Talking Heads - Healthcare Reform

[nlhome]

Talking Heads #6

"It occurred to me that nothing is more interesting than opinion when opinion is interesting..."
Herbert Bayard Swope, creator of the Op-Ed page.

A two week  forum for opinions on anything in print: magazines, newspaper articles, online: bring your ideas and let's discuss.

Our Sixth  Selection is:  
Health Care  Reform~! Are We on the Fast Track?

7 Ways Health Reform Is Going to Affect You
Newsweek June 10, 2009

There is a VA health program, but like anything else it has its red tape and rules and, if the medical need is not service-related, financial eligibility rules too. I would guess that some of the vets are unable to get into the system for one reason or another. They need advocates. Our county right now is cutting the program that helps veterans here apply for benefits - supposedly it won't hurt the veterans, but for some of them even a phone call returned a day later might be the final straw...

[ANNIE]

The VA takes very good care of all the vets from all the wars.  I have heard bad and good concerning about their hospitals but most vets have access to the VA Medical Centers and ours here in Columbus,OH, is really a good one.
 
Two of our largest VA hospitals have been reported in very bad shape and I have seen the pictures which are awful.  But it is my understanding that repairs are being made quickly.  I certainly hope so.

My BIL is taken care of by the VA hospital and center in Indianapolis and he is receiving marvelous care although he is not in the hospital itself.   The man has heart disease  and diabetes which might have been caused by his exposure to Agent Orange.  He receives money from the Agent Orange settlement each month. They have provided him with a wheelchair plus an electric chair for getting about outdoors.  They are now providing his dialysis three times a week.  They will pick him up if my sister or her daughter can't get him there on a busy day.  They provide all of his meds.  He is a Vietnam vet who has a purple heart plus a medal of honor.  I am saying too much so I will stop. This is quite enough for now. 

But I can't quit!   My husband who is a Korean vet gets care and his wound supplies(from his heart pump surgery back in March) from our VA center here.  The people there are just wonderful.   

[bellemere]

Just curious about veterans who are discharged from the service and then get sick with something not related to their military service.  If they are working, do they rely on thier employer based insruance?  If they are over 65 do they get Medicare?  If they have a prmanent disability not related to service and cannot afford insurance can they get Medicaid? As a general rule, VA facilities treat veterans with service-related problems, right?
Other vets are in the same boat as the rest of us?
there is a big VA hos;pital near me whcih treats alcoholism, drug addiction, and post traumatic stress syndrome.  Are those conditions tied to their service?  I think progably the PPTSD must be. What about the others?

[nlhome]

Veterans with service-related disabilities are treated at the VA for those problems. Others, depending on their income, also get treatment for their problems. They get Medicare if they are 65 and have enough work credits. They can get Medicaid if they ar4e low income, although I think the VA provides better.

Like anything else, there is no simple answer. It often depends on the circumstances.

My husband is a veteran, has always received his health insurance through work and now as a retirement benefit. If we were low income, he could go to the VA for help with medical issues. The VA care is good in our area.

[ANNIE]

I guess that I didn't make the story of my husband very clear.  He was not injured during his time in USAF, but VA are taking care of his supplies that he needs to keep his perc site clean and sterile.  This is a lifetime of wound care and those supplies would cost us $300 a month if it weren't for the VA. Medicare doesn't pay, at this time.  I had forgotten that he could get some things from the VA but my sister who is married to vet in the wheel chair suggested that I call them.   Success!!!
VA will also fill Ralph's Rx's when they are generically available but they charge more than our insurance charges so for now we will stick with our insurance.

[mrssherlock]

The history of America is rife with unintended consequences of bills passed.  That shouldn't prevent us from acting.  We have to start somewhere and as abuses come to light in the future we can make corrections.  Crying that this is wrong or that was left out should go only so far.  We need to have a line drawn in the sand and say this is where it stops.  The bill goes forward now, as it is, and we will continue to make up policy as we go along when we find the flaws.

[Babi]

 Makes good sense to me, JACKIE.

[nlhome]

Reading of the Senate discussions and versions, I'm confused - where's the reform? It's just more red tape and confusion. In the end, the insurance companies will come out ahead. I think it's sad.

[Babi]

 Isn't red tape and confusion SOP for Congress?  I just hope they muddle
through with something reasonable, and then as JACKIE says we can plug up the holes as we discover them.

[nlhome]

I've spent a career as a "red-tape cutter" and find the government programs easier to deal with, usually. The problems with government programs come when private companies are given too much control, as in Medicare Part D. What I see in health care reform is too much insurance company involvement - Congress is afraid to deal with the industry. While no one says so, I believe it's because they don't want to risk a market decline in that area.

[ANNIE]

NL and Babi,

I am still worried about this bill being passed with so many new ways to implement health care.  And the new news is that we will have the government looking over the insurance industry's shoulder to make sure everything is copacetic. I can just hear the cases before judges with the government on one side and the insureres on the other blaming each other for mistakes that are being made.  
And if I understand you, its easier if the government is running it all?  If that is so, why are all these expensive mistakes already being made by the medicare and medicaid systems not being investigated??
  
I firmly believe that if Congress had instigated torte reform plus thoroughly gone after the medicare and medicaid errors that are made every day, we would be okay.  Unfortunately that is not even being considered.

Yes, we need to get everyone covered and maybe the only way to do so is with a single payer insurance.  Of course, that's not going to happen because the insurance lobbies have too much power.  It seems as if the next election's results  are the only thing that is important here.

[nlhome]

I'm not saying everything is better with the government running it entirely, although I see in other countries that they spend less for good outcomes, but it is easier to address inequities with the government.
I believe there is some consideration for tort reform.

I agree that there is fraud and abuse with Medicare and Medicaid, and that is really annoying because it isn't being pursued as much as it should be. However, we don't know how much fraud and abuse there is in the private insurance world because they aren't going to share that information, while the government has to.

What annoys me is that when the big companies, such as the drug companies, are fined or punished, while the amount seems big to us, it is a drop in the bucket compared to their earning from such fraud. The government uses a law from the Civil War era, the false claims act, to prosecute much of the fraud. But the companies pay the fines and then that becomes part of their cost of business. I believe that the people who countenance such large-scale fraud should be imprisoned - because if there is no personal responsibility, then the executives in charge can just look for another devious way to get more money out of the programs.

There are fraud and abuse programs in every state, where people are supposed to report instances where they think there is fraud. Of course, then Medicare has to investigate, and that takes employees and money, and.....

[Babi]

 I never said that, ANNIE. That it is better if the government is running
it all, I mean. If I'm not mistaken, the government running anything in
the private sector, means it will be more expensive, inefficient, and
badly run. Imagine our countries big businesses run by a bureaucracy!
[shudder]

[ANNIE]

Sorry to include you in that comment, Babi! I was just aiming my comments to both of you because I was too lazy to separate your comments.  Mea culpa, mea culpa??

Yes, the government needs to stay out of our business but it looks to me as though they are just taking on more and more of our private industries plus this healthcare decision.

nlhome,
Seems that when we do catch anyone cheating on Medicare or Medicaid, we never hear the results.  Did you see the program about the Medicare cheaters and how easy it is to make money making false claims?  What a shocker that was to me!

[nlhome]

Although I didn't see that program, I have read about it and have listened to a speaker discuss some cases.

Medicare used to send explanations of benefits whenever it paid a claim, then it went to monthly statements, now they are quarterly, and not all claims are included. So, how do people even know what Medicare and their insurance pay for them? Especially if there is no amount due that would rais an eyebrow or two.

People who are computer literate, have a computer with Internet and a good connection and want to spend the time can check their claims on line.

We kne of a dentest who was charged with insurance fraud - it wasn't just Medicaid, it was private insurance fraud too. As I said, the government does reports on fraud, but how do we know what problems private insurance have? They wouldn't want to upset investors.

[ANNIE]

Oh, yes the new way to save the trees, by Medicare!
nlhome
Now we get the quarterly on one or two or three pieces of paper with my husband's listed first and mine listed last.  I don't know about all of you, but I used to keep our EOBs plus bills paid or still pending in separate folders.  Now, if I need to challenge any of these, I have to search both of our folders and then online.  Last time that I called, the private insurer couldn't answer my questions because they hadn't been paid yet so that part wasn't included on the Medicare EOB but on the private insurer's.  Go figure!  I sure can't.  One can't even have a common sense conversation with the poor operator who just doesn't get it.  Very frustrating!

[maryz]

nlhome and adoannie - we get a Medicare EOB for every claim.  Sometimes there are two or three on an EOB, but usually for the same date of filing (not necessarily the same date of service).  Maybe each state is handled differently. 

[Babi]

 

Did you see the program about the Medicare cheaters and how easy it is to make money making false claims?  What a shocker that was to me!

  It doesn't really surprise me, ANNIE. The plain fact is that the govt.
gets so many of these claims it is simply impossible to check out each
one thoroughly.  The clerks who handle the claims will have guidelines
on how to proceed, and personnel costs will be a major consideration.
That's one reason why they publicize so much the need for people who suspect fraud to report it.
   

[nlhome]

maryz, do you have original Medicare or a Medicare Advantage plan?

I think sometimes the Medicare carrier that processes claims for original Medicare has its own schedule, but I know some claims don't make it on to the Medicare statements here. There are different carriers around the country. But getting a statement once a quarter is frustrating.

[maryz]

nl, we have original Medicare.  Our supplement is through John's retirement.

[bellemere]

As the Health Care Reform debate comes to a boil, it becomes easier to see how the entire effort has been taken over by the private insurance industry and their lobbyists. Think of it: Millions of people will be required to buy health insurance , and all of that business will go to private insurance companies, which can charge whatevere they want.  If I had money I would be buying stock in AEtna right now!  and to top it off, the government will be subsidizing the purchase for low income people.  What a windfall!
A badge of shame to Joseph Lieberman - the Medicare buy-in for 55 and older gives a break to all those who are "downsized" in order to give jobs and benefits you younger less expensive people. But is you ever drive into Hartford Ct you will see all the huge private insurance buildings that dominate the economy of that state! 
If it actually passes, let's see what the regulatory process can do with the insurance companies.  That is how it is done in Germany;' all the insurance is "private" but strictly regulated as to what they can charge, make as profit, pay their execs.  We may still have a chance to rein in costs that way. 

[bellemere]

Trying to visualize what this is going to look like in final form.  Most of it doesn't even take effect until 2014.  But from the moment the President signs it, there is one important provision that takes effect immediately: no child can be refused health insurance on the basis of a pre-existing condition. 
There are some restriciton on insurance companies:  They must pay out, in claims, 85 percent of what they collect in premiums and cannot "cap" benefits in the case of a long illness.  When the fog finally clears, maybe we can make some sense out of it.
But a lesson has been learned for senators:  When the vote is close on your side, and your vote is critical, you can hold out for a bribe in the form of financial benefits for your state, and a boost for your reelection.  Politics as usual.

[marjifay]

I heard this morning that the U. S. Attorney General might look into the provision providing Nebraska with federal benefits that no other state can have.  They think this might be unconstitutional.  Even the other senator from Nebraska didn't think that was right.  I hope they deny it. 

Marj

[bellemere]

So many of the posts here talk about "the government" as if it were some alien force, distant and removed from us, working its will on us helpless people.  This is a democracy, the government is us.  We get exactly the government we deserve by our inaction, passivity, selfish attention to our own narrow interests.  Look at the low level of voting, what is it, a third of eligible citizens vote?  In Iraq and Afghanistan, hardly models of democracy, people risk their lives to go to the polls and vote.   The streets of Iranian cities are seeing wild demonstrations of citizens who want a more democratic form of government.  Yes, the governement should not be taking over banking, car manufacturing, etc.  But they had to bacause the vaunted private management ran the industries into the ground.  Nobody wants to strangle pri ate enterprise, but the corporations have to be more sensible and not always grab for the short term profit. The private insurance industry, coupled with Americans' demand for every possible form of medical treatment gave us the best health care system in the world for those who could afford it.  And almost a third of our population can't.

[Babi]

But a lesson has been learned for senators:  When the vote is close on your side, and your vote is critical, you can hold out for a bribe in the form of financial benefits for your state, and a boost for your reelection.

  Nothing new there, BELLE. SOP for politicians. And your other statement is equally true. 

This is a democracy, the government is us.  We get exactly the government we deserve by our inaction, passivity, selfish
attention to our own narrow interests.

[ANNIE]

I believe that we can still let our congressmen/women know how we feel.  Just go to Congress members.gov and find yours now and say what you do or do not want in this bill.  I, for one, want to take the government paying for abortions so my voice will be heard.  Whether or not, anyone is listening is not knowable. 

[bellemere]

Yes, it is never out of line to contact your rep or senator about your views.  One thing to remember: one phone call is worth ten emails. Always request an answer.

[Babi]

 I believe I've always gotten a reply to a letter or e-mail to a political
figure.  Send by an aide, no doubt, and assuring me my concerns are
of interest to the politico in question.  The last one I received, as I
recall, referred me to a recent article in which the pol. had expressed
his opinions on the subject.  He disagreed with my views, but I thought
the reply showed they were making an effort to be reachable.

[ANNIE]

I usually receive an answer to my concerns, either by email or snail mail. 

[bellemere]

So now the "reconciliation process" when they come back.  More of the same fighting, name-calling and deal-making that has been going on for so long?  Don't know how much more we can take.

[bellemere]

I guess I am having an epiphany of sorts;  why, oh why , didn't they just expand Medicare to cover everyone?  Workers ow have a deduction from thier paychecks for medicare; the system is in place.  Medicare, a government funded program that reimburses private hosptals and doctors for providing care. Its costs have risen, but according to James Suriowicki, economist , they have risen at a much slower rate than the costs at private insurers.
As I understand it, insurance will now be sold b;y private companies but now they will not be able to take anything in to account settin premium orices except age, region, and whether or not you smoke.  A far cry from all the slicing and dicing ofpopulations they are so good at.  the new system is called community rating, and all that actuarial expertise is now useless.  We could easily get along without the private companies, but Joe Lieberman, whose state floats on the insurance industry, obviously could not.
I think the new bill contains something for every demagogue, rather than something for all the people.
How nice that the wealthy enterainer, Rush Limbaugh was able to obtain good care in his  recent health evergency.  "Best health care system in the world, he says,
Nothing wrong with this system. "  the doctos who know better must have had tobite their tongus

[maryz]

It'd never work, bellemere - it's WAY too simple and logical and obvious. 

[nlhome]

I think the single payer system, particularly Medicare for all, would be the best, too. Insurance companies could be in a supplementary role then, either as Medicare carriers (the insurance companies that handle the claims for a fee) or providing supplemental coverage as they do now for Medicare. I suspect that most of the Democrats, at least, know that we need something like that. However, I believe they fear the effects on the stock market, if insurance companies were curtailed like this, but they don't have the courage to come out and say that.

[ANNIE]

Well, Bellemere, you have solved the problem.  I wish that you could get the ear of the those dodos in DC!  Lets see, what about adding torte reform to that package.  That would bring down the drs' costs and also the medical bills we receive with a 10-20% add on to pay for the drs' insurance protection from law suits. 

[bellemere]

I think tort reform is needed.  I would like to see doctores whose careafully kept records show they acted consistently within proper protocols should either be immujne from malpractice suits; or should get a big break in their primiums.  I would also like (and this would be controversial) more mandated mediation of claims rather than jury trials where the lawyers trot out all their manipulative techniques to get ordinary juries to award scandalously big money.  I do not believe patients should give up their rights to sue, however.

[maryz]

Also great, bellemere!

[bellemere]

Okay so when I run for president my health care platform will be Medicare for everhyone with a job and Medicaid for everyone without one.   Problem solved. Private insurance companies can insure houses, businesses, cars, airlines, ships, trips to the moon and movie stars' legs. Keep your greedy capitalist hands off my health care!

[Steph]

Ah Bellemere, I do agree on lawyers. At the urging of my sons went to see a accident type attorney. All he wanted to hear was how much money my own insurance company was kicking in. He admitted freely that the person who hit us has no money and minimum insurance. My insurance company has been very helpful thus far and I have no intention of suing them for the amount they have already promised me.. If Idid, he would get 1/3.. He must have taked one look at grieving widow and thought he could snow me. Bah..

[bellemere]

Good for you, telling off the ambulance-chaser!  You are sounding like our Steph

[ANNIE]

TELL ME YOUR STATE.  I WILL RUN YOUR CAMPAIGN!  JUST KIDDING