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The PPACA - Implementation Phase I

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Re: The PPACA - Implementation Phase I

LynahFan said:
Yawn. We did the exact same exercise when I was a kid (early '80s) except it was a lifeboat with only 6 seats. It's a generic exercise in ethical and moral reasoning, not a specific indoctrination about health care.
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Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.
 
Re: The PPACA - Implementation Phase I

FreshFish said:
Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.
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Yep. Keep me comfortable, feed me, and hydrate me. But beyond that, it's my wishes as to what degree of care and maintenance I want.
 
Re: The PPACA - Implementation Phase I

FreshFish said:
Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.
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Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take. My living will is on file with three hospitals, my doctor's office and in the family's safe. It takes five minutes to complete and is a piece of cake.
 
Re: The PPACA - Implementation Phase I

Priceless said:
Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take. My living will is on file with three hospitals, my doctor's office and in the family's safe. It takes five minutes to complete and is a piece of cake.
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Agree and spot on. What I don't want is a 3rd party making the decision based on economic or similar reasons. *I* or my designees can make it, but not a somebody who does not have a vested interest in my life.

SCTV clip: http://youtu.be/8LQYBXQwD_s
 
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Re: The PPACA - Implementation Phase I

joecct said:
Agree and spot on. What I don't want is a 3rd party making the decision based on economic or similar reasons. *I* or my designees can make it, but not a somebody who does not have a vested interest in my life.

SCTV clip: http://youtu.be/8LQYBXQwD_s
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Yes, but if you haven't made the decision to write a living will and you don't have insurance that will cover "heroic" end of life care, then you *are* making an economic decision. If you rack up $400,000 in end of life care, you're saying, "it's worth it for enough tax payers to work long enough and hard enough to pay $400,000 in taxes (a heck of a lot of labor hours) just so I can lie in a lousy hospital bed for a few extra weeks." Why should *you* be entitled to make that choice, which affects the economics of dozens and dozens (if not hundreds) of tax payers?

Choosing not to decide is still making a choice.
 
Re: The PPACA - Implementation Phase I

Priceless said:
Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take….
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….or not take.

LynahFan said:
Yes, but if you haven't made the decision to write a living will..., then you *are* making an economic decision.

Choosing not to decide is still making a choice.
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or to be more precise, choosing not to decide is a tacit way to authorize the government to make a choice for you.



In every US jurisdiction, if a person dies without a will, his/her debts are settled and property is allocated according to that jurisdiction's "laws of intestacy." Typically an administrator is appointed, charges "reasonable and customary" fees for his/her time, determines which debts are valid, then distributes whatever is left to various relatives by default. [SUP]1[/SUP]

We can probably all agree that there certainly is a valid concern whether the federal government would in this situation try to pre-empt all state laws and impose a single uniform federal law upon everyone.



Now, let's make an analogy between a will and a "living will." Everyone should have one of each, granted. Many of us would prefer that both situations be regulated by state law, and not to allow the federal government to supersede them.

if you strip away the hysteria about "death panels" you will find in some cases a very reasonable concern: does PPACA tacitly assert federal jurisdiction over end-of-life care (i.e., does it pre-empt state end-of-life care laws somehow)? might it even eventually be used to assert federal jurisdiction to pre-empt individuals' living wills too and dictate a single uniform end-of-life care standard imposed on everyone regardless of their wishes otherwise? even if you think the latter unlikely, wouldn't you prefer that the answer be "of course not" ?

Yet even an attempt to request this minor clarification gets rebuffed. If in fact it does get rebuffed ought to make all reasonable people nervous (except Rover of course ;) ).





[SUP]1[/SUP] From time to time you read about a scandal at a local office: administrators' fees are too high, or administrator alerts a buddy to present a claim asserting a debt against the estate, administrator does not verify said debt but merely pays it to the buddy and splits the proceeds with him/her; administrator finds a buddy and sells off estate assets at below-market value, buddy then sells assets and splits profits with administrator; etc.

So not only do you want a will to make sure your property eventually goes to whom you designate, you also make sure that people you trust hold interim title between your death and the ultimate distribution of your asets.

Similar concerns no doubt if you have a default administrator of a living will as well!
 
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Re: The PPACA - Implementation Phase I

Miami Herald

WASHINGTON -- As the battle over the healthcare law grinds on — Republicans no closer to victory than when they forced the government shutdown — a different fight was rising on a recent Saturday from inside Sharkey’s, a bar near the campus of Virginia Tech, 260 miles away.

Lured by free beer, gift cards and the chance to win an iPad, 100 students heard a pitch from the young staffers of a group named Generation Opportunity: Obamacare is a bad deal, and you should opt out.

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Generation Opportunity, which formed in 2011 and gets funding in part from the conservative Koch brothers, is about to embark on a tour of 20 college towns nationally, including a Nov. 9 stop at the University of Miami. The pitch is that you shouldn’t feel compelled by the government to buy insurance, and that it may be cheaper outside the marketplaces.

A blueprint for an upcoming tailgate calls for games such as beer pong and cornhole, free Taco Bell and beer. Pictures of people signing petitions to opt out would be sent over Twitter, Facebook and Instagram.

The group, and more recognizable conservative organizations such as Americans for Prosperity and FreedomWorks, show how the fight has shifted from Congress to the grassroots. Young people are among the law’s most ardent supporters, but at the same time many are unaware of the benefits, providing an opening for critics.
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Not sure I want to play "Cornhole"
 
Re: The PPACA - Implementation Phase I

has anyone heard how many folks have signed up since Obama care went online? I've heard as little as 30,000 and as many 51,000.
 
Re: The PPACA - Implementation Phase I

walrus said:
has anyone heard how many folks have signed up since Obama care went online? I've heard as little as 30,000 and as many 51,000.
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some scattered data points:

The states running their own exchanges report enrollment more regularly [than HHS], which ranges from the low thousands in big states like California to a single person so far in Delaware. Literally, one.
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Re: The PPACA - Implementation Phase I

If the rollout of the exchanges was an MMA bout, the referee would have already stopped the match. It is even worse that the most pessimistic critics feared. What a disaster. :(

I hardly have the heart to post links any more. The data from the exchanges submitted to insurance companies is so corrupted, they have resorted to telephoning people and processing applications by hand.

Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified.

Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans. Blue Cross & Blue Shield of Nebraska said it had to hire temporary workers to contact new customers directly to resolve inaccuracies in submissions. Medical Mutual of Ohio said one customer had successfully signed up for three of its plans.
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Meanwhile, HHS is refusing to release any information and is intimidating people who do know something to remain silent:

HHS, which is running all or part of the marketplaces in 36 states, has repeatedly declined to answer specific questions about its handling of the rollout, including specific glitches, enrollment figures, or its plans to fix the problems.

Health-department officials have pressured insurers to refrain from commenting publicly about the problems, according to executives at four health plans, who asked not to be named.
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Re: The PPACA - Implementation Phase I

I am shocked that people who opposed the law are now saying it is a failure. Truly astonishing.
 
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