morning on Medicare. I think he gave us a window into what is coming.
He outlined a number of measures that would help to put Medicare on
firmer footing.
The federal government will spent north of $1 trillion in 2011 for
health care (7% of total GDP!). Half of that will go to Medicare. That’s
a bad result. But it is nothing compared to what will happen in the
coming decade. The cost of all medical treatment will rise substantially
above Mr. Bernanke’s measurement of inflation and there will be many
more people on the Medicare line due to the rapidly aging population. So
what does Doug suggest?
Cut payments to Medicare providers for services they provide.
There have already been cuts made. But they are temporary. Elmendorf
wants more. This makes sense. Cutting payments to Dr’s, hospitals and
service providers like nursing homes would make a big difference on the
financial side. It would also make a big difference to Granny in that
nursing home. It’s worth noting that Elmendorf doesn’t think this is
likely to happen:
Whether the reductions will be sustained over a long period of time remains to be seen.
Another suggestion is to extend the eligibility schedule for Medicare from 65 to 67.
I am quite certain this will happen. The only question is how soon it
will happen. Some smart fellow will do an analysis on the proposal and
conclude “It will save us X dollars, but Y people will die as a result”. The X in this calculation will be big. The Y will also be big.
This recommendation will strike a dagger at the Administration and all those Dems who supported Obamacare:
Reverse the expansion of Medicaid and the subsidies for purchasing insurance that were enacted in last year’s legislation.
The suggestion is that we will have Universal Health Care “Lite”. It also implies that Obamacare comes up for some redrafting. If they start messing with this it will be the death of it. (Politically this would suit the Republicans and Tea Party set-ergo look for it to happen)
A separate suggestion is to treat employer contributions to health insurance as income and tax it accordingly. This is just a tax increase for workers. It will go over like a lead balloon.
But we need to remember that this concept is already part of the
current law. It was part of the Obamacare stealth tax increases. These
tax increase are scheduled to go into effect in 2018. This could happen
much sooner according to Elmendorf:
Last year’s legislation changed the tax treatment of employer-sponsored health insurance, but only in 2018 and beyond. That provision could be accelerated and strengthened.
The most significant recommendation (to me) is the suggestion that
Medicare will not cover new treatments under some circumstances. This is
the Death Panel concept of rationing health care that everyone has been taking about.
Currently,
Medicare pays the costs of nearly any medical treatment or procedure
that a doctor recommends. An alternative would be for Medicare to pay only the cost of existing ways of dealing with a specific health problem
I was surprised that Elmendorf made it clear that if someone on Medicare
had the money to pay for the better, newer treatments they could do it.
But they had to shell out of their pocket. In this plan, what happens to those who don’t have that money? Easy, they die or get inferior treatment.
Under such an approach, patients would be able to use their own money to pay for the more-expensive care, but the federal government would not pay more
Elmendorf acknowledges the difficulty in making the choices of which treatments are covered and which are not:
It
would be an immense challenge to formally classify treatments and
procedures into sets that address the same health problems and to
evaluate whether some treatments and procedures are better for some or
all patients.
Yes Doug, it will be an “immense challenge” to come up with that list. But that list is coming. And again, as a result of the list, some will die.
We have to make hard choices. Ones that will result in suboptimal health
care and yes, premature death. It’s good that the CBO put this on the
table. It’s still not easy to read. Anyone who says that America is such
a wealthy country ought to look at it. We’re not as rich as we’d like to think we are.
Part of the solution is moving away from low co-pay plans and reverting to what was more common in the days before the HMO model became popular. When patients are paying 20% (pick a number) of the cost of care, they pay a little more attention than they do when an MRI costs them $20. Make that $160 and suddenly maybe they don't need that treatment.
HMO plans were originally marketed as a lower cost method of delivering medical care and it seems to me that it has removed any price sensitivity from the consumer. Won't solve every problem but would certainly provide some cost containment.
DING DING DING we have a winner! Its amazing that costs go up when the consumer and supplier of the service rely on a third party to foot the bill isn't it?
A few years ago I switched to the high-deductible plan + HSA thing. My premiums are 10% what they were before and the max out of pocket expense is only 20% more with the same company. What does that tell me? That folks are running to the hospital every time they have the sniffles because its a $20 copay. I pay the first $1500 out of pocket so I try the clinic and generic drugs first if there's anything wrong.
Being clueless on the solution is fair. I share that. I don't know what the answer is either. All I know is that the existing system isn't working, and it is obvious that on the current course it will fall apart.
But repeating the nonsensical propaganda about death squads for a certain approach is not. Show me an approach which doesn't offer limits to a finite resource (as in health care). Then you can honestly talk about death squads.
Here are seven things that a good attempt at Health Insurance reform should do:
1. Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax-deductible (for the Employer, that is!), but individual health insurance is not (So sorry, middle-class, wage-slave!).
2. Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able to
use that insurance wherever we live. With no real competition in CA, is it any wonder that Blue Cross can raise their rates around 39%?
3. Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars.
What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying. Why should a single man have to pay extra for OB-Gyn coverage, for example?
4. Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. Perhaps then Doctors can go back to ordering medical tests when they're necessary and not
just to cover their @ss, when dealing with some lawsuit-happy patient!
5. Make costs transparent so that consumers understand what health care treatments cost. Ever see a price list in a Doctor's office? Neither have I, yet we're
expected to pay $?? Whenever we get an appointment!
6. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and RESONSIBILITY. Too many people (especially their children!) order Doctors
to "Spare No Expense" when it comes to saving granny's life, even though she's been bed-ridden and on a ventilator for the last year. With no Quality of life, just what are these people trying to save?
7. Revise tax forms to make it easier for individuals to make a voluntary, tax deductible donation to help millions of people who have no insurance. In Minnesota, we can volunteer to spend some extra tax for a Wildlife fund,
why not a "People's Health Fund?"
Solutions exist, but they do NOT fit into Progressive notions of expanding the Leviathan Govt!
Someone has submitted either this list or one very much like it to ZH before. And the list has been critiqued - so I'm not going to re-do that here. Other than to make a couple of points.
Point 2 - history shows that insurance companies will cheat their customers whenever they can, so they must be regulated. If Point 2 were implemented, states would loose the ability to call insurance companies to account.
Point 5 - you don't see a price list in a doctor's office because the doctor changes his price for the same procedure based on what you are wearing when you walk in. Trust me on this one. Doctors charge well-off familes a different price than less well-off families. If you want a price list, talk to the doctor's biller. For any given procedure, ask what your insurance company's allowed amount is and what the covered amount is (covered is some percentage of allowed). The doctor should not be charging you more than the difference between the insurance covered amount and the allowed amount. But they usually do. Most people don't pay enough attention to catch it.
6. Medicare limits what procedures the doctor can do on grandma, while she is healthy as well as when she is at end-of-life. When the family says spare no expense, it won't be Medicare paying for what is done. They only pay for a limited set of procedures, and that is it. If anything more is going to be done, it is paid for with supplemental insurance, or it comes out of the family's pocket.
There is no spare no expense attitude bankrupting Medicare. But folks not on Medicare don't understand this, so it is an easy charge for dishonest politicians to make.
This is a really frustrating situation and no easy answers exist. It would be nice if everyone in "civilized" society could receive A+ care at a reasonable cost, so why don't we? Part of the answer to that has to be the profit motive and the corporate structure of universities, pharmaceutical companies, insurance companies, all seeking first and foremost to maximize shareholder value. To then add government mandates, obamacare, to this well established profit hungry machine, the only result is rising costs. To fix the problem we need to remove much of the profit motive in health care, it needs to be considered more of a utility, or public good, than a corporation. If medicaid will pay what hospitals charge then hospitals will charge as much as they can to maximize profit / shareholder value and therefore raise private insurance premiums. any talk of reforming healthcare without addressing the incentive to price services or products as high as possible is totally meaningless. but, oh no, this is socialist, and how dare we... I am ignorant to the details, these are only impressions.
Correct. The Palin/Limbaugh/et. al. approach is to basically implement Death Squads based upon the profit motive. Which seems rather stupid, but it's amazing how many people lap that up.
Bruce, I'm so grateful that you got the health care you needed, and I hope you're health now. I would like everyone to have the same.
I note your acknowledgement that your health insurance was responsible for your care and indirectly for your recovery. So shouldn't A+ health insurance be available to everyone at reasonable cost? Of course, but with D.C. in the way, and with all the monies diverted to the Ponzi-scheme-system instead of being available to individuals who earned them to buy private insurance coverage, how's that ever going to happen?
And as one now contemplating the smaller number of years I have left instead of the great number I used to have, I can acknowledge without any regret that we don't live forever and should not only be allowed but should be encouraged to make what we can of the time we have left -- without regret and without government restrictions on whatever income we have.
What gets in the way is government; it never solves any problems, but only constitutes a black hole down which we are forced to pour our hard-earned money. In that direction lies death. In freedom lies possibilities.
To say that government never solves any problems is a seriously uninformed statement. Government has solved problems you didn't even know existed. Commerce, as well as modern medicine, would be impossible without a standard system of weights and measurements. Government provides those and enforces the standards. The fact that you swallow perscription medicine without even thinking about it is testimony to the effectiveness of those standards. I won't even get started on the government research that has lead to solutions to all kinds of health problems.
To say that governments are as fallible as the people who populate them is one thing. To insist that government has never solved any problems is a different issue, and is incorrect.
I've been without health insurance for over 20 years, and I'm not dead...
I insure my own health by the food I eat and my own actions. Too bad we can't manage to teach that to our population. I have catastrophic ins. so as not to be a burden to society or my family in case of a "catastrophy" to my health, but you can not "buy" health - only your own actions can insure it.
Wow... this is one of the best and most succinct comments on healthcare I have ever seen.
+++++
Millions of Indians and Chinese have done quite well without health and life insurance. They may have sub par healthcare but atleast it does not cost an arm and a leg to get the basic needs covered. The rest is called "savings" a seemingly very very novel concept especially for the TPTB !!
Oh please. Why don't you be honest here and mention the limits to your catastrophic coverage? In real life, sh*t happens, and you are delusional if you think that your coverage is going to protect you from being a burden to your family. If your medical expenses go beyond a certain limit, you are cut off. Plain and simple. Once you hit that, you WILL be a burden to your family.
Numerous examples abound, including formerly wealthy people who had insurance, passed the limit, and the health costs wiped them out.
Sorry, but to think you can control the future is the epitomy of arrogance and delusion.
This doesn't even get into the fact that there are people with preexisting conditions who can't get coverage. And no, those aren't all lifestyle issues. Or those who are faced with bankruptcy because they require prescription drugs to live, which your coverage won't cover.
The problem is that there are limits to health resources. No matter how you slice it, there will be "death panels". Attempting to protray "death panels" just in the light of the Faux-news style that Bruce has done is deceptive and disengenous.
And with the current rate of increases in health care (with or without Obama's approach), it's only a matter of time before even your coverage is taken away from you.
Catastrophic ins. limits are 6 mil with a 10k deductable. I can cover the 10, and if we breach th 6mil... adios!
Yes, many have thought the same with their high deductible. Only come to find out years later that inflation in the health industry resulted in far less care than they had expected.
6 million might well end up buying you just a bad aide. Especially since health costs are going up faster than the rate of dollar destruction.
So you understand that paper of any sort can not fix the problem, right? I'm all on board for helping my family 1st, friends 2nd, community 3rd.
I will continue to care for myself and mine regardless of "money" or "insurance."
I'm sorry, but what is it about Countries which have much better health care coverage for their citizens that you find isn't working for them? Those are "paper" solutions, and they are doing a far better job than what we have here.
You propose the country as solution, I propose Self as a solution.
So it goes...
I'm showing solutions that work quite well for large groups of people. You are not, alas.
You are showing solutions that require endless fiat, I am showing you solutions that require only some knowledge and self discipline. I do, however, understand that my solutions do not work well for large groups of people.
Sorry, I disagree that endless fiat is required. At least we're in agreement then that your solutions are the preferred approach, but unfortunately don't scale.
As long as stupidity remains relatively painless, you will remain in the minority, the Ignorati will continue to bleat for a "Govt. Solution."
Yes, free market death squads are sooo much better, aren't they?
I will take care of myself. Woe to those who try and manage or prevent that.
Should my catastrophic insurance not cover a catastrophy, then I will die. On along enough timeline... you've been here before - right?
You state "Sorry, but to think you can control the future is the epitomy of arrogance and delusion." Ummm... that is why I take care of myself. Your arrogance is in thinking that there are solutions within your maze of paper (insurance, money, etc). Good luck with that.
I salute you in your independence. But alas, your approach doesn't work for all, does it? For example, being born with autism. Which, by the way, at least one insurance company is trying to categorize as a "lifestyle choice".
Applying your approach to such people is, alas, one of those death panel decisions. Sorry, I find that reprehensible. You apparently do not, I take it?
As far as your insinuation that there aren't solutions out there, well gosh, I think you just need to take a look at every other first world country out there. The US has the least bang for the most buck. Yes, there are indeed better solutions than what we have here.
The "death panel" in the stystem I subscribe to is called Nature. I do my best to have it work for me, of course with some effort on my own part.
No centralized system works for ALL - ever, in any way.
No one said it did. But civilized society is about living better than just by purely nature. If you wanted to subscribe completely to a primitive level, you wouldn't be on the Internet in the first place.
And no, you're not living competely by "Nature" as far as your health goes, either. You have catastrophic coverage. If you really believed in what you were saying, you'd drop that.
Cars abound. Car accidents happen in this nature.
You suggest that the laws and rules of men trump those of nature, or at the least can bend the lwas of nature further to your will. I say not.
So you avoid one of your inconsistencies by not addressing the issue, and instead create a strawman. And stating something that I never said, to boot.
A pity. I had expected better.
So the issue is socializing a healthcare system? I say it is first and foremost taking care of your own health as you should. No strawman - I view the issue from that of an individual, not from the hive. Address that FIRST and then we can talk about all for one and one for all.
The original point was about death panels, and how we already have them. And they are unfortunately based upon for-profit motives.
Ignoring your inconsistancies (which you didn't address, I note. Don't blame you, as things kind of fall down from there), I think it's great that you've solved your problem. And that you have the luxury of family and resources to do so.
Not everyone is so lucky and well off. Your approach is to just let them die. Personally, I think that's barbaric. You, apparently, do not. That kind of says it all.
To Apply Force:
Good for you, you put your money where your mouth is and take responsibility. It's troubling that so few realize that most of what they're assured is good for them (D.C. diet dictocrats who are in the pockets of USDA and its agribusinesses) is not, and that it's very easy to be healthy even in the US. However, people have to be motivated to seek information that's unimpeachable and whose facts they can test themselves for workability. Don't hold your breath for that to happen.
Clues to better health: don't depend on doctors, and don't listen to most doctor's advice on what to eat.
Why? How many well people go to doctors? Doctors' annual incomes depends on sick people, not on well ones, so why would they tell anyone the truth? If that sounds cynical, it isn't. My abandonment of all medical advice has resulted in experiencing good health for the first time, including recovery from insulin resistance. Finding the right information about diet was key. I had to keep on reading, discarding, and searching until I found the right book about 35 years), but if I can do it, so can everyone else.
I admire your spirit and your assumptions of responsibility for yourself.
For anyone who believes that our so-called health system is worth farts, read on:
"History reveals that the AMA was dictatorially led for the first half of the twentieth century by George H. Simmons, MD (1852-1937) and his protégé, Morris Fishbein, MD (1889-1976). Simmons and Fishbein both served as general manager of the organization and as editor of its journal, the Journal of the American Medical Association (JAMA). While these two leaders provided substantial benefit to the organization and to medical doctors, their methods of doing so have been severely criticized, with some historians referring to them as "medical Mussolinis."When George H. Simmons began in 1899 what became a twenty-five-year reign as head of the AMA, it was a weak organization with little money and little respect from the general public. The advertising revenue from the medical journal was a paltry $34,000 per year. Simmons came up with the idea to transform the AMA into a big business by granting the AMA's "seal of approval" to certain drug companies that placed large and frequent ads in JAMA and its various affiliate publications. By 1903, advertising revenue increased substantially, to $89,000, and by 1909, JAMA was making $150,000 per year. In 1900, the AMA had only 8,000 members, but by 1910, it had more than 70,000. This substantial increase in advertising revenue and membership was not the result of new effective medical treatments, for there were virtually no medical treatments from this era that were effective enough to be used by doctors today or even just a couple of decades later.
Some critics of the AMA have called their seal-of-approval program a form of extortion because the AMA did no testing of any products. When George Abbott, owner of a large drug company, Abbott Biologicals (known today as Abbott Laboratories), did not provide "blackmail" money to the AMA and when none of his products were granted AMA approval, Abbott went on the offensive. He arranged for an investigation of the AMA president that revealed that Simmons had no credible medical credentials, that he worked primarily as an abortion doctor for many years, and that he had had sex charges brought by some of his patients as well as charges of negligence in the deaths of others. After this meeting, the drugs made by Abbott Laboratories were regularly approved, and the company was not required to place any ads.
Simmons was shrewd enough to have the AMA establish a Council on Medical Education in 1904. This council's mission was to upgrade medical education -- a worthy goal. The formation of the council seemed a good idea to homeopaths because surveys in JAMA itself had consistently shown that the graduates of the conventional medical schools failed the medical board examinations at almost twice the rate of graduates of homeopathic colleges. However, the AMA developed guidelines to give lower ratings to homeopathic colleges. For instance, just having the word "homeopathic" in the name of a school had an effect on the rating because the AMA asserted that such schools taught "an exclusive dogma."
In 1910, the same year that the Flexner report was published, the AMA published "Essentials of an Acceptable Medical College", which echoed similar criteria for medical education and a disdain for non-conventional medical study. In fact, the AMA's head of the Council on Medical Education traveled with Abraham Flexner as they evaluated medical schools. The medical sociologist Paul Starr wrote in his Pulitzer Prize-winning book: "The AMA Council became a national accrediting agency for medical schools, as an increasing number of states adopted its judgments of unacceptable institutions." Further, he noted: "Even though no legislative body ever set up ... the AMA Council on Medical Education, their decisions came to have the force of law". With the AMA grading the various medical colleges, it became predictable that the homeopathic colleges, even the large and respected ones, would eventually be forced to stop teaching homeopathy or die.
In 1913, Simmons and the AMA went on the offensive even more strongly by their establishment of the "Propaganda Department," which was specifically dedicated to attacking any and all unconventional medical treatments and anyone (MD or not) who practiced them. In this same year, Simmons hired Morris Fishbein, MD, as a publicity man for the AMA.
In 1924, Simmons was forced out of the AMA due to the many scandals around him, and he took home all his personal files and burned them, though Simmons was again wise enough to have trained his replacement, Morris Fishbein. Fishbein's specialty was publicity and the media, and he used the media to attack anyone who provided a real or perceived threat to conventional medicine. Besides severe attacks against anyone who practiced unconventional medical treatments, Fishbein and the AMA were also initially extremely antagonistic to those conventional medical doctors who supported pre-paid health insurance.
Fishbein was a medical doctor who never practiced medicine. He was, however, an effective advocate for conventional medicine and a vocal critic of unconventional treatments. Shortly after he became head of the AMA, he wrote several books sharply critical of "medical quackery." He called chiropractic a "malignant tumor," and he considered osteopathy and homeopathy "cults." While Fishbein certainly provided benefit to the general public by warning them about some of the medical chicanery that existed at the time, he lumped together everything that was not taught in conventional medical schools and considered all such modalities quackery. When one considers that the vast majority of medicine practiced in that era was inadequately tested and dangerous to varying degrees, Fishbein's obsessive fight against certain treatments provided direct benefits to the physicians he was representing.
Fishbein's frequent and strident attacks on "health fraud" were broadcast far and wide, in part through his own newspaper column, syndicated to more than 200 newspapers, as well as a weekly radio program heard by millions of Americans. His influence on medicine and medical education was significant, and it is surprising how few medical history books mention his influence or his questionable tactics. Time magazine referred to him as "the nation's most ubiquitous, the most widely maligned, and perhaps most influential medico."
There are also numerous stories about Fishbein's efforts to purchase the rights to various healing treatments, and whenever the owner refused to sell such rights, Fishbein would label the treatment as quackery. If the owner of the treatment or device was a doctor, this doctor would be attacked by Fishbein in his writings and placed on the AMA's quackery list. And if the owner of the treatment or device was not a doctor, it was common for him to be arrested for practicing medicine without a license or have the product confiscated by the Food and Drug Administration (FDA) or the Federal Trade Commission (FTC). Although Fishbein denied these allegations, he and the AMA were tried and convicted of anti-trust violations for conspiracy and restraint of trade in 1937. Further, Fishbein wrote numerous consumer health guides, and his choice of inclusion for what works or what doesn't work was not based on scientific evidence.
Fishbein extended Simmons's idea for the AMA seal of approval to foods, and by including a significant amount of advertising from food and tobacco companies, he was able to make the AMA and himself exceedingly rich. In fact, under his reign, the tobacco companies became the largest advertiser in JAMA and in various local medical society publications. In fact, Fishbein was instrumental in helping the tobacco companies conduct acceptable "scientific" testing to substantiate their claims. Some of the ad claims that Fishbein approved for inclusion in JAMA were: "Not a cough in a carload" (for Old Gold cigarettes), "Not one single case of throat irritation due to smoking Camels," "More doctors smoke Camels than any other cigarette," "Just what the doctor ordered" (L&M cigarettes), and "For digestion's sake, smoke Camels" (because the magical Camel cigarettes would "stimulate the flow of digestive fluids").
By 1950, the AMA's advertising revenue exceeded $9 million, thanks in great part to the tobacco companies.
Coincidentally, shortly after Fishbein was forced out of his position in the AMA in 1950, JAMA published research results for the first time about the harmfulness of tobacco. Medical student Ernst Wynder and surgeon Evarts Graham of Washington University in St. Louis found that 96.5 percent of lung cancer patients in their hospitals had been smokers. Very shortly after the AMA withdrew its seal of approval for Morris Fishbein, he became a high-paid consultant to one of the large tobacco companies."
This article is based on an excerpt from the book "The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy" (Berkeley: North Atlantic Books, 2007) by Dana Ullman, MPH
Learn more: http://www.naturalnews.com/023195_AMA_the_home.html#ixzz1IZTMwzOv
Thanks for the info.
awesome post. Anecdotally I have noticed that patients of classical homoeopathy are extremely healthy. The science profs and pharmacists around Leipzig succeeded in running Hahnemann out of town too I believe.
Excellent comment.
Personal accountability is the only way out, and it's free.
Too many health care problems are lifestyle related, but not all. I wonder if the system can differentiate?
You touched on the heart of the matter - the system is inherently flawed when government crosses healthcare (at all).
Remove the government life-support on insurers and provider bottom lines and the system is free to adapt (correct itself). First and foremost are price and quality changes - price decreases, quality increases, and labor increases (more individuals motivated to be doctors, etc.).
Bottom line is no amount of government funding can address laziness and will to care for one's self.
The system today is insulated protectionism for the benefit of the predatory few - and it's ALL about greed.
I thought they had a pill for that.
It's a suppository.
I saw Provenge for prostate cancer was approved for use by Medicare. $90,000 plus per treatment course. Average life extension...4 months. Same issue exists for all manner of other expensive treatments.
We just don't know enough about genetics and cancer to allow taxpayer dollars be used for every avant-garde drug, biologic or medical device that shows promise. Provenge is great... for some patients. If it extends your life 3 or 4 years as it has for some then its worth the money but until we know more about whom these horribly expensive treatments will actually benefit Medicare and Medicaid shouldn't provide them.
On a long enough timeline...
Expensive drug therapies are no match for the Federal Gov't. They just have the FDA de-approve it! No approval, no can use! Easy peasey!
And cut Mdicare for providers. Hell, most providers won't take it anymore anyway.
$90,000 to treat a cancer where the majority of people die from something nonprostate cancer related.
Don't worry, the death panels will be influenced by big pharma and medical device companies, so everyone will still be able to get the latest"breakthrough treatment" that is, at best, marginally better than what it replaced.
"as a result of the list, some will die."
Probably not, Bruce. They were going to die anyway, whether or not we spent $230k on chemo cocktails to drag the death out. Everybody dies.
Two quotes:
"No one here gets out alive." --Jim Morrison
"Um, no. He was already dead; that's why we called him Dead Tom." --Kermit the Frog
Tks for this. I think if you asked Elmendorf if Provenge should be on the list of new treatments he would say it should be not be covered. 4 months is a poor payoff to a broke society. Much better to spend this money on infant mortality and other childhood diseases. That's simple economics.
This type of thinking runs very counter to our way of life. This isn't going to be easy.
Unfortunately, patients will have to become savvy and game the system. There will be ways. With lower payments to doctors, people will eventually learn how to bribe them with cash to code or reclassify illnesses in a manner that will get them properly covered.
all that being said: its a middle class Logans Run, pure and simple.
Gawd, the horrors of Sarah Palin being correct about death panels...ARGH!!
Medicare payments to doctors in the L.A. area are already lower than the cost of providing many services. Lowering payments further will lead to many more doctors not participating in the Medicare program - it won't lead to cash bribes. Google concierge doctors and medicare. Doctors who can are already requiring cash in exchange for seeing Medicare patients. It's legal for now, but maybe not for long.
CMS (runs Medicare) is forcing doctors into Electronic Health Records systems (by reimbursing up to $44,000 of the cost). These systems have CMS/Medicare rules built into them and will not allow the doctor to enter codes/data that violate the rules. Makes it difficult for doctors to mis-code. But more importantly, the doctor generally is not the one who sends the bill off to CMS. It is his biller. They would need to be bribed to get the mis-coding through, if they knew how to circumvent the rules that make the software just sit there if you don't enter the proper codes/data.
No death panels. But lots of death. All health insurance companies have people who review claims and who accept or deny them. This is generally just a single person - M.D. sometimes, but not always. These gatekeepers are already causing many people to die because they deny coverage and the patient dies during the appeal. Death panels are not necessary, and are not likely. But the phrase makes for good theater for people who don't know better.
What is also counter intuitive is that you never hear the other logical question: can we try and lower the cost of this treatment before dropping it? [where 'this' means any expensive procedure]
We never hear it... despite being simple economics too.
Yes, I agree. Big pharma can sell some of these drugs cheaper. Think of all the charitable organizations that raise money for cancer research. Where does all this money go? I know some of it probably goes to "administrative purposes" but think about all the people that donate to these causes year round and then they get gaffed when they have to buy these medications. Makes me sick.
What if the "new treatment" is much cheaper than the old--a frequent occurrence? Bureaucrats will do a terrible job sorting this out.