Kindness Deficit

[Shapley]

Citations for this unmitigated crap?

Obamacare and the elderly


Of course, you'll tell me it's 'taken out of context'...

[OperaTenor]

You're hopeless.

If that's the kind of stuff you use to form the basis of opinion, then you are indeed hopeless.

Unbelievable.

[Shapley]

There are none so blind as those who will not see. I present you, in his own words, the statements of Mr. Obama with the quote I provided, exact and in context, and your only response to is ignore the statement. What, then, do you propose he is discussing when he says "Maybe you're better off not having the surgery, but taking the painkiller," if not the rationing of healthcare? He is concerned, he claims, with the amount spent on end-of-life treatment yet, as I have noted, we generally do not know until the treatment is complete whether it be done at end-of-life or not. Clearly, the hope is that it will not be.

My stepson is thirty years old, despite having been given a life expectancy of about six years. Sixteen years ago, he received a life-saving spinal fusion (x-ray technicians and doctors today still comment on how artfully it was done). Based on Mr. Obama's statement, I expect that, had we had his 'universal health care' plan, my stepson would have been denied such treatment given that he was already eight years past his diagnosed end-of-life.

You continue to comment that it is 'insurance companies' that deny or delay care, which is incorrect. However, you ignore the fact that Mr. Obama is proposing 'national insurance', not 'national healthcare'. What leads you to believe that Mr. Obama's insurance company will be any more gracious than the private ones, particularly in light of his statement on 'painkillers vs. surgery'?

[Shapley]

If that's the kind of stuff you use to form the basis of opinion, then you are indeed hopeless.

I agree. Anybody who bases their opinions on Mr. Obama's words is, indeed, hopeless.

[piqaboo]

Glad to hear your stepson is doing well.

Friends of ours have been agonizing over colleges - $$, their kids preferences etc.
Arent you about there for your son? (I lose track of time).

Yeah, sometimes we would be better with the painkiller, but its so hard to tell when that time is, except in hindsight.

[Shapley]

This table is interesting in this context. It's deaths from cancer rather than survivals, but I notice that we are next to the U.S., notwithstanding our Socialised Medicine.

http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer

The stats are from the OECD.

Interesting to look at. When you compare the United States and UK, you find that life expectancy at birth in the UK is greater than in the US, but only by a few months, for both male and female. However, you notice that deaths from automobile accidents are far greater in the US, which probably accounts for a more sizable difference. (Belgium and New Zealand are closest to us in Auto accident deaths).

We also far outpace other nations in obesity, which probably accounts for more of our health problems than any other factor. National Insurance will not fix that, unless we're going to ration food as well as medical care. "A nation that takes control of the economy for the good of the people will end up taking control of the people for the good of the economy."

[Shapley]

Glad to hear your stepson is doing well.

Thanks. He is doing quite well. He went on the cruise of Europe with us, and I believe he really enjoyed it. We were concerned about how he would handle the eight-hour flight to London, but he did quite well. We put a lot of miles on his wheelchair.

Cruising works well for us, because nearly everything is accessible. The tenders are sometimes a bit scary, but we had calm seas and the staff were very capable. They've even installed wheelchair lifts on the accomodation ladders, which were not available on our previous cruise.

Friends of ours have been agonizing over colleges - $$, their kids preferences etc.
Arent you about there for your son? (I lose track of time).

Yes, we're getting there. He's sixteen now. Tow more years until college. He'll probably attend the local university, which is a blessing (we'll save a bundle on housing costs). We thought we were all prepared for the costs, till the economy turned sour. Our extra income pretty well dried up with the downturn. We're hoping for a recovery before then. At least the mortgage will be done by then.

Yeah, sometimes we would be better with the painkiller, but its so hard to tell when that time is, except in hindsight.

There's the rub. How do we know, and who gets to decide? The current system is not perfect, but it offers options. If insurance won't pay, there is self-pay, charity, etc. With a single-payor plan, the single payor gets the final word.

[OperaTenor]

Shap, you're twisting what was said on that clip to fit your "argument"(let alone the stupid interpretive flashes from the guy who posted the video). It was obvious Obama was speculating, and he deferred to the expertise of doctors. Obama's a creep, but not in this instance, and not the kind of creep you want to make him to be.

[Shapley]

Fisrt of all, I had not seen the 'interpretive flashes' until I posted that for your perusal. you asked for a citation for that which you called "unmitigated crap", and that was the first reference that Google gave which placed the quote "in context", i.e. out of his own mouth and including the question that illicited the response.

Secondly, Nowhere does he say he will defer to the expertise of doctors, which was the response the questioner was apparently looking for (since she deferred to their expertise to get the pacemaker implanted in the 100-year-old woman under the current plan). His response, which was more of a non-response, was exactly the statement you called "unmitigated crap".

[Shapley]

Straight from Medicine.net:

Elective surgery: Surgery that is subject to choice (election). The choice may be made by the patient or doctor.

For example, the time when a surgical procedure is performed may be elective. The procedure is beneficial to the patient but does not need be done at a particular time.

As opposed to urgent or emergency surgery.

I would point out that, by definition, my stepson's life-saving spinal-fusion surgery, and the necessary surgery that proceeded it, were 'elective' in that we elected to have it done at a time that we were able to take off from work. Our 'election' was limited by necessity, which is to say it had to be done within a certain timeframe, but we were able to select a window that suited our schedule.

Prior to the surgery, he had to have a feeding tube installed. That turned out to be a major deal, even though it was not expected to be so. We then had to have him on a feeding pump 24/7 until he had gained sufficient weight to survive the spinal fusion, which was about six months. We then spent our Christmas vacation in the hospital, at which time the surgery was performed. (As I noted, this was sixteen years ago, during the time my wife was pregnant with our other son.)

Just pointing out that 'election' is a matter of a number of consequences. There are also a limited number of surgeons available to do some proceedures, and their schedules have to be taken into consideration. Sometimes, one may 'elect' to wait until a specific surgeon is available to perform it, because of his expertise and/or reputation. This option is available under the current, imperfect system. Will it be under the new plan?

[Selma in Sandy Eggo]

You continue to comment that it is 'insurance companies' that deny or delay care, which is incorrect...

Nonsense. If I did not have a group policy as part of my employee benefits, I would be in a wheelchair. I don't have assets to pay the "full price" cost of my surgery and rehab (the negotiated reimbursement my HMO paid was quite a bit less: the cost of a middle-class home in a decent suburb, rather than the cost of an executive home in a gated community). Arthritis is not an emergency, and the inability to walk is not the same as a heart attack. For joint replacement, the hospital, the surgeon, and the nursing home will require evidence of the ability to pay for the care provided.

What leads you to believe that Mr. Obama's insurance company will be any more gracious than the private ones, particularly in light of his statement on 'painkillers vs. surgery'?

Sometimes, painkillers are the better choice. I'm not in favor of heroic measures in all cases, for myself or anyone I care about. Depends on age, reasonable prognosis, and probable quality of life. That being said, I'm also not entirely in favor of letting the beancounters make these decisions on a purely financial basis. Denial of treatment is always less costly than treatment.

Mr. Obama's insurance may not be any more gracious than the private stuff, but it could hardly be less gracious. HMOs and insurance companies are eager to deny a claim. Really. They are. And they've got lawyers and they know for a fact that if they stall for long enough the problem will, quite literally, die. OTOH, Medicare has a certain reputation for non-excellence from time to time... Didn't someone phrase socialized medicine as having the efficiency of FEMA and the compassion of the IRS?

[Shapley]

Nonsense.

No, it is not. Insurance companies pay, or don't pay, according to their ever-changing rules. Nontheless, they do not bar the door to the hospital to prevent people from entering. If you are denied care, it is by the caregiver. Insurance companies do not provide care, hence they are incapable of denying it, all they can do is refuse to pay for it. The caregivers set the policies by which they provide care sans insurance coverage, not the insurance company or companies.

If I did not have a group policy as part of my employee benefits, I would be in a wheelchair. I don't have assets to pay the "full price" cost of my surgery and rehab (the negotiated reimbursement my HMO paid was quite a bit less: the cost of a middle-class home in a decent suburb, rather than the cost of an executive home in a gated community). Arthritis is not an emergency, and the inability to walk is not the same as a heart attack. For joint replacement, the hospital, the surgeon, and the nursing home will require evidence of the ability to pay for the care provided.

That is immaterial. The surgery center would be the one who denies the care, not the insurance company. They are the one who says "You do not have the means to pay, so you cannot be treated". Again, I say, the insurance company is not barring the door.

As I've said, the system is flawed, but it's not so badly broken that it needs to be scrapped in favour of a system that puts all the choices in the hands of the government. We need to remove the disconnect from the care recipient and the cost. Mr. Obama's plan further insulates them from it. As I've said, money is no object, if it's not your money.

I would like to see the system offer a more equitable cost structure between covered and self-pay care. However, that can be achieved without scrapping the system.

Insurance seeks to reduce costs, because those costs have to be recouped. If they don't cut costs, they have to raise premiums. In a competitve market, higher premiums means fewer buyers, which means more lost revenue, which requires more cost cutting. It's best to keep the costs down up front, obviously.

In a non-competitive market, i.e. a single payor plan, there is no danger of fewer buyers, but higher costs still have to be recouped through higher premiums (taxes). There exists a limit even to the amount of taxes that can be recouped, although you would never realize it by watching the current Congress's spending spree. This means that even the single payor plan will have to cut spending, which Mr. Obama proposes to do by reducing end-of-life treatment, i.e. painkillers in lieu of surgery.

[OperaTenor]

Nonsense.

No, it is not. Insurance companies pay, or don't pay, according to their ever-changing rules. Nontheless, they do not bar the door to the hospital to prevent people from entering. If you are denied care, it is by the caregiver. Insurance companies do not provide care, hence they are incapable of denying it, all they can do is refuse to pay for it. The caregivers set the policies by which they provide care sans insurance coverage, not the insurance company or companies.

Thus spake the corporate apologist.

If I did not have a group policy as part of my employee benefits, I would be in a wheelchair. I don't have assets to pay the "full price" cost of my surgery and rehab (the negotiated reimbursement my HMO paid was quite a bit less: the cost of a middle-class home in a decent suburb, rather than the cost of an executive home in a gated community). Arthritis is not an emergency, and the inability to walk is not the same as a heart attack. For joint replacement, the hospital, the surgeon, and the nursing home will require evidence of the ability to pay for the care provided.

That is immaterial. The surgery center would be the one who denies the care, not the insurance company. They are the one who says "You do not have the means to pay, so you cannot be treated". Again, I say, the insurance company is not barring the door.

As I've said, the system is flawed, but it's not so badly broken that it needs to be scrapped in favour of a system that puts all the choices in the hands of the government. We need to remove the disconnect from the care recipient and the cost. Mr. Obama's plan further insulates them from it. As I've said, money is no object, if it's not your money.

I would like to see the system offer a more equitable cost structure between covered and self-pay care. However, that can be achieved without scrapping the system.

Insurance seeks to reduce costs, because those costs have to be recouped. If they don't cut costs, they have to raise premiums. In a competitve market, higher premiums means fewer buyers, which means more lost revenue, which requires more cost cutting. It's best to keep the costs down up front, obviously.

In a non-competitive market, i.e. a single payor plan, there is no danger of fewer buyers, but higher costs still have to be recouped through higher premiums (taxes). There exists a limit even to the amount of taxes that can be recouped, although you would never realize it by watching the current Congress's spending spree. This means that even the single payor plan will have to cut spending, which Mr. Obama proposes to do by reducing end-of-life treatment, i.e. painkillers in lieu of surgery.

Really, Shap? Then how come we have outspent every other industrialized nation per capita by at least over 55% for years now, if not decades, if our system is so......competitive?

[Selma in Sandy Eggo]

No, it is not. Insurance companies pay, or don't pay, according to their ever-changing rules. Nontheless, they do not bar the door to the hospital to prevent people from entering.

I invite you to read several policies, and then review their BBB and Consumer Guide and CALPIRG (or whatever the equivalent Misery organization is) evaluations.

In passing, I'd like to note that a routine denial of claim for any and all cancers will let a number of them proceed from stage II to stage IV while the paperwork goes in circles: this is an effective way to avoid long-term costs and improve profits.

Paperwork denial-of-claim and delay-of-treatment tactics will also encourage most anterior myocardial infarcts to lose enough tissue that neither bypass nor stent treatment is immediately safe. This will shorten up that nasty, expensive hospitalization and recuperation process, in a predictable proportion of the cases, and further improve profits.

Just for comic relief, you can also look at Kaiser Permanente, in which the insurance company and the medical care provider is one and the same organization.

I'm not going to suggest any conclusions because one detail will be picked out to obsessively disagree with. I also won't expect you to actually check any of your assumptions or do any fact-checking or research. Why start now.

[Shapley]

Just for comic relief, you can also look at Kaiser Permanente, in which the insurance company and the medical care provider is one and the same organization.

I am aware that there are insurance companies (HMO's) That own care providers and care providers that insurance, but in the long run it is the provider, not the insurer, that denies care. The insurer can only deny coverage. That may be "one little detail" to you, but that really gets down to the vary basis of our problem.

I won't expect you to actually check any of your assumptions or do any fact-checking or research. Why start now.

Indeed? My assumptions are my own, but I have posted links in the past regarding these issues. Because we provide health coverage for our employees, but not health care to them, I have a pretty thorough understanding of the problems involved. In addition, as one who has had to pay for care out-of-pocket because of a lack of coverage, I have some understanding of the difference.

Our politicians talk excessively about those forty-plus million without health coverage. They, apparently, are not the ones being denied health care. At the town hall meetings and congressional hearings, they bring out the people who were denied health care, supposedly by their health coverage providers. One is left to conclude that those who do not have coverage are receiving better care than the ones who have it. Why not eliminate the coverge for the rest of us, rather than drag those poor forty-plus million into the pool who are being denied care because they have lousy coverage?

[Shapley]

Really, Shap? Then how come we have outspent every other industrialized nation per capita by at least over 55% for years now, if not decades, if our system is so......competitive?

I answered that question, in this very forum, in 2006. The answer really hasn't changed:

As for the cost savings of switching to a single-player plan: I've already mentioned that we Americans are addicted to high-cost remedial treatment instead of preventative medicine, and we're addicted to prescription drugs as an alternative to healthy lifestyle choices. If we have digestive problems we would much rather just take a little pill two or three times a day than simply changing to healthier eating habits. Never mind that the pill may produce undesirable side-effects, there's surely another pill to treat those. By the time we reach our '70s, we're taking six or seven little pills a day, two of which treat an affliction and the rest to treat the side-effects of the first two. A simple lifestyle change earlier in life could probably have prevented the need for the first two.

Europeans, by and large, lead healthier lifes than we do. I went on a cruise last year. There was a health spa on board and it was full - of Europeans. The Americans were too busy feasting the buffets which seem to run 24/7 on board. We've tried to remedy this to some extent - by exporting our unhealthy eating facilities to European countries. You can now find a McDonald's in just about any country in world. But it didn't quite work out like we wanted. Instead of luring the Europeans into our unhealthy eating habits, they wound up changing the menu to reflect the diets of the locals. The Big Mac is still available - usually enjoyed by the Americans who travel half-way around the world so they can stay in a Holiday Inn and eat McDonald's food as they pretend they are enjoying the local flavour of a foreign country.

Unless and until we change our habits - our health care will only get more expensive. The inflation rate will probably accelerate, in fact, since money is no object - if it's not your money.

[OperaTenor]

I'm not going to suggest any conclusions because one detail will be picked out to obsessively disagree with. I also won't expect you to actually check any of your assumptions or do any fact-checking or research. Why start now.

Selma, I just want you to know I'm giving you a big virtual hug right now.

[OperaTenor]

:sigh:

Haggis has once again left me wanting of an answer.....good thing I'm not holding my breath...

[Shapley]

Whey are the emergency rooms full all the time, with so many of these ‘emergency' patients patiently waiting until the doctor will see them? Clearly, their conditions do not constitute a true emergency, or they would be rushed right in. Is it because of a doctor shortage? Is it because of the hours? Is it because they perceive they will receive better care at the hospital than at a doctors office?

Hospitals in our area responded to the ‘doctor shortage' by establishing ‘convenient care' centers in their emergency rooms. Supposedly, these handle the non-emergency emergency-room cases. However, certain conditions have to be met to qualify for ‘convenient care' as opposed to emergency room treatment - a low-grade or no fever being among those criteria. Most people I know use a fever as a basis for going to the doctor, so they pretty much are excluded from ‘convenient care' when they go. Sore throats and runny noses are okay, otherwise, they herd you into the emergency room for care. Expensive care.

We also have walk-in doctors office, which have sprung up in the past decade or so, in response to the ‘physician shortage'. These are staffed by doctors although, as in the case of ‘convenient care', you are more likely to be seen and treated by a nurse practitioner. In Missouri nurse practitioners can perform most of the duties of a doctor. Not so across the river in Illinois, where nurse practitioners' capabilities are limited to little more than a registered nurse. Illinois has many more restrictive rules than Missouri, Kentucky, and Indiana regarding the licensing of physicians, nurses, and care providers. Missouri hospitals and clinics are filled with Illinois patients, as are Kentucky and Indiana. I presume the same to be the case in States bordering the northern part of Illinois, such as Iowa and Wisconsin, though I cannot say for sure since I don't frequent those areas.

Doctors offices, whether walk-in or not, require a co-pay from most insurers, which has to be paid at the time of the visit. This is usually $15 - $40 for our area, depending on the coverage. Emergency rooms, however, do not usually collect co-pays or deductibles at the time of service, usually waiting for the billing to arrive. I do not know if this is a factor. I can tell positively that some people do not pay their co-pays and deductibles if billed after-the-fact. I have wonder if that may explain why some people choose to visit emergency rooms rather than doctor's offices. But, of course, I have no way of finding that answer.

Hospitals spend lots of money trying to recoup unpaid bills. Obviously, these recovery efforts are aimed at the patient, who is ultimately responsible for the bill (being the recipient of the service) rather than at insurance companies, who only serve as a payment representative for the patient. Normally, the insurance pays their part, whether a great or small percent of the total bill, without our being ‘in the loop'. The hospital then bills us for the difference. This is where they usually find difficulty in receiving payment. I assume there is sometimes difficulty with the insurance company, which would explain why it may take two to six months after service before we receive a statement from the hospital but, being not ‘in the loop', I have no idea. It may simply be a combination of factors involving the speed of the hospital billing procedure, the timing of the service, and the coverage providers review-and-payment procedures.

We recently received a statement from a local hospital eight months after service was rendered. This was our first statement for this visit. It was for the full amount of service, as the provider had not paid. Unfortunately, they had billed a provider which we no longer used, but which was apparently still on their records as our current provider. It apparently took them that long to process the request, refuse it, and then for the hospital to receive and process the refusal and bill us. There may have been an ‘appeal' process that was used, accounting for some of the delay. After receiving the bill, we gave the hospital the information on the provider we were using at the time of service. We have since switched providers again, so this process may take some time. However, as they were the legitimate provider at the time, they are obligated to pay the hospital in accordance with the terms of the contract in place at the time. We now have to wait while the billing procedure is passed through, again. At some point we will receive a statement for our share of the bill, which we will pay. I know some of you have no sympathy for the poor hospital and insurance clerks that have to deal with all of this, but I do. If that makes me a ‘corporate apologist' so be it.

Coverage providers to a lot of research on costs of services. Some of them negotiate price reductions based on ‘customary' rates for basic services, and refuse to pay costs for these services in excess of those rates, unless the care provider can justify the excess. In some cases, coverage providers may organize networks of care providers in which they will facilitate payment processing to network members in exchange for standardized or discounted rates. Presumably, these reduce costs to the providers of both. Self-payers cannot guarantee these facilitated payments so they do not get the benefit of network discounts. In addition, since all costs are the ultimate responsibility of the service recipients, additional costs such as collection fees are ‘front loaded' to those who are not network members, since network membership frequently forbids such front-loading of costs to members.

The hospitals must recoup the costs of non-payees and payment delinquencies somehow. It was decided that this would be done by spreading them among those with whom they have not negotiated payment schedules which prohibit them from doing so, which only makes sense. If you provide a service and half of your service recipients do not pay, how do you recoup the costs? Do you ‘gouge' your best customers, or spread them among the rest?

But, if you will not accept that there is a difference between "coverage" and "care", then I waste my effort explaining this.

[Shapley]

Selma, I just want you to know I'm giving you a big virtual hug right now.

When you said you denied care by your insurance company, did they actual say you couldn't receive the treatment, or did they say they would't pay for it?

When the caregiver said that the insurance would not pay for it, did they actually say they would not perform it, or did they ask if you had other means of paying for it?

Perhaps, in California, the care providers let the insurance companies call the shots, but that is not the case in Missouri. If so, it is a California problem, and you should not ruin Missouri's health system trying to fix your State's flaws.