to start thinking practically instead of politically.
Well, for starters, it SHOULD NOT be the government!!!
As I said, this is not an easy issue but also one we just can't continue to ignore and run away from. That's the problem as I see it today...we as a nation don't want to confront the hard stuff (i.e. Social Security, etc.).
It should not be all dollars, but there needs to be a real dialogue about treatment, coverage and quality of life.
We are kidding ourselves if we think Obamacare is going to offer the same level of care to everyone. If you can afford the coverage, you will be treated at the private room, higher end acute care facility like Morristown Memorial (part of Atlantic Health System)....if you don't you'll be treated at St. Michael's in Newark. Take a guess where outcomes data is better.
The government vs. a private company making end of life decisions is certainly debatable.
Personally, if it is my procedure I would prefer someone who does not have a profit motive making that decision. If you are talking about cost containment, the government would clearly be the worse choice.
I agree that the conversations need to be had though. We need to stop keeping people alive just because we can and focus on quality of life.
Also, money equaling better care has always been, and will always be the case. Really nothing we can do about that and Obamacare didn't really help or hurt there.
FWIW, I don't think a private company should be making that decision on their own either. The fact that the government can't even get a website to work for $1 billion gives me pause that they can make life/death decisions on their own as well....lol
I actually think Obamacare is going to negatively impact the quality of patient care for the poor, who will now be forced to join a plan, and will choose the cheapest plan with the greatest subsidy, which coincidently will be the plans that direct them to the poorest quality healthcare facilities and providers. Remember those words from BO..."If you like the plan you have; you can keep it"....well, as we know now that is far from reality.
I actually think Obamacare is going to negatively impact the quality of patient care for the poor, who will now be forced to join a plan, and will choose the cheapest plan with the greatest subsidy, which coincidently will be the plans that direct them to the poorest quality healthcare facilities and providers. Remember those words from BO..."If you like the plan you have; you can keep it"....well, as we know now that is far from reality.
By negatively impact, are you saying that a bronze level plan is worse than having no insurance?
and yes, it is true that if you liked the plan that you had, that didn't really cover anything, that you would be forced into a better plan. This will also provide a better level of care, although I do completely understand why people would be upset about the increased cost.
Forcing people into a better level of care vs. allowing the buyers to choose what they want. Good article in the WSJ today from the former President of a large insurance company discussing young healthy insureds and how now they cannot buy high deductible policies even if that is what they feel is better coverage for them. This bill has too many flaws to list right now with no way out unfortunately with the logjam in DC. A disaster right now.
There is still choice among levels of coverage and we have set a minimum level of adequate coverage.
The problem with the high deductible plans was that they discouraged people on them from going to the doctor.
http://archinte.jamanetwork.com/article.aspx?articleid=226261
Massachusetts also had set a minimum level of coverage with their reform under Romney with similar deductibles and out of pocket maximums.
The deductibles and eventual co-pays are very high under any of the Obamacare plans. Unfortunately I've had to look into Obamacare. Subsidies may help the low income (although subsidies up to 400% of the poverty level seem a bit ridiculous) but they won't help with the out of pocket expenses.
Obamacare is not about health care but about health insurance. It artificially forces the young and healthy to subsidize the poor and unhealthy. Who the hell is the federal government to determine what is substandard insurance? Health care and health insurance are a responsibility. Give help to the truly indigent. Get out of the way of insurance companies and purchasers of health insurance and let them purchase what is in their best interests, given the risks, etc.
Obamacare is not about health care but about health insurance. It artificially forces the young and healthy to subsidize the poor and unhealthy. Who the hell is the federal government to determine what is substandard insurance? Health care and health insurance are a responsibility. Give help to the truly indigent. Get out of the way of insurance companies and purchasers of health insurance and let them purchase what is in their best interests, given the risks, etc.
Obamacare certainly isn't perfect but I think the intent is in good faith. Will it work? I have no idea.
I think it is absolutely foolish for any person to go without health insurance, no matter how healthy you think you are. Accidents and serious, unexpected illnesses can happen and people need to be covered to prevent themselves from going bankrupt given the ridiculous cost of heathcare in this country.
I recently went to the ER for treatment for what turned out to be a common, non-serious issue. Had I not had health insurance, the bill would have been $2,500 for just a three hour stay. That is insane and represents the true problem of healthcare costs in this country. Affordable healthcare should be available to each and every citizen, no matter how much money you make.
I do not agree with the government telling people their plans aren't good enough and forcing everyone to buy insurance. That should not be its business. But if it drives costs down over the long run and gets more people insured, I'm reluctantly for it.
This post was edited on 11/7 9:23 PM by shu09
I think it is absolutely foolish for any person to go without health insurance, no matter how healthy you think you are. Accidents and serious, unexpected illnesses can happen and people need to be covered to prevent themselves from going bankrupt given the ridiculous cost of heathcare in this country.
I recently went to the ER for treatment for what turned out to be a common, non-serious issue. Had I not had health insurance, the bill would have been $2,500 for just a three hour stay. That is insane and represents the true problem of healthcare costs in this country. Affordable healthcare should be available to each and every citizen, no matter how much money you make.
I do not agree with the government telling people their plans aren't good enough and forcing everyone to buy insurance. That should not be its business. But if it drives costs down over the long run and gets more people insured, I'm reluctantly for it.
This post was edited on 11/7 9:23 PM by shu09
That $2,500 ER bill is determined by the hospital charge master that is an artificially created list price that has ballooned over time. Rates negotiated between an insurer and hospital are market driven and have no relationship to that charge master. If the government wanted to do something productive they would set hospital and physician rates for uninsured so they couldn't take advantage of them.
The bronze plans will end up warehousing the poor in the lowest quality quadrant. Today if you are uninsured you can walk into any ER and not be denied care because that is the law. Going foward, theoretically since everyone will be insured their coverage will dictate where they can and can't go...so an indigent patient who could have walked into any ER before will now be legally denied access to many hospitals. So yes. You were better off without insurance if you are poor than if you have a bronze policy now.
The bronze plans will end up warehousing the poor in the lowest quality quadrant. Today if you are uninsured you can walk into any ER and not be denied care because that is the law. Going foward, theoretically since everyone will be insured their coverage will dictate where they can and can't go...so an indigent patient who could have walked into any ER before will now be legally denied access to many hospitals. So yes. You were better off without insurance if you are poor than if you have a bronze policy now.
I agree with this. By the way, my ER visit was to Morristown, the hospital you referenced in another post.
If the uninsured are not denied care (as is the law), they need to be set up on some payment plan so others don't foot the bill. How does the process work now? I honestly do not know.
Why is it a stretch? And there is no law change required since there will still be uninsured. If you have insurance, you are now directed to a site and provider for care. If you don't have insurance, you go to any ER and can't be denied care. You can't have it both ways to say, I'm poor and now have insurance and I can go anywhere for treatment. Providers and insurers will now be able to send Bronze members where they want them to go. For instance, if you look at the Barnabas Health System, they will be able to direct/limit patients to certain facilities and providers based on the plan they select. A Bronze patient may have to go to Newark Beth Israel for a procedure versus a Gold patient being offered a choice of any hospital in the Barnabas System (St. Barnabas, Monmouth, Community in Toms River, etc.).
An unisured patient can walk into any Barnabas ER today and not be denied care.
The was the system works today is that the cost of providing indigent care is eventually added as a surcharge to paying patients in NJ. So at some level the insurer and patient (out of pocket/deductable) is paying for that uninsured patient.
An unisured patient can walk into any Barnabas ER today and not be denied care.
The was the system works today is that the cost of providing indigent care is eventually added as a surcharge to paying patients in NJ. So at some level the insurer and patient (out of pocket/deductable) is paying for that uninsured patient.
Another true story on how goofy the hospital charge master is. A couple of years ago one of our neighbors daughter was hit by a car as she was crossing the street when leaving a HS football game. (Fortunately, she only suffered a broken arm and nothing worse). They actually brought in a med-vac helicopter that had to land in a field on the northbound side of Rt 31, just across the highway from where the accident occurred (no more than 200 yards). Because of that, they had to put her in an ambulance to travel the 200 yards and the bill was $3,500 for a 30 second, 200 yard ride. Now the rate negotiated between payor and hospital was much lower (which is all that matters) and the only impact to my neighbor was the deductable, but explain to me how that "suggested list price" makes any sense?
So take that one step further...if she had no insurance, the hospital would go after my neighbor for $3,500 or if she was indigent without insurance, they will take that $3,500 and add it to the bills of paying customers as part of the indigent surcharge. Pretty nice scam all based on an artificial list price.
So take that one step further...if she had no insurance, the hospital would go after my neighbor for $3,500 or if she was indigent without insurance, they will take that $3,500 and add it to the bills of paying customers as part of the indigent surcharge. Pretty nice scam all based on an artificial list price.
The uninsured will now have access to physicians outside of a hospital. They will be able to treat illnesses and obtain prescriptions for things that may prevent the ultimate need of a trip to the hospital.
The "care" someone receives when they are uninsured is not a high quality level of care. They are treated and sent away. If they would benefit by return visits or check up's.. they are turned away unless it is an emergency.
It is not a perfect system and I don't think anything will be... but having access to healthcare is better than access to emergency care.
50% of physicians are now employees of hospitals and that number is going up to 80% in the next five years. The hospital will be the gate keeper and eventually with the merger and scale will also be insurers as well (see Pittsburgh market).
Access to care is a good thing, but Obamacare as I've stated was an insane way to go about that is just adding uneccessary costs and inefficiencies to the system.
Access to care is a good thing, but Obamacare as I've stated was an insane way to go about that is just adding uneccessary costs and inefficiencies to the system.
It's not going to be a high quality level of care this way, either, with many quality physicians getting out while they can still afford to, others moving into pharma and concierge medicine, and a serious decline in the quality (think foreign grads) of the primary care residents, as the pay is not on an upward trend, and the volume of patients, and complexity of the medical problems (previously under/uninsured) will be higher.
The ACA was bad legislation. The people's champion, Nancy Pelosi, was quoted as saying something to the effect of, "Let's get it passed, and see how it runs;" doesn't sound like the scientific method to me. The website disaster is just the tip of the iceberg, believe me.
This post was edited on 11/8 11:24 AM by donnie_baseball
That is 100% false in any of the Obamacare marketplace plans available.
Physician visits, drugs, labs, etc. must be paid towards the high deductibles before they pay dollar one. I can email you the plans I've gotten quotes on if you'd like.
This is the cheapest plan that would be available to me in essex county. copay only.
http://www.valuepenguin.com/health-insurance/NJ/amerihealth-amerihealth-nj-tier-1-advantage-bronze-epo-h.s.a.
Here are other example's of plans that would be available to me.
http://www.valuepenguin.com/health-insurance/NJ/horizon-advantage-epo-bronze
http://www.valuepenguin.com/health-insurance/NJ/amerihealth-amerihealth-nj-tier-1-advantage-bronze-epo-h.s.a.
Here is a plan that does has a 50% coinsurance instead of a copay.
http://www.valuepenguin.com/health-insurance/NJ/amerihealth-amerihealth-nj-premium-local-value-bronze-hsa-epo
If you go down to catastrophic coverage, they don't pay anything towards doctor visits.
Notice the first thing they all say:
"Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs."
These high deductible plans and their effects on people actually seeking care as youmduly noted,will the next shit that hits the fan, IMHO.
"Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs."
These high deductible plans and their effects on people actually seeking care as youmduly noted,will the next shit that hits the fan, IMHO.
That site is informational only and the platinum plans say the same thing.
Here is the blue cross bronze plan
http://www.horizonazul.com/sites/default/files/ifp/en/IHC_Adv_EPO_Bronze_100_50%20$30_50P_On_Exchange(G3457_P2160_G3547_P2161).pdf
Primary care visits for illness or injury are a $30 copay only.
Same thing for AmeriHealth EPO for NJ.
http://www.amerihealth.com/pdfs/health_plans/epo/ihc_30-50.pdf
This is off topic from the Merge / SPK exchange.... but......
with regards to the web site.
The administration admitted that there are a couple hundred "punch list" items (never heard "punch list" before... it must be a political term) or problems that needed to be fixed. And that they would have them fixed by the end of November.
They also admitted that they didn't do an end to end user test of the system.
First, as an IT guy for almost 40 years... I gagged at that statement. How do you roll something of this magnitude out with no end user acceptance testing?
Let's suppose that they code for the hundreds of problems by end of November... that still leaves a system that has not been tested and the resulting system won't be much better than the one that was rolled out October 1. Unless they bite the bullet and take the system off line for two months (at minimum) to fully test, I guarantee that another hundred problems will surface.
I heard one supporter of Obamacare say that they'll have most of the problems fixed by the end of November. Would you put your personal information onto a commercial web site that claims they have most of the bugs worked out of their web site? It darn better be perfect or that company will go out of business.
The American people should demand the same from the government that they would demand from any commercial enterprise.
This post was edited on 11/11 1:22 PM by PiratePride
with regards to the web site.
The administration admitted that there are a couple hundred "punch list" items (never heard "punch list" before... it must be a political term) or problems that needed to be fixed. And that they would have them fixed by the end of November.
They also admitted that they didn't do an end to end user test of the system.
First, as an IT guy for almost 40 years... I gagged at that statement. How do you roll something of this magnitude out with no end user acceptance testing?
Let's suppose that they code for the hundreds of problems by end of November... that still leaves a system that has not been tested and the resulting system won't be much better than the one that was rolled out October 1. Unless they bite the bullet and take the system off line for two months (at minimum) to fully test, I guarantee that another hundred problems will surface.
I heard one supporter of Obamacare say that they'll have most of the problems fixed by the end of November. Would you put your personal information onto a commercial web site that claims they have most of the bugs worked out of their web site? It darn better be perfect or that company will go out of business.
The American people should demand the same from the government that they would demand from any commercial enterprise.
This post was edited on 11/11 1:22 PM by PiratePride
Are they bronze level plans?
All of the bronze plans that I have seen in NJ pay something towards doctor visits. Looks like 50% or a copay.
The catastrophic plans do not pay anything towards doctor visits but they are not available if you are over 30.
The point is that there is coverage available at the bronze level that will cover doctor visits which will be helpful to people who should be going to a doctor but avoid the m because of the costs.
