Monday: Back to Action!

I will have to read the bill before I support anything coming out of Obama’s administration and certainly anything asked for by Nancy Pelosi…She should go to MoveOn.org and Acorn to get her sheep responses.

Murphy: Hillary also showed that Barack’s plan was seriously flawed.
I remember that as well.

Murphy: Then why prowl now ? Give a yes to what we do not even know she has in mind or the supposed bill will or does contain?
And have her come back and say..The American People overwhelmingly support our plan..(whatever the hell she et al make it to be?) as they have done incessantly..and give it whatever name works?

No..not I ..not under those circumstances.

Murphy: I am clearly no advocate of “silence” but I am also no advocate of support of a concept as it is going to be defined by Pelosi and others …and given whatever name works..

The first link references H.R. 676..as the “single payor” bill.
Should we not at least review that? Knowing that that will also be altered in Senate? And should we not at least have a language for what we see as appropriate Single Payer action?

Giving a carte blanche to a request by a Pelosi aid to “make us do it” is whatever the nature and text of the it will be coming from Pelosi et al is in my view not prudent.

Murphy: In any case you have called the Prowl and my postion is noted..and for the record..I have never felt you are trying to make me do anything..mostly because I know you know that would be a useless attempt!! and a waste of your good energy…and time!

Prowl done;

BB after I catch up.

People had just better face the facts. Anything this congress and administration does will hand out freebies to illegals. They are a huge, albeit illegal, voting block for the Dems. And don’t try to tell me they didn’t vote in the last election with our ACORN buddies out there registering them as Mickey and Minnie Mouse. I know better. Their offspring will be a source of votes for the far future as well, as long as the Dems keep the freebies flowing.

Oh let me shut up. As a legal immigrant, this subject just incenses me.

LEGISLATION

H.R. 1200:
AMERICAN HEALTH SECURITY ACT OF 2009

And

H.R. 676:
United States National Health Care Act or the Expanded and Improved Medicare for All Act

And

Article against Single Payer

Information at 411 on the 111 pumapac forum:

http://pumapac.org/forums/411-on-the-111/ post 133-135

prowl done!

#15

I’m not rolling over.
Immigration laws need to be enforced.
“You’re already paying” just serves to make me more determined.

Acceptance makes me part of the problem, IMO.

Thanks everyone downthread for the visual of Matthews in drag and big dumb football players-oops is that a stereotype-humping each others’ legs

jennforhillary 04.27.09 at 12:38 pm
prowl done!
———–

PROWL HAPPILY COMPLETED!

ps I think katalusis is great too!

Done!
Also faxed my so-called Congressional representation at both DC and local offices. My penchant for faxing is one of just two reasons why I continue to maintain my land line. Hear that, Verizon?

Ihave to go back to reading HR676. I will come back when I am finished.

Jenniferfor Hillary: Youneed to read HR676..You also need to answer the question..the mystical question..Who has and does make the decision of what are “medically necessary services”
and who or what and what perameters determine that for that determines whether care that is appropriate gets done or is refused…and this issue is the essence …Too many years reviewing and following this issue have moved me to adamancy for this concept and its definition and pragmatic manifestations have and will continue to dessimate the quality and quantity of quality care under any and all regimes or models.

oops-that’s paid into “medicare” not “medicaid”

Brooklyn, from Krauthammer:

The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger. “Isn’t it an epic mistake to try to sell Democratic health-care reform on this basis? Possible sales pitch: ‘Our plan will deny you unnecessary treatments!’ … Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending — so the government can decide their life or health ‘is not worth the price’?”

It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.

“Defensive” medicine: Lawyers’ bills pile high, driving up health care costs

Fear of lawsuits prompts doctors’ to overprescribe diagnostic tests.

Health care costs are out of control, as we heard constantly during the presidential campaign. Yet that doesn’t stop sensible physicians from shunning the sickest patients or ordering needless hospitalizations, drugs, tests and invasive procedures.

Against their better judgment, physicians practice “defensive medicine” — actions designed to protect themselves from lawsuits rather than serve patients’ best interests.
Why? The threat of being sued is pervasive, and doctors simply don’t trust the legal system.

One in seven obstetricians/gynecologists has stopped delivering babies, and three-quarters have been sued at least once, according to a 2003 study. Years of staggering malpractice premium increases have forced many to alter their practices or quit treating patients.

A study by the Massachusetts Medical Society found that 83% of its doctors practice defensive medicine at a cost of at least $1.4 billion a year. Nationally, the cost is $60 billion-plus, according to the Health and Human Services Department.

• Physicians fear that candor about mistakes could get them sued. A safe harbor is needed. In 2006, then Sens. Barack Obama and Hillary Clinton proposed a law that died in committee to give physicians and hospitals an alternative to the courtroom and a chance to discuss errors without fear.

The current system is arbitrary, inefficient and results in years of delay. Reform would encourage doctors to focus on patient needs instead of what unnecessary tests might keep a lawyer away from their doors.

http://blogs.usatoday.com/oped/2008/12/lawyers-bills-p.html

Doctors in IL pay between $125,000 and $300,000 a year for medical malpractice insurance.

Doctors in IL pay between $125,000 and $300,000 a year for medical malpractice insurance.
——————–
What percentage is that of their annual income?

Murphy – Post # 26.. I could not agree more. There are too many illegals draining our system. I know that first hand. I ask my born in America employee – she has entire families and inlaws that came illegally a long time ago. I asked her what she thought if non Mexican illegals came in now and took away jobs from these now legalised immigrants.. She said well, they came just to work in this country. Which sparked this idea in my head… the “key buzz word” is WORK. They make it sound very honorable that they came to work. But I think their intention is to come here to LIVE. Which comes first, work or live ? To say that they come here to live would ruffle feathers but what is the difference? How many actually go home after they come here to “WORK” ????

I get a very good insight from this employee – who by the way is totally legal and very much assimilated into Western culture and looks like any American young girl. Some of her friends can’t speak English very well , she said. Some days, I don’t want to hear anymore of this “rape” of our country by these so called illegals that only want to WORK. Bear in mind, I do know that not too many BIA (born in America) folks want to toil in the fields.. but that is another argument altogether. If there are no illegals, I wonder how much we have to pay for a head of lettuce… BIA folks want to earn a bit more than minimum wage, is my opinion.

#25 NOP

This bill covers “visitors”…

Sometime back my partner and I took her mom + uncle to Italy for a “last trip”. Uncle was dying of leukemia. Well, uncle became dangerously unwell in the city of Venice. As a “visitor” they treated him graciously & humanely – at midnight they took him by water taxi to the hospital, infused massive quantities of blood, discovered that the medications prescribed by the geniuses at Kaiser were upside-down exacerbating his leukemia, and put him right.

I will never forget the kindness & decency of being a visitor in Venice, being treated as a human being. No charge, by the way.

Imagine if all countries (including ours) considered health care to be a basic human right instead of a privilege. No more “out of network” denial of coverage!

I agree that illegal immigration is an issue that merits national conversation. But I think it’s a separate issue and should not be coupled to universal health care.

just my opinion

Dances – I got 3 hours sleep last night – I got energized by all the fun we were having . I am so foggy today. Do you need an aquarium ?

Freddie
Do you need an aquarium ?
————–
Um… not that I know of. Thank you anyway. I could use a Porche though.

MKfromLA: I have asserted I am in support of the Single Payer concept…I have asserted for years this idea. I have also asserted for years what is not available and denied under the concept of “medically necssary services” here like John the Baptist in the desert eating locusts!

Our system here is currently not what you indicate and that is because the concept of who decides what about who gets what and when has been usurped and held under the aegis of Insurers who since 1971 have continue to erode the quality and care at all with incessant and increasing decisions about “medically necessary services.” The mere concept of a single payer system does not mitigate this reality..and as I have noted..H>R> 676 does not either.

Whom do you trust to make that decision? Your doctor or a clerk or an electronic review of your health records..with a subsequent oh no..does not fit box 2 or 3..and if that does not please you and you appeal…talk to a high school clerk at Medicare with a great title..

This issue is not an intellectual one. It is a pragmatic one whatever one names the system.

here..meaning in the USA

MKfromLa: sorry for errors..another ..quality of care for all

If the Hispanic crews ever found out how I had infiltrated them I wouldn’t be here typing, I’d have been fish food a long time ago.

Dances – you so funny gal – I appreciate the laughs. I may take you for a ride on the Porsche one day – first I take it past the driveway. I put the key in yesterday and vroom vroom it in the drive. Got Fred very worried. I might end up liking it -

Some of them will never get out of prison~~they have “free room and board” for life.

they have “free room and board” for life and no life.

I should re-word my above statement.. I should not say that I know it first hand – about illegals – i have none in my closets.
But they seem to have a network of information that is like a whisper network. I was amazed that this employee has 9 deductions on her returns – I’ve never heard of anyone claiming 9 but I don’t do our payroll, an outside company does. My accountant says it is legit. They don’t pay taxes but they get refunds and rebate checks. Does it make me mad ? Yes.

Forgive me if I show ignorance about this subject, but are you all really sure that you prefer single payer health insurance?

Are you willing to leave it up to the government to decide who gets care and for what reason?

As a person who is very happy with her doctor, gyn, dentist and so on, the thought of govermnent rationing scares the hell out of me.

I can give you cases, but I’m sure you’ve heard them all already – if you’ve been listening.

Delle

PUMA-SF… I already have an FBI file… you want me to add to it?

I am not wasting my breath on politicians, I say, off with their heads, the whole lot of them…

What I would like to do, however, is a lot of consciousness raising for everyone in America. We are ALL being manipulated. 100% manipulation. Top to bottom. Nothing we hear on the news, much of what appears on MSM and private blogs, is all spin and manipulation, and it is quite successful in results. The expected behavior, the necessary public movement, comes out in favor of their top to bottom machinations.

I say, reject everything, 100%, turn those evil maggots out, every election cycles. I do not care if one more law, budget, whatnot is passed for the next decade. What has been passed in the last 7 months will suffice until we get out selves out of the catastrophic mess we are all in.

DeadGirl: Please do tell. I’ve been doing this since the 60′s so I’m pretty sure I have one as well. Hell, I’m going to keep at it until they drag me away.

PumaSF: I am attempting here to extend the necessary nature of reflection knowledge and discussion about what reform is necessary and where. no matter the system.

Once I stated that I would not do the Prowl..that issue for me was closed. Ihave moved on and am trying to ..frankly..educate about which I have spent many years…tracking..

and that is what are the pragmatic realities in any healthcare bill or reform that are important to understand.

The concept and reality of “medically necessary services”
as it has and in the current bill as I understand it continue to mean…is the crux of what one will receive or hope to receive under any system…including single payer.

That is my sole intent here…with the set of posts I have offered. I hope as well that a Prowl seeking to reform the definition as set forth in current and future rules and regulations returning determination and defintion of “medically necessary service” to the hands of practitioners not Insurers may result down the line..if people here choose to focus their attention in that direction.

DancesWithPumas 04.27.09 at 1:20 pm

Doctors in IL pay between $125,000 and $300,000 a year for medical malpractice insurance.
——————–
What percentage is that of their annual income?

———————-
Dances – I don’t know. There was a woman who called a local radio station recently and said her heart surgeon husband made $420,000 a year. Each January he had to send a check to the Illinois Medical Society for $125,000 for malpractice insurance. He had never been sued. They pay about $140,000 in taxes to the IRS.

I think the subject was the cut of medicare payments to doctors.

good points on health care all- it sounds like the one thing we agree on- whether we want national health care or not is that the BO administration will not be able to pull it off.

One thing I talked to so many voters about when I was working on Hillary’s campaign was her experience w/ health care reform- and how important I believed her first failure was- as we all know- we learn way more from our mistakes than from our successes- and Hillary being as hard working as she is- had a very good plan in place.

I don’t think it would have gone smoothly but I think she had a running start,. I think she knew where the priorities were and how to allocate resources

Obama on the other hand- not a clue- does anyone know how this national health plan is supposed to work?

And I didn’t see any response about the cabinet and other positions- I guess I will go google b/c I still don’t know if we have a HHS secretary or a surgeon general- I am thinking that would be a good start for health care reform? As well as a response to the swine flu epidemic?

NOP-I appreciate all your posts today. And agree with reading the bill.

PumaSF-your post #67 cracked me up.

MK-your story of what happened in Italy is a good example of how the system can work. I had the opposite situation in Canada in the 80′s with a softball team. One of our players fell down the side of a hill catching a pop fly and broke his leg. I drove him and his wife to the hospital. The hospital refused to set his leg, because he wasn’t Canadian, unless they were paid in advance. They didn’t have that much cash on them. Fortunately I had my credit card with me so I was able to pay for the services.

I agree with the posters who have a distrust of what this administration proposes; gosuef4hill worded it well. I do not want this administration determining what is necessary medical care. And once a system is in place it will be harder to get rid of it.

The health care issue is a tough one.

How are we going to pay for what seems to be a ridiculously expensive and unsustainable program? (oh yeah-by rationing care!)

I see this as part of a big pander to illegal immigrants. The ones that will help re-elect Obama.

Gosuef4Hill: I had as I have said almost given up hope re health care reform until Hillary Clinton brought out her ideas and literal ways of paying for them…showing her capacity to as you say..learn..and totally reimagine..No ..she did not per se redefine “medically necessary services” but she had imagined a way for people to participate in plans as good as that of Congress..(and who has heard any of them complaining of their plans or for that matter trying to imagine same for all of us)

I as well believe that the practical repercussions of the rules and regulations determining medically necessary services either within or outside of government programs would have in fact been altered in time to reflect what was already available in the best plans as people understand the nature of the difference among them..Expectations would have been rasied higher and the system of care would have risen not sunk to the mediocrity promised by this administration as it ignores just how powerful a control over care is the what and who determines “medically necessary services” bodies forth.

Of all that was lost with her…it is this issue that continues to break the heart with me.

gay gal & scarlet-

gay gal is absolutely right- plenty of illegals pay into the tax system w/ their fake SS cards- most employers know they are hiring illegals and simply turn their eyes away.

As for Gabrielle Giffords- I have absolutely no use for her- again- in a state that supported Hillary- Giffords came out as a SD for Obama- Giffords considers herself a blue dog and voted on every piece of pork-laden crap that has come out of the WH- from the stimulus to the budget to the bail out- even though I don’t live in her distract, I call her office often and express my disgust w/ her. Of course, my rep., Harry Mitchell isn’t a lick better-

GOSUEF4HIL 04.27.09 at 2:40 pm
And I didn’t see any response about the cabinet and other positions- I guess I will go google b/c I still don’t know if we have a HHS secretary or a surgeon general- I am thinking that would be a good start for health care reform? As well as a response to the swine flu epidemic?
—————————————————————-
According to the official websites we still have an acting HHS secretary and an acting surgeon general. There is information on the swine flu available at the websites.

http://www.surgeongeneral.gov/index.html

http://www.hhs.gov/

Kerry Linys:HR 676 is one kind of single payor…and it keeps in place the worst of every government anything especially healthcare and Medicare..limitations…Conyers…introduced it with others in the House…Are you Kerry..saying Conyers is a rogue here..along with all the others who signed on?

\He is not a rogue…from Obama and Pelosi..

rules and regulations defining “medically necessary services

________________
All Insurance Companies do this NOW! They approve or deny or state up front only what they will cover.
One needs several types of insurance policies for adequate coverage

If single payer UHC..added coverage for those who can afford it. Medicare system plus more insurance as supplement.

NOP- totally agree- health care was my BIG decider back in the primaries- when I was naive and pretty happy w/ all the candidates (I can’t even believe I can say that) but it was really looking at health care that sold me on Hillary-

That being said- I know that there are just too many pieces of the puzzle and too many hands in the pot to re-vamp the system- basing it on the plan available to congress makes great sense. I have always thought – why re-invent the wheel? If there is a system in place- add to it- much like the SCHIP program was recently expanded – as KerryLINY can attest to.

Same thing I think about health care information- the Obie administration is going to try to come up with a whole new electronic medical record- when a beautiful system is already in place at the V.A.- but I guess that wouldn’t provide as many jobs and Obama wants to toot his own horn about all of the jobs he created w/ his stimulus plan-

It most likely won’t matter in a few years- we will all b e crippled by inflation and the disasters of this administration.

Yes NOP- my heart breaks about health care too…

NOP I dont know what the final form of the SP will be – details of how they will work a budget around it to make sure we are not broke, levels covered people will pay, how private option will complement, etc, will be debated. It would be nice to have Hillary in that detailed process because she knows about the issue and worked on it for years. I bet the final form will be different from Europe because we’ll probably keep competing private options. Only those will be forced to skim their profits a bit and some tort reform might need to be worked in to reduce practice insurance.

What I do know is that mandatroy health coverage is good for America and businesses as Social security. Small businesses are being hampered by high cost of insuring workers, people are allowing their health degeenrate until its so costly and overall national productivity compromised etc. Its just like mandatory car insurance. If we dont have SP in our current reform, we’ll only be trying to repaint our current system and it will end up still expensive. I also know BO’s plan is not as good as Hillary’s.

Actually BO’s plan is the same junk as all his plans – cover up the problem by painting over it – denying a role for SP in the final policy. Good thing is BO I believe is not drafting this bill – or we might as well expect some half-hearted pandering nonsense.

93KerryLinys: I with some trepedation (true) have taken up most of the space on this blog today regarding the issues and certainly that has not been my focus…mine has been more of a boring one…and that is a problem as well…Why the hell NOP are you so up in arms about three words?…becasue since Medicare was enacted and since HMO et concept took over Insurance and its nature…these three words have determined by definition of provider be that government or private what you will or will not get and will continue to do so unless redefined.

Oh you educated me in several ways and forced me to think NOP. Trust me.

98KerryLinys: See my comments early on…I support single payer but not at the cost of institutionalizing in the hands of private insurers and government rules and regulations the power to determine what a medical necessary service is and now that power is theres..not the practitioners…Redefintion is absolutely necessary or this game is another version of the same old game and the direction for healtcare is in the wrong hands …that of the physician and nurse practioner…as well as speech pathologists..physicial therapists..and others who are educated and trained to determine necessary medical services…

It should be in the hands of the practitioners and it is not. and will not be.

re: health care and illegal immigrants

yes, they are covered now.

but is that the same as covering them under this legislation?

legislating coverage for illegals is not just a step towards amnesty, it also means sharing the coverage of the people who have paid into medicare.

I’m sorry to be repetitive-but how does this get paid for?
Will my mother get rationed care?

Does congress get the same coverage as everyone else?

Your understanding or my understanding or 1000 groups understanding of what you or they may think is medically necessary service are irrelevant now and have been.
It is what the current and future providers determine ….and that is why such a redirection and redefinition is required.

—————————
Yes it is THE problem….What ever the INSURACE Co’s and THE POWER PLAYERS decide/ we live or die by…what is the solution? redirection and redefinition is required.
Not boring NOP, we are all being thoughtful..with little hope of changing the system with the people who are now in charge.

Tell me how and be specific……chuck it all and start over?……refine the system we have, VA, Medicare, Privatize?

HP
xxoo to Mr HP!

Will my mother get rationed care?

———————————-
We all get rationed care of one kind or another.
All hospitals and Doctors follow “guidelines” for treatment of everything!

NOP you are right that SP will always have budgetary limitations that makes them limit what is covered – medically necessary service. This so the government do not break the bank or mount deficits (they probably still will anyway) we will turn around and complain of.

As HP said, and as is practiced with those with Medicare today, the choice and power to augment what is covered with extensions in private insurance will be there. Its like how there is mandatory car insurance and some folks with really nice cars add comprehensive coverage and other additional protection. I guess healthy young people for instance will not want the government to mandate so much services that their contributions have to be significant.

There’s probably a long way to go to get the best system for us. We might argue fight that Viagra should not be covered and contraceptives should. That’s why we should show them we are taking notice. I believe the reform should include SP which is why I prowled them to not paint over the current system. One thing we all agree on is that this is current system not it. (I cant seem to say this as succintly as HP).

112HPBoston: I have vigorously promoted here a redefinition of “medically necessary services”…removing decision for what is and is not that from current holders.

Trust a physician or nurse practioner you say? Yes. They are the providers..and yes…this is what was done for years and years before insurance and the government decided to make that choice.
and place my care and your care…

What has happened is that authority and compensation has simply been shifted from these individuals into the hands of instittuitions likeinsurance providers.
ANd as well more parameters of care provision have been in fact usurped by entities above.

Do I trust my physician more than I trust the insurer or government? And if I do not like him or her or what they do or do not do..I leave.

or, is it Old English? Please advise.

KerryLInys: As I understant HR 676…one will be able to buy insurance for what is not covered as medically necessary ..thus that definition and its importance will determine the quality and kind and affordability of anything else..so we are to think what? Oh good…I will just get more and better? That is an assumption of disproportianate expectations.

my heart has been reemed like the inside of the core of an apple attempting to navigate with all my lights the intertices of the toxic phrase and gatekeeper
” medically necessary services.”
—–

. And youre probably paying a lot for that basic, confusing, and even tricky coverage too.

KerryLinys: And by the way that is what we are all supposed to think ..just as we used to think that medically necessary service means what I need..It doesn’t. and that need certainly is determined by my physician…It doesnt.

correction: That need is determined by my physician.It isn’t..
not if you are into chronic health issues it doesnt..It doesnt even mean if if you “need” a test…and this with all the marketing about preventive health care…all marketing debris.

When you are debating health care coverage- don’t forget “medically necessary” is defined by whom? The insurance company? THey say you can have whatever you want- but they won’t pay for it?
The government? DO any of us trust the government to decide? How many advisory boards, committees, group summits will it take to reach concensus?
Don’t bet on your health care provider to decide-as I mentioned above- we are fearful of litigation if we don’t do something.
The patient? Ever work with a hypochondriac? Or a completely non-compliant person? Alcoholic? Drug dependent? Schizophrenic? Abused? Illegal? Mentally ill? Sociopathic?
It is very very complicated-

I see Murphy says she pays $1200/mo for coverage for her and her family- that is outrageous- I don’t know what kind of coverage that is- at the end of the year you have paid $15,000 for coverage- I hope you are getting your health care delivered to you on a silver platter-

MKfromLA 04.27.09 at 3:53 pm
DWP – i stand corrected. somehow I was thinking Middle Aged english. Seemed right at the time.
—————-
I was trying to help you avoid going there, youngin’.

KerryLinys: This heart has been reemed more on behalf of others when I had access to them professionally and could help than for myself..I know how to fight what Ihave described but that does not mean Ihave won and will win in the future. Nevertheless..if “the definnition of medicaly necessary services” doesnt kill one…attempting to navigate its intertices certainly does not give one nourishment!

And if I persist like the Capricorn goat I am on this it is because this mountain I have climbed is getting more filled with debris in the name of sustenance and safe footing than ever before..And while this Capricorn goat who has traveled the debris strewn mountain is still at it..I know better the paths.
I am trying to keep walking with my goat horns forward hoping that others understand where I am trying to go and follow or at least remember the Capricorn goat who said…keep going..keep looking..keep paying attention…think…and do not just accept what sounds good..It is supposed to sound good.

pesehone: No I am not an insurance professional ..My knowledge comes from many years of working in social service..as a Planner for a large Areawide Agency on Aging and other entities..as well as the practicum of attempting to move my mother through every possible phase of health care provision over a three year period as well as doing that with others in various stages of issue and medical need at income levels below at and above poverty within various levels and kinds of healthcare coverages private and government alike. As a result I have read more things I know more wanted to read than anything I wanted to…and have as a result over time configured in my imagination what I have tried to give here as well as other issues I have not…

Pesephone:As a result I have read more things I no more wanted to read.. and I have seen more than I ever imagined possible regarding the gatekeeping power of “medically necessary services”..and have worked harder on this item than anything I have ever done. It is a feeling like Hercules rolling the earth back and forth up the hill…i.e. this Capricorn goat image!

Murphy: and might I suggest that if you had the lower plan..you would not be paying 20% but more of the overall bill than that because negotiated service payments from Insurers with hospitals do not pay them 80% of th ebill the patient would get from the hospital…but far less..and you would not pay 20% but more of the real cost..given the arrangements…I note.

I am glad right now you can afford the higher payment regardless of the architecture of these plans…

NewOrleansPuma 04.27.09 at 3:48 pm

112HPBoston: I have vigorously promoted here a redefinition of “medically necessary services”…removing decision for what is and is not that from current holders.

Trust a physician or nurse practitioner you say? Yes. They are the providers..and yes…this is what was done for years and years before insurance and the government decided to make that choice.
and place my care and your care…

Do I trust my physician more than I trust the insurer or government? And if I do not like him or her or what they do or do not do..I leave.
—————————–
NOP I will say I have the same fear as all about UHC..it will be rationed, we will have little choice, “THEY” will regulate care, Insurance Co’s have ruled the roost forever.
Way back hospital and insurance Co’s worked closely together and regulated everything. Almost all hospitals were private or state run…or charity wards of church run hospitals.
Care was hit or miss then. Insurance Co’s and HMO’s took over and are the pits!
I have to say the Medicare system with basic coverage and added payer supplemental insurance has worked rather well. You do not need a your primary care doctor to MANDATE an HMO doctor. You may go to ANY doctor or specialist you choose on your own, so good, as I disliked the last doctor I had, no trouble finding a rheumatoligst I like. I chose my primary care doctor also but I still know and always have that“medically necessary services”… have been way out of my control and always will be in this imperfect world.

CYL NOP.

persephone 04.27.09 at 3:51 pm

HP

I mean reaaally rationed care, where they let the old folks rot like mushrooms, like in GB.

Obama has some cost cutting surprises in store.

————————————
This of course will happen to the poor as it does NOW!!!!

National Institute for Health and Clinical Excellence

From Wikipedia, the free encyclopedia

The National Institute for Health and Clinical Excellence or NICE is a special health authority of the National Health Service (NHS) in England and Wales. It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (still abbreviated as NICE).

NICE publishes clinical appraisals of whether particular treatments should be considered worthwhile by the NHS. These appraisals are based primarily on cost-effectiveness.

NICE carries out assessments of the most appropriate treatment regimes for different diseases. This must take into account both desired medical outcomes (i.e. the best possible result for the patient) and also economic arguments regarding differing treatments.

Cost effectiveness
NICE attempts to rationalise for the NHS the trade off between spending money on different forms of treatment and when and when not to treat. It attempts to weigh up factors such as how much benefit the treatment gives, how long the benefit of the treatment will last for, and how much it costs. Once it has done this it will make recommendations about which treatments can be given and in which circumstances in order to maximise the delivery of care within the available budget.

Quality-adjusted life years
NICE utililises the quality-adjusted life year or QALY to measure the benefits of a treatment quality and the quantity of life delivered by a given treatment regime. One interpretation of QALY would be how much lifespan a person would be prepared to give up to deliver one year of perfect health from the current state of ill health.

Cost per quality-adjusted life year gained
The cost of a treatment may be relatively easy to calculate but because people may be at different ages when they receive treatment, the gain may be different according to age. A heart operation on a small child may deliver many more years of quality of life than the same operation on a 76 year old man.

Criticism

Decisions not to fund expensive treatments or those with no proven benefits are necessary to ensure that public funds are used wisely. From an individual’s perspective it can sometimes seem that NICE is denying access to a potentially life-saving treatment but the denial is only effective as far as the use of public resources are concerned. Treatment may be available if the patient can find the resources to pay for treatment in the private sector and a doctor willing to administer it.

Some of the more controversial NICE decisions have concerned Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease and Bevacizumab, sorafenib, sunitinib and temsirolimus for renal cell carcinoma. All these are drugs with a high cost per treatment and NICE has either rejected or restricted their use in the NHS on the grounds that they are not cost-effective. In effect NICE is saying that the money could and should be better used to treat other patients and deliver even greater benefits to the community overall.

http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence
———–
Are medically necessary services the same as comparative effectiveness that was in the stimulus package or the same as NICE? Wonder if doctors will be able to be sued for malpractice under single payer?

thanks scarlet-that’s exactly what I was referring to..

Health care is already rationed by HMO’s, it has been for years now. And the U.S. will never have the kind of care that is used in the NHS “British” system. The NHS systems covers far more than what some other systems do and is not likely to go over in the U.S. What they would end up would look more like the health care system in Canada. I’m all for it. I’ve lived in Canada and despite the fear mongering in the U.S that I grew up with was astonished and pleased to see how well their system works for everyone.If you are sick and need surgery, you get it and do not have to worry about whether or not you will lose your home to pay for it. If it’s your child let me tell you it is a huge weight off your mind. They have state of the art facilities and CHEO of Ottawa was on the cutting edge of experimental treatments that saved my sons life. It’s more compassionate a system AND more HUMANE.

The thing about these “OMG!! We will have horrible healthcare!” stories is that north of the border they tell them too, about the U.S. system. They talk about how people die from lack of insurance, about patient dumping and are thankful they don’t have the same system that is used there. No system is perfect and any interest group and cherry pick their “horror” stories. I’m just saying what I saw as opposed to what I was taught to believe. The reason I ended up being in Canada was not being able to afford decent health care at home for my son who was extremely ill.

Both systems have their flaws. My dad was a doctor in the U.S. and my mom a nurse so I grew up around medical people in the U.S. …it’s six of one and half a dozen of another and if anyone says different they are ill informed. However, nobody in Canada goes bankrupt or dies because they can’t afford an operation. For all the fears about universal health care most western countries have it and it seems to be working well enough that it’s not even considered to be dropped for something else any time soon.

Hillary’s plan was a lot better as Obama’s left loop holes for the insurance companies and pharma companies that hers didn’t. I wondered for long time how so many lefties missed that one. It’s going to be harder with his plan to make it work but, it’s past time to have universal health care in the richest country on earth. I’m not sure HOW Obama’s plan will work without people ending up getting cut off or not being able to afford the drugs. There also wasn’t a component for autism research at first until after Hillary’s plan had it…and again hers was more comprehensive.

Using republican talking points to shut her down we WILL end up with a system that isn’t all it could have been…more expensive and covers fewer people with more loopholes for big businesses in the medical field. However, the time for universal healthcare in the U.S. is NOW. No more waiting.

We ARE already paying for “illegal” people since when they go to the hospital without insurance and are treated those costs are absorbed and passed along to everyone. That’s true of everyone who uses the system and doesn’t pay into it. That’s why universal care is better and works best, being cheaper all around.

I’m prowling this one. I’m tired of people I love and care about worrying about being able to afford health care. I’m worried about the cuts to medicaid that are already being talked about too. Hospice patients are our parents and loved ones and will be harmed by these cuts terribly. Medicaid already had a six month cut off for hospice patients..in a universal health care system this wouldn’t be the case. Why on earth should we have to agonize over if or how much treatment a cancer patient can get due to costs? That is barbaric and it always was.

Also, in the Canadian system certain treatments are done under general anesthetic that are done under local in the U.S. to save money…because it’s “cheaper” so care IS rationed there. It’s rationed in one form or another in the practice of triage. I think the rationed care argument is a straw dog and if you really are worried about that one the insurance companies are the big bad wolf on that score. They won’t cover people who have pre existing, another thing Hillary wanted to stop them doing, they also cut people off if they are using the insurance “too much” it’s a disgrace.

Medical care ought to be a right not something you have to “earn” sink or swim. That is truly heartless.