thyme4change
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Post by thyme4change on Apr 4, 2011 12:14:18 GMT -5
Death panels?
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973beachbum
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Post by 973beachbum on Apr 4, 2011 12:36:27 GMT -5
We can start by not paying for those stupid scooters! And work our way up to those lift chairs without a major fight by people to prove why this person needs a chair while still living at home and driving to the store etc. If they need a wheelchair then they can get a wheelchair. Wheelchairs even electric ones cost way less than those scooters. Then we can work up to not paying crazy claims that blind martians know are bogus. Like the claims that say someone got 3 prosthetic limbs when they have never even been in the hospital. Now we pay the criminals and then after we realize it is bogus they ask the criminals nicely to give the money back. I am not advocating not paying legitimate claims but this pay first and ask questions later is crazy.
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Gardening Grandma
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Post by Gardening Grandma on Apr 4, 2011 12:41:48 GMT -5
I think that allowing Medicare to negotiate drug prices (like the VA is allowed to do) would be a major step in the right direction. Something that bugs me is that I'm required to get Part D coverage even though I don't take any meds at all. If I don't get it now and need to get it later, there will be a penalty.... So either I pay now for something I don't need or I don't pay now and pay a penalty later if I do need something.
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whoisjohngalt
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Post by whoisjohngalt on Apr 4, 2011 14:14:54 GMT -5
We are paying for scooters?? But... but... but.... the guy on TV told me that they are free to anyone who would just call 800 number. He couldn't have been lying!!!!! He was on TV!!!!!!!!!
Lena
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Post by Deleted on Apr 4, 2011 14:34:23 GMT -5
Personally, I think the ideal way to solve the insurance problem is, instead of a deductible and then 80% co-insurance, would be to have a gradual build-up in co-insurance the more you pay.
So you cover 100% up to a certain point, 80% up to a certain point, 60% up to a certain point, etc. etc.
The problem is, even with high deductible plans, that there is a tendency to just go hog wild once your deductible is hit. I have a high deductible plan of $3K. So it should make me a "Smarter Consumer". But realistically, if I have to go in for any procedure/testing, I'm blowing through that $3k. So it makes me a smarter consumer until I hit $3K. And most doctors know this as well, so cost never comes up.
Costs will continue to rise as long as this type of system is in place. You need the doctors/patients both equally as concerned with the cost/benefit of the procedures they recommend.
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973beachbum
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Post by 973beachbum on Apr 4, 2011 14:41:37 GMT -5
We are paying for scooters?? But... but... but.... the guy on TV told me that they are free to anyone who would just call 800 number. He couldn't have been lying!!!!! He was on TV!!!!!!!!! Lena He is sort of telling the truth. It's free to them. You get the bill.
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Gardening Grandma
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Post by Gardening Grandma on Apr 4, 2011 15:00:47 GMT -5
We are paying for scooters?? But... but... but.... the guy on TV told me that they are free to anyone who would just call 800 number. He couldn't have been lying!!!!! He was on TV!!!!!!!!! Lena He is sort of telling the truth. It's free to them. You get the bill. 80% is covered if they qualify. That's not exactly free. That 20% puts it out of the range of lower income medicare recipients.
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Post by Deleted on Apr 4, 2011 15:09:17 GMT -5
I've read that around 1/4 of medicare expenditures are in the last year of life. Many seniors don't have written instructions on the care they would like so families insist on getting every procedure done, even if won't extend life or it's quality. The local newspaper has reported stories of comatose seniors being given heart surgery at the families insistence.
There was an article recently on doctor's wanting to take a look at dialysis and see if it made any sense past a certain age. They interviewed a 70 odd year old woman who was told that dialysis would cause more problems than it would solve. In her case she ended up with numerous surgeries due to the dialysis. These are heavy expenditures at the end of life.
I believe better education, advance directives and hospice care could greatly reduce medicare outlays.
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formerexpat
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Post by formerexpat on Apr 4, 2011 15:15:13 GMT -5
I'm afraid your history is a bit hazy.
The government turned health insurance from what used to be; for catastrophic issues only prior to Medicare to subsidizing every boner a senior might want. Tie a disorder to it so insurance has to cover it. Enter EDD, enter ADD, blah, blah, blah.
There are a handful of modifications that can be made from both a public and private perspective to eliminate government healthcare and provide it fully through private entities. Nobody is interested in common sense though.
Two simple changes: 1) a centralized IT record / billing system and 2) taking a strong look at litigation reform that creates defensive medicine and malpractice premiums for our doctors that are 10x that of European doctors would go a long way to help reduce costs.
Other than that, I am a fan of forcing people to have health insurance. This would enable insurance companies to offer guaranteed acceptance since a person wouldn't go without insurance until they were 50 and only get it AFTER they became critically ill. A risk sharing product can't work under this scenario.
I'd also separate the connection of insurance with employers so people would have portability, and have the system build reserves like it does with life insurance and annuities so it can save for the medical bills that are going to come as you age. So, while a 25 year old might only use $4k per year now, we know they're going to use a lot more later. Charge $4.5k and put a $500 reserve for 40 years that can accumulate and earn interest [just throwing out numbers]. [/size]
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Post by Deleted on Apr 4, 2011 15:18:18 GMT -5
So, while a 25 year old might only use $4k per year now, we know they're going to use a lot more later. Charge $4.5k and put a $500 reserve for 40 years that can accumulate and earn interest [just throwing out numbers]. That would be nice. DH and I paying for private health insurance now (no medical or dental) for ourselves and DS. We pay around 1k a month in premiums and have been paying an additional 1k a month on average in other healthcare bills. I think people really underestimate what their medical expenses are going to be in retirement.
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Gardening Grandma
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Post by Gardening Grandma on Apr 4, 2011 15:27:33 GMT -5
I've read that around 1/4 of medicare expenditures are in the last year of life. Many seniors don't have written instructions on the care they would like so families insist on getting every procedure done, even if won't extend life or it's quality. The local newspaper has reported stories of comatose seniors being given heart surgery at the families insistence.
This is a very good point. Last year when they proposed letting Medicare cover an "end of life" consultation with the doctor, the Republicans started screaming "Death Panels!". But that sort of consultation would clarify, for the patient and their families, exactly what should and should not be done. And, quite probably, would cut down on expensive procedures that serve only to prolong the inevitable result.
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973beachbum
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Post by 973beachbum on Apr 4, 2011 15:31:07 GMT -5
He is sort of telling the truth. It's free to them. You get the bill. 80% is covered if they qualify. That's not exactly free. That 20% puts it out of the range of lower income medicare recipients. GG most of those companies that sell this type of product don't charge the recipient the 20%. By waiving it they sell way more than they otherwise would. There are no laws to stop them from doing this. DH's grandparents got both scooters and the chairs that lift the seat. They were pretty low income. They did not even need them at the same time. but when it came time for grandma she actually said why use grandpa's old one when medicare will get me a new one for free, and they did. Those two chairs and two scooters are in DH's father's garage and how much does anyone want to bet that if DH's father need either he will get Medicare to buy a new one rather than use the ones in the garage?
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Gardening Grandma
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Post by Gardening Grandma on Apr 4, 2011 15:39:25 GMT -5
80% is covered if they qualify. That's not exactly free. That 20% puts it out of the range of lower income medicare recipients. GG most of those companies that sell this type of product don't charge the recipient the 20%. By waiving it they sell way more than they otherwise would. There are no laws to stop them from doing this. DH's grandparents got both scooters and the chairs that lift the seat. They were pretty low income. They did not even need them at the same time. but when it came time for grandma she actually said why use grandpa's old one when medicare will get me a new one for free, and they did. Those two chairs and two scooters are in DH's father's garage and how much does anyone want to bet that if DH's father need either he will get Medicare to buy a new one rather than use the ones in the garage? BB, I kind of wondered about that. If the companies can afford to waive the 20%, then they are probably over charging to begin with..... I do think that there are areas where Medicare **COULD* cut and this may well be one of them; the caveat being the question "How many more people would they have to hire to do that? Would the savings be greater that the increased cost?"...
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Sum Dum Gai
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Post by Sum Dum Gai on Apr 4, 2011 15:43:08 GMT -5
They could take a page from private insurers play book and put a few things on the elective list and refuse to pay for them. Viagra comes to mind. However, I imagine AARP would be getting quite a few irate phone calls.
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Post by Deleted on Apr 4, 2011 15:43:28 GMT -5
I agree on providing end of life consultations, and negotiating/reimporting drugs. (And lets stop Pharma FRAUD in medi programs too... how about some criminal convictions... that might start to discuade them... or make they pay out more than just a small fraction of what they make when they defraud the government...)
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973beachbum
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Post by 973beachbum on Apr 4, 2011 15:53:33 GMT -5
Defrauding Medicaire has over taken dealing drugs in some parts of the country. That alone should tell everyone how easy and lucrative it is. I don't remember the law, and am too lazy to look it up right now , but Congress made a law that medicaire is not allowed to not pay a claim even if they know it is fraudulent. The law says that they must pay the provider first and then investigate the claim. So the former drug dealer is suppsed to be a good boy and return the money afterwards?
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phil5185
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Post by phil5185 on Apr 4, 2011 15:55:47 GMT -5
Those two chairs and two scooters are in DH's father's garage and how much does anyone want to bet that if DH's father need either he will get Medicare to buy a new one rather than use the ones in the garage? Yes - and the scooters have zero resale value. Why would someone pay even $50 for one when they are 'free'? We couldn't give one away when my father died. And I would feel the same way - you don't know what the disease was, where the scooter came from - so why not wait for a new one?
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Post by Deleted on Apr 4, 2011 15:57:17 GMT -5
And lets stop Pharma FRAUD in medi programs too... Have you seen what's been happening with the drug for preterm babies? It's disgusting. This week, the cost of an injection to prevent a premature birth is roughly $10 to $20. Next week, it will cost $1,500. Why? That is when KV Pharmaceutical starts marketing its newly approved Makena, a form of progesterone that, for many years, was offered by compounding pharmacies. Now, though, KV has an exclusive lock on the market and is threatening compounders who dare to encroach.
“I’ve never seen anything as outrageous as this,” Arnold Cohen, an obstetrician at Albert Einstein Medical Center, tells the Associated Press. “That’s a huge increase for something that can’t be costing them that much to make,” says Roger Snow, deputy medical director for Massachusetts Medicaid. And Joanne Armstrong, who heads women’s health at Aetna, says: “I’m breathless.”
Indeed, insurers and government healthcare programs must now contend with the soaring cost, despite a patient assistance program (see this). KV Pharma ceo Greg Divis says the price is justified because caring for a premature baby can run $51,000 in just the first year after birth. “Makena can help offset some of those costs,” he tells the AP. “These moms deserve the opportunity to have the benefits of an FDA-approved Makena.”
With $1,500 injections given to patients between 16 and 20 weeks of gestation, Makena can run $27,000 to $33,000, according to an investor note by Imperial Capital analyst Doug Dieter, who pointed out KV is tripling its sales force to 150 reps. He forecasts Makena revenue reaching nearly $1.1 billion by 2015, if there are no hiccups. This would amount to a remarkable turnaround for a drugmaker that, not long ago, was something of a train wreck.
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973beachbum
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Post by 973beachbum on Apr 4, 2011 16:02:01 GMT -5
GG most of those companies that sell this type of product don't charge the recipient the 20%. By waiving it they sell way more than they otherwise would. There are no laws to stop them from doing this. DH's grandparents got both scooters and the chairs that lift the seat. They were pretty low income. They did not even need them at the same time. but when it came time for grandma she actually said why use grandpa's old one when medicare will get me a new one for free, and they did. Those two chairs and two scooters are in DH's father's garage and how much does anyone want to bet that if DH's father need either he will get Medicare to buy a new one rather than use the ones in the garage? BB, I kind of wondered about that. If the companies can afford to waive the 20%, then they are probably over charging to begin with..... I do think that there are areas where Medicare **COULD* cut and this may well be one of them; the caveat being the question "How many more people would they have to hire to do that? Would the savings be greater that the increased cost?"... GG it is my understanding that those scooters that are advertised on TV cost 4 to 5 times as much as an electric wheelchair. Clearly it is high profit item. The fact that they advertise on TV is a good indicator. DH's grandparents ended up needing an electric wheel chair anyway. The scooter just couldn't do some of the things that it did. And if anyone really wants one I am sure they are thousands of them in people's basements and garages. A for profit insurance company would at least take the scooter back when the patient was done. Then the next time someone wanted one they would give them the used one. It happens all the time with durable medical equipment. Except when Medicare is the payer.
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Deleted
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Post by Deleted on Apr 4, 2011 16:06:27 GMT -5
"So the former drug dealer is suppsed to be a good boy and return the money afterwards? "
He should return the $$ X 3... which the law allows... and then have his bum thrown in the brig... so to speak... But these cases take tooo long to prosecute... and they end up settling for a fraction... and no one goes to prison... I'm watching... it could be changing... we can hope...
Anne... i've heard some, but am not up on it a lot... I'm not surprised.. my area of main interest and research is psych drugs... into which pharma has exponentially increased their 'markets' in the past decades to foster kids and the elderly... and for which they market drugs that are not better, as better and manipulate medi to pay patented prices for subjective 'diagnoses' that they help to write the criteria for and educate doctors about ...
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Deleted
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Post by Deleted on Apr 4, 2011 16:06:33 GMT -5
Medicare Fraud in 2010: 48 Billion
Profits of 10 largest Insurance Companies: 13 billion
Just saying.
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Post by Deleted on Apr 4, 2011 16:07:54 GMT -5
davebo... where are you getting your number? Thanks. I would doubt that most fraud from 2010 has even been uncovered yet?
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Post by Deleted on Apr 4, 2011 16:14:09 GMT -5
You know what snerd... studies show that people often don't want that stuff at end of life. And if you allow for consultations and help people plan their end of life contingencies, when they are a still able to do so, then the cost of end of life goes down. But lots of that stuff is done today because 1) there is no legal paperwork drawn up and emotional next of kin end up asking for things that the person himself would not want and/or 2) there is no legal paperwork drawn up and the doctor and facility are covering their backsides...
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Post by Deleted on Apr 4, 2011 16:15:23 GMT -5
oped - have you read "We've got Issues" by Judith Warner? It really made me think regarding children and medication.
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973beachbum
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Post by 973beachbum on Apr 4, 2011 16:15:59 GMT -5
Medicare Fraud in 2010: 48 Billion Profits of 10 largest Insurance Companies: 13 billionJust saying. I actually think the fraud is higher than that. And these felons who commit most of it really used to drug dealers. They use a system they learned in prison to get lists of peoples names and SS/Medicare numbers. Then they bill Medicare for the most expensive thing they can think of. Even if a blind martian could tell it is fraudulent they know that they law requires the Medicare claims dept to pay first and ask questions later. By the time they get around to even looking for them they have moved and changed names. There was a piece on 60 Minutes a few years ago. Anyone want to bet it's gotten worse?
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resolution
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Post by resolution on Apr 4, 2011 16:17:09 GMT -5
And lets stop Pharma FRAUD in medi programs too... Have you seen what's been happening with the drug for preterm babies? It's disgusting. This week, the cost of an injection to prevent a premature birth is roughly $10 to $20. Next week, it will cost $1,500. Why? That is when KV Pharmaceutical starts marketing its newly approved Makena, a form of progesterone that, for many years, was offered by compounding pharmacies. Now, though, KV has an exclusive lock on the market and is threatening compounders who dare to encroach.
“I’ve never seen anything as outrageous as this,” Arnold Cohen, an obstetrician at Albert Einstein Medical Center, tells the Associated Press. “That’s a huge increase for something that can’t be costing them that much to make,” says Roger Snow, deputy medical director for Massachusetts Medicaid. And Joanne Armstrong, who heads women’s health at Aetna, says: “I’m breathless.”
Indeed, insurers and government healthcare programs must now contend with the soaring cost, despite a patient assistance program (see this). KV Pharma ceo Greg Divis says the price is justified because caring for a premature baby can run $51,000 in just the first year after birth. “Makena can help offset some of those costs,” he tells the AP. “These moms deserve the opportunity to have the benefits of an FDA-approved Makena.”
With $1,500 injections given to patients between 16 and 20 weeks of gestation, Makena can run $27,000 to $33,000, according to an investor note by Imperial Capital analyst Doug Dieter, who pointed out KV is tripling its sales force to 150 reps. He forecasts Makena revenue reaching nearly $1.1 billion by 2015, if there are no hiccups. This would amount to a remarkable turnaround for a drugmaker that, not long ago, was something of a train wreck. The good news in this case is that the FDA announced that they would not stop the other pharmaceutical companies from continuing to manufacture the drug, so it will still be available for $20 as a generic. KV responded by cutting it's price by 55% and offering rebates. Kind of shows the value of allowing actual competition in the marketplace. www.fiercepharma.com/story/will-kvs-55-makena-price-cut-satisfy-critics/2011-04-01?utm_medium=rss&utm_source=rss
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Post by Deleted on Apr 4, 2011 16:18:36 GMT -5
Thanks for the update kari - it's nice to know that public outcry can actually accomplish something!
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Post by Deleted on Apr 4, 2011 16:34:37 GMT -5
davebo... where are you getting your number? Thanks. I would doubt that most fraud from 2010 has even been uncovered yet? United States Government Accountability Office www.gao.gov/new.items/d11430t.pdfFrom the report: In the February 2011 High-Risk Series update, GAO continued designation of Medicare as a high-risk program because its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges. In 2010, Medicare covered 47 million people and had estimated outlays of $509 billion. The Centers for Medicare & Medicaid Services (CMS) has estimated fiscal year 2010 improper payments for Medicare feefor-service and Medicare Advantage of almost $48 billion.
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runewell
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Post by runewell on Apr 4, 2011 18:56:05 GMT -5
By the way, this is a shift of taxpayer dollars, many borrowed now, to the insurance industry pharmaceutical companies which is are going great guns.
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stats45
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Post by stats45 on Apr 4, 2011 19:23:11 GMT -5
Rationing is the only way to lower health care costs. Nothing goes down in price if there are an endless amount of subsidies, programs, and regulations to require care.
There are two ways to effective use rationing to control health care costs.
(1) You can have a government operated or centrally-run health care system. This system either heavily regulates an individual insurance market or provides (or pays for care). In this system, costs are controlled directly or indirectly through regulations and cost-effectiveness calculations. Ability to pay is not as important in determining care as the relative need posed by the health care program.
It is like saying that everyone will pay 10% of their income for health costs. This 10% of GDP (just as an example) would be used to implement a health care system that would have to cover all needs. Priorities in care would be based upon medical need, age, and the effectiveness of a program.
(2) You can have a completely market based system to provide for health care needs. Health care costs decrease as people cannot afford health care at certain prices. Prices either fall or certain types of treatments fall out of use as they are no longer cost effective.
#1 can be inefficient and bloated but #2 is just not politically feasible in any major democracy. Most countries choose to do #1, and we choose to do a very costly and inefficient combination of #1 and #2 that provides us with medical technology that would not be viable in other countries but absurd costs that far outpace the rest of the world due to how heavily we subsidize ability to access these technologies and services.
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