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Trump's Full Court Press on healthcare

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Re: Trump's Full Court Press on healthcare

Post by LawBeefaroni » Wed Dec 07, 2016 3:28 pm

Paingod wrote:
RunningMn9 wrote:utter lack of cost transparency to the consumer.
Somewhat off-topic, but this is the part that's really frying my bacon anytime we see a medical bill. They just send us this big "$523" bill with absolutely no idea what it's for. When we ask for an itemized list of charges, they sputter and stammer and have a real hard time doing it. We don't pay unchallenged lump sum bills, sorry.
Who is "they?" (Insurer, hospital/facility, doctor's office, system/medical group, lab, etc)

You should always get a breakdown that includes either a line item description or a code (DRG or CPT or HCPCS). Some facilities and/or insurers try to simplify with "consumer friendly" data obfuscation but they should always be able to provide a breakdown.

Out of professional curiosity, I line-itemed every charge when we had our kid recently and found about $80 in incorrect charges to billed me. All from 3rd party professional services. I actually considered that pretty good but it still burned me up that some out of state lab that got sent a hearing test result not only charged $125 to read it but tried to over charge my coinsurance on top of it.



On the cost discussion that I missed, a facility's procedure cost is not a great gauge for pricing. Procedure-specific cost doesn't account for losses in free care, Medicaid, delinquencies, bad debt, reserach, etc. You'd get a vicious circle in poor/underprivileged areas where prices are driven up by no-pays and payer mix which result in more no-pays which results in higher prices... Should cardiac cath surgeries help support losses in ER and psych? Do we want our hospitals to turn into surgery centers that only perform predictable, highly profitable procedures and nothing else? Just getting into an ambulance run by the Chicago Fire Department results in a $975 bill. Mileage is extra. I'm guessing $200 of that is for the actual service and $775 is for the 24 hour availability. Acute care hospitals are similar. They staff, train, and keep available very expensive personnel for the rare instance that you need them.


Even if there were a simple way break such things down into each procedure the insane cost of equipment, implants, drugs, and liability are still going to result in costs, and therefore pricing, that the average person will think is insane. Cost containment has to include the supplies hospitals use. Fun fact, implant supplier reps are often on-site outside ORs waiting until someone needs a rare, expensive piece of equipment stuck into their body. The purchase contract is signed right there and the rep procures the devide so the hospital doesn't have to carry the overhead for a device that they may never use or that my go bad in a store room. The reps also advise the surgeons in theater on the specifics of the device during surgery (thus ensuring their place outside the OR for the next sale).




You also have the extremely complex relationships that most hospitals have. Not all doctors are employees of the hospital. They are merely on-staff which means they have privileges to admit and/or perform certain procedures at the hospital. They are freelancers who may or may not be in he same insurance plans as the hospital and who may or may not share the same pricing/cost philosophies as the hospital. You may have per diems and locums. You may have on-site 3rd parties. Then consider that a hospital may see 20-30 core insurances and well over a hundred total, all with different rules and networks. It's a mess.
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Re: Trump's Full Court Press on healthcare

Post by Grifman » Thu Dec 08, 2016 9:30 am

Tolerance is the virtue of the man without convictions. – G.K. Chesterton

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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Thu Dec 08, 2016 9:53 am

So we should expect random tweets from the President Elect telling everyone (by using their names) how awful the CEOs and Presidents of various hospitals and insurance systems are?

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Re: Trump's Full Court Press on healthcare

Post by Max Peck » Thu Dec 08, 2016 12:15 pm

Smoove_B wrote:So we should expect random tweets from the President Elect telling everyone (by using their names) how awful the CEOs and Presidents of various hospitals and insurance systems are?
Not at all. They won't be random.
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Re: Trump's Full Court Press on healthcare

Post by LordMortis » Thu Dec 08, 2016 3:43 pm

This looks like if should go here

http://www.nextavenue.org/creating-safe ... er-adults/

I think about this occasionally because I'd not dream of becoming an attempted burden to my nieces and nephews.

The radio also said that the life expectancy for Americans went down, with none of the normal explanations for the first time.

http://www.npr.org/sections/health-shot ... port-finds
Still, he believes the data from 2015 are worth paying attention to. Over that year, the overall death rate increased from 724.6 per 100,000 people to 733.1 per 100,000.

While that's not a lot, it was enough to cause the overall life expectancy to fall slightly. That's only happened a few times in the past 50 years. The dip in 1993, for example, was due to high death rates from AIDS, flu, homicide and accidental deaths that year.

On average, the overall life expectancy, for someone born in 2015, fell from 78.9 years to 78.8 years. The life expectancy for the average American man fell two-tenths of a year — from 76.5 to 76.3. For women, it dropped one-tenth — from 81.3 to 81.2 years
Hello sloth, TV, Internet, and office jobs.

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Fri Dec 09, 2016 2:28 pm

I think it's going to keep going down, in spite of more people being insured. Why? Because copays and high deductibles result in insurance only being used for high-dollar expenses. The cost of routine healthcare and maintenance is becoming more than anyone wants to spend. There are many things I am not doing right now because of cost. I have not seen the retina doc in over two years, so I have no idea if my diabetic retinopathy is getting worse. For diabetes and thyroid issues, I'm supposed to get an array of labs done twice a year with follow-up office visits. I've pushing this out to once a year, and as a result, I now have to take more meds. Other nagging pains go from something I would have had looked at to something I'll just live with. I just hope none of it is a so-far subtle indication of very bad things to come.

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Re: Trump's Full Court Press on healthcare

Post by malchior » Sat Dec 17, 2016 12:52 pm

The LA Times poses the question is the Obamacare repeal effort just about a tax cut for the rich? The evidence is there. And it fits the pattern.

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Re: Trump's Full Court Press on healthcare

Post by Holman » Sat Dec 17, 2016 1:03 pm

malchior wrote:The LA Times poses the question is the Obamacare repeal effort just about a tax cut for the rich? The evidence is there. And it fits the pattern.
Of course.

While we spend the next four years frantically wrestling with Trump's authoritarianism, Congress will be busy restoring the Gilded Age.
Much prefer my Nazis Nuremberged.

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Re: Trump's Full Court Press on healthcare

Post by Kraken » Sat Dec 17, 2016 1:16 pm

Holman wrote:
malchior wrote:The LA Times poses the question is the Obamacare repeal effort just about a tax cut for the rich? The evidence is there. And it fits the pattern.
Of course.

While we spend the next four years frantically wrestling with Trump's authoritarianism, Congress will be busy restoring the Gilded Age.
We are already in a second gilded age as measured by inequality. I argued in the Gilded Age thread that it must eventually lead to a new Progressive Era. However, since then I have read convincing arguments that extreme inequality is one precondition for the rise of fascism, and it looks like that's the path we're following.

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Re: Trump's Full Court Press on healthcare

Post by Zarathud » Sat Dec 17, 2016 9:55 pm

The IRS budget, staff and morale has already been decimated in the Roman style. And the rumored blueprint for IRS reform does not include a criminal prosecution division.
"If the facts don't fit the theory, change the facts." - Albert Einstein
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Re: Trump's Full Court Press on healthcare

Post by Isgrimnur » Sat Dec 17, 2016 9:58 pm

Ponzi schemes create jobs!

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Re: Trump's Full Court Press on healthcare

Post by Holman » Sat Dec 17, 2016 11:05 pm

Zarathud wrote:And the rumored blueprint for IRS reform does not include a criminal prosecution division.
Enlarge Image
Much prefer my Nazis Nuremberged.

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Re: Trump's Full Court Press on healthcare

Post by malchior » Thu Dec 22, 2016 9:28 am

Ah the wonder of Kakistocracy taking root in our country. You can't make this shit up. So let's run this down. Kid breaks arm. He sets it himself. Takes son to GP because it is cheaper!?! Are you kidding me? What is this the frontier 1839? FFS. This can't be a real thought process. In any other first world nation this is a $40 visit. WTH - this country has people with legit mental problems running it.

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Thu Dec 22, 2016 10:10 am

Emergency Room costs start at "how much you got?" and escalate rapidly every minute you breathe their air. That antiseptic smell ain't cheap, you know!

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Re: Trump's Full Court Press on healthcare

Post by gilraen » Thu Dec 22, 2016 11:02 am

Jeff V wrote:Emergency Room costs start at "how much you got?" and escalate rapidly every minute you breathe their air. That antiseptic smell ain't cheap, you know!
Granted, most metropolitan areas now have urgent care clinics that can treat the majority of things for which people still routinely go to the ER. It's usually much cheaper and faster, but many people still need to be educated on this option. Obviously, if you're out in a rural area with one major hospital ER, then you don't have many (or any) other choices.
But setting a broken bone yourself, possibly causing major problems down the line (especially for a kid who's still growing) - that's absolutely asinine and should constitute child endangerment.

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Re: Trump's Full Court Press on healthcare

Post by LordMortis » Thu Dec 22, 2016 11:14 am

gilraen wrote:
Jeff V wrote:Emergency Room costs start at "how much you got?" and escalate rapidly every minute you breathe their air. That antiseptic smell ain't cheap, you know!
Granted, most metropolitan areas now have urgent care clinics that can treat the majority of things for which people still routinely go to the ER. It's usually much cheaper and faster, but many people still need to be educated on this option. Obviously, if you're out in a rural area with one major hospital ER, then you don't have many (or any) other choices.
But setting a broken bone yourself, possibly causing major problems down the line (especially for a kid who's still growing) - that's absolutely asinine and should constitute child endangerment.
Urgent Care seems to be a myth to me. If something is serious enough to see someone RIGHT NOW, I want to go to a hospital, not a clinic, and all of our hospitals have emergency entrances, not urgent care entrances. Also, the right RIGHT NOW aspect makes things difficult because all of the urgent care clinic only seem to be open during office hours, like 8-5 M-F, which is not likely the time you have an accident the results in the need for stitches or XRays or whatever. I have done things like a broken a finger, for which it was obvious I need an image and a splint and be sent on my way and then spent the next two hours calling to find all urgent cares closed.

That's just my experience. However, we seem to have an awful lot of urgent care clinics around here, so they must be getting used for something.

I've never gone to the doctor for a flu or the like, so urgent care isn't really something. The closest I've come is after apparently having whooping cough for a couple of months before giving up on it getting better on its own and for that I went to the general practitioner.

My kidney stone flare ups probably could have been dealt with by urgent care but again they've always been closed and when a kidney stone incapacitates you and you feel like you are dying a painful death, it's not a wait until Monday after 09:00 situation.

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Re: Trump's Full Court Press on healthcare

Post by gilraen » Thu Dec 22, 2016 11:26 am

Well, yeah, part of the reason why you don't get charged ER prices is because urgent care clinics don't staff 24 hours. It's understandable that you don't have much choice in the matter if your emergency is late at night. I've gone to urgent care with a UTI, and between the visit and the lab work, it cost about the same as it would have been at my doctor's office (it would have taken several days to get an appointment with her, and I couldn't wait that long). People drag their kids to the ER with ear infections, sore throats, minor sports injuries (those usually happen during the day when most urgent cares are open). Not all of those facilities have full-size x-ray equipment, but you can check that on their website.

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Re: Trump's Full Court Press on healthcare

Post by malchior » Thu Dec 22, 2016 12:08 pm

ER prices are partially what they are because the system is broken at efficient health delivery. For example, "fraudulent" billing. I've never personally gone to a hospital without have to fight a slew of bullshit charges as every doctor in the place sticks their nose in the room and then bills. I got cut at work years ago and a random doctor stopped in to the room. I said are you here to treat me? No? Get out. He billed me. I fought it and won. There was no reason for a orthopedic consult on routine stitches for a cut on my leg.

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Re: Trump's Full Court Press on healthcare

Post by Grifman » Tue Jan 03, 2017 3:31 pm

This is an excellent article on the dilemma facing the Republicans' plan to "repeal and replace":

http://nymag.com/daily/intelligencer/20 ... rever.html

I've always thought the Republican criticism of Obamacare was incoherent and unrealistic. They wanted to keep the popular provisions (no limits on dollar coverage, no pre-existing conditions, letting older children stay on, etc.) but were totally unrealistic by saying that they would not require coverage. So what keeps people from jumping in and out? And even if you limit that in some way, how do you keep just the sick and unhealthy (who are expensive to cover) from signing up while the young and healthy ignore coverage (and can't subsidize the older/sicker population).

It was one thing to campaign against it but now they own it, and as the article states, they just can't cut off coverage for 20 million people. It's also interesting in that many Republican states refused to expand Medicaid coverage for the working poor (so if you work, you can't get help!?) but will Congress repeal that - obviously they can't and throw millions off their coverage. As the article points out, there are a lot of parties involved - individuals/families, insurance companies, hospitals, etc. Obama care exists as a whole and it's going to be hard to deal with individual pieces - they need to craft a comprehensive replacement but don't look nearly unified enough to do so.

Rhetoric is meeting reality, and this is going to get interesting.
Tolerance is the virtue of the man without convictions. – G.K. Chesterton

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Tue Jan 03, 2017 3:37 pm

Why can't they cut off coverage for 20M? It's not as if they give a rats ass about anyone too poor to pay for massive health insurance premiums anyway.

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Re: Trump's Full Court Press on healthcare

Post by Toe » Tue Jan 03, 2017 3:41 pm

Grifman wrote:This is an excellent article on the dilemma facing the Republicans' plan to "repeal and replace":

http://nymag.com/daily/intelligencer/20 ... rever.html

I've always thought the Republican criticism of Obamacare was incoherent and unrealistic. They wanted to keep the popular provisions (no limits on dollar coverage, no pre-existing conditions, letting older children stay on, etc.) but were totally unrealistic by saying that they would not require coverage. So what keeps people from jumping in and out? And even if you limit that in some way, how do you keep just the sick and unhealthy (who are expensive to cover) from signing up while the young and healthy ignore coverage (and can't subsidize the older/sicker population).

It was one thing to campaign against it but now they own it, and as the article states, they just can't cut off coverage for 20 million people. It's also interesting in that many Republican states refused to expand Medicaid coverage for the working poor (so if you work, you can't get help!?) but will Congress repeal that - obviously they can't and throw millions off their coverage. As the article points out, there are a lot of parties involved - individuals/families, insurance companies, hospitals, etc. Obama care exists as a whole and it's going to be hard to deal with individual pieces - they need to craft a comprehensive replacement but don't look nearly unified enough to do so.

Rhetoric is meeting reality, and this is going to get interesting.

Never fear, I am sure the big pharma and insurance lobbyist are working diligently on the laws they want their congressmen to pass.

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Re: Trump's Full Court Press on healthcare

Post by Skinypupy » Tue Jan 03, 2017 3:59 pm

The most obvious solution is already staring them in the face. Go through all the motions of repealing "Obamacare", then make a grand public spectacle of unveiling the "Trumpcare" replacement (the exact same plan with a different name), touting it as all Trump's idea.

Problem solved.
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Re: Trump's Full Court Press on healthcare

Post by Kraken » Tue Jan 03, 2017 5:34 pm

Skinypupy wrote:The most obvious solution is already staring them in the face. Go through all the motions of repealing "Obamacare", then make a grand public spectacle of unveiling the "Trumpcare" replacement (the exact same plan with a different name), touting it as all Trump's idea.

Problem solved.
Obamacare started as Romneycare, after all. It's a Republican model. If you insist on a system based on private insurers, this is how it has to work.

We all knew that Obamacare has to fail before we can have true socialized medicine like the rest of the civilized world. We figured it would fail gradually on its own because insurance companies are the weak link. This is going to speed things up. Thanks, Republicans!

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Re: Trump's Full Court Press on healthcare

Post by Fireball » Wed Jan 04, 2017 11:23 am

Skinypupy wrote:The most obvious solution is already staring them in the face. Go through all the motions of repealing "Obamacare", then make a grand public spectacle of unveiling the "Trumpcare" replacement (the exact same plan with a different name), touting it as all Trump's idea.

Problem solved.
This is actually what I suspect would have happened with a Jeb Bush or Marco Rubio presidency: reintroduce Obamacare with some structural differences (less generous subsidies, smaller medicaid expansion, allow differentiation of premiums by sex as well as age, allow a larger multiplier for premiums for older people) and call it something new. With Trump, I'm afraid we might actually get the absurd hodgepodge of "reform" proposals bandied around by Congress, none of which would actually expand coverage to those who need it most.
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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Wed Jan 04, 2017 2:35 pm

Fireball wrote: With Trump, I'm afraid we might actually get the absurd hodgepodge of "reform" proposals bandied around by Congress, none of which would actually expand coverage to those who need it most.
And that should not surprise you at all. This is not a demographic that the Republicans have any interest in and anyone in need of such coverage that DID vote Republican is a just a special kind of stupid anyway. With any of their policy changes, you must ask yourself, "How does it benefit the obscenely wealthy and/or the corporations they run?"

I can't envision them making any change that will result in lower premiums or deductibles for anyone. I do expect it will get much higher as employer obligations are lessened, however.

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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Thu Jan 05, 2017 1:36 pm

From the NYT Opinion pages, The Health Care Plan Trump Voters Want:
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Thu Jan 05, 2017 1:40 pm

Smoove_B wrote:From the NYT Opinion pages, The Health Care Plan Trump Voters Want:
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.
So...they want to be Canadian? I thought "socialized" was an obscene word to them?

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Re: Trump's Full Court Press on healthcare

Post by Default » Thu Jan 05, 2017 2:06 pm

Jeff V wrote:
Smoove_B wrote:From the NYT Opinion pages, The Health Care Plan Trump Voters Want:
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.
So...they want to be Canadian? I thought "socialized" was an obscene word to them?
It's "socialism" only when it applies to someone else. It's a gol-durn right as a 'Murrican when it applies to them.
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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Thu Jan 05, 2017 2:13 pm

By "someone else" you mean when the dems suggest it?

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Re: Trump's Full Court Press on healthcare

Post by malchior » Thu Jan 05, 2017 2:14 pm

More cynically but I think more accurately - it depends if "their guy" on the tv tells them something is socialism and isn't something they get for "free". Sorta like Medicare since other people aka the young foot the bill for that.

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Re: Trump's Full Court Press on healthcare

Post by LordMortis » Thu Jan 05, 2017 2:21 pm

It's socialism and anti American if there is a perception that I have to pay for someone else or that government is removing my choice. The world beyond perception and the alternatives available are not up for discussion.

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Thu Jan 05, 2017 2:35 pm

The dems should enthusiastically support it and shout from every pulpit how great it is that the Republicans are finally coming to their senses and are completely embracing Socialism. In fact, they should take out TV ads in every market commending by name the congressman that supported this unprecedented Socialist movement. Of course, that takes just 15 seconds out of a 30 second ad. The rest of the time could be spent anticipating the next great Socialist ideal: massive gun control.

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Re: Trump's Full Court Press on healthcare

Post by malchior » Thu Jan 05, 2017 6:03 pm

Know the news will be bad? Just ban it! The low these scumbags are stooping to are astonishing.

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Re: Trump's Full Court Press on healthcare

Post by Skinypupy » Fri Jan 06, 2017 3:53 pm

The ACA repeal also strips federal funding from Planned Parenthood because of course it does. Assholes.
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Re: Trump's Full Court Press on healthcare

Post by Captain Caveman » Fri Jan 06, 2017 4:12 pm

Skinypupy wrote:The ACA repeal also strips federal funding from Planned Parenthood because of course it does. Assholes.
PP doesn't really get "funding", does it? Don't they just get reimbursed for services rendered like any other provider? Not that I expect consistency out of the GOP, but what's the rationale for denying payment to PP when they give a cancer screening or a pap smear but providing it for another medical provider when they do the same? I know, I know-- ABORTIONS!!1!-- but so many people (mostly low income) depend upon PP for care that has nothing to do with abortions. Fuck 'em all, I guess?

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Re: Trump's Full Court Press on healthcare

Post by Skinypupy » Fri Jan 06, 2017 4:21 pm

Captain Caveman wrote: but so many people (mostly low income) depend upon PP for care
DING DING DING
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Re: Trump's Full Court Press on healthcare

Post by gbasden » Sat Jan 07, 2017 12:14 am

Skinypupy wrote:
Captain Caveman wrote: but so many people (mostly low income) depend upon PP for care
DING DING DING
It's like the R's are embracing the image of a cartoon villain. I expect them to be tying helpless maidens to train tracks next.

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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Mon Jan 09, 2017 10:55 am

gbasden wrote:
Skinypupy wrote:
Captain Caveman wrote: but so many people (mostly low income) depend upon PP for care
DING DING DING
It's like the R's are embracing the image of a cartoon villain. I expect them to be tying helpless maidens to train tracks next.
Yeah, but something something HILLARY SUPPORTER something something SHE DESERVES IT!

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Re: Trump's Full Court Press on healthcare

Post by malchior » Tue Jan 10, 2017 8:37 am

The Republican healthcare "plan" apparently is chaos.The Health lobby doesn't even know what to do at this point. They have the Mad Man in Chief hanging over them.
Some companies, anxious about changes in health policy, said they were afraid to speak out because they feared that Mr. Trump would attack them on Twitter, as he has badgered Boeing, Ford, General Motors, Lockheed Martin and Toyota.

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Re: Trump's Full Court Press on healthcare

Post by Grifman » Tue Jan 10, 2017 12:00 pm

malchior wrote:The Republican healthcare "plan" apparently is chaos.The Health lobby doesn't even know what to do at this point. They have the Mad Man in Chief hanging over them.
Some companies, anxious about changes in health policy, said they were afraid to speak out because they feared that Mr. Trump would attack them on Twitter, as he has badgered Boeing, Ford, General Motors, Lockheed Martin and Toyota.
The Republicans have had years to develop a plan to replace the ACA, but instead they chose to have I think it was, 60+ fruitless votes to repeal it under Obama. There's no excuse for them to not have had a plan now to pull off the shelf and implement, or at least form the basis for implementation after hearings and input from the health care industry. Or course, the reason is that this is hard work and they don't really have an agreement among themselves as to what it should be. Such a bunch of doofs.
Tolerance is the virtue of the man without convictions. – G.K. Chesterton

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