The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

FF: I normally agree with you for the most part. But on the point of forcing people to take medications or else they would pay more for coverage. If you force a patient to take a medication-for example Lipitor or another statin-and they get rhabomyolysis and are incapacitated or die from protein overload shutting down their kidneys (and trust me it does happen and we have seen it)-who gets sued and for how much and who pays? After all, perhaps the doctor felt it really wasn't indicated but had to give the medication because it was mandated by someone.

I can certainly understand that on a case-by-case basis; the widespread antipathy however cannot all be chalked up to a few exceptions. Something else clearly was going on in this particular situation.

BTW, I'm not for "forced" anything. It would be easy enough to include a waiver if the doctor was closely monitoring the situation and had misgivings.

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

I am always annoyed at those news stories about people who become too big to fit through the door of their apartment and can no longer get out. They got in, didn't they?

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I can certainly understand that on a case-by-case basis; the widespread antipathy however cannot all be chalked up to a few exceptions. Something else clearly was going on in this particular situation.

BTW, I'm not for "forced" anything. It would be easy enough to include a waiver if the doctor was closely monitoring the situation and had misgivings.

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

I am always annoyed at those news stories about people who become too big to fit through the door of their apartment and can no longer get out. They got in, didn't they?

As always we are pretty much agreed. But i love playing the other side. In my career i have seen quite a few very obese (morbidly so) people who do not get that way voluntarily. There a several metabolic syndromes (some inherited, some gene mutations, some not otherwise specified) that lead to some patients having to be weighed down at the meat packing company. Years ago we had one lady who was about 565 pounds and strictly adhered to a 1200 calorie diet. Where do these people fit in this schematic? Granted they are the distinct minority of obese people.

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

Just a thought-why should you and I (assuming you are a safe driver) be charged to subsidize all those other morons who are out there driving irresponsibly? Sure they get charged more-if they decide to pay for insurance, since many just drive anyway without it. But my auto insurance has gone up virtually every year as long as i can remember, even with older cars-and neither Jen or I have had an accident in over 30 years each of driving.

I fully agree with you-people who make poor or dangerous choices should pay a penalty for them. But how do we implement that system for healthcare effectively. how do we decide exactly what unhealthy decisions are? And who makes these decisions? Insurance companies? The US Government? Hard to draw lines in this-is eating one Big Mac bad for you? Two? 300 per year? I like the concept but i cannot wrap myself around how this could be accomplished easily.

 

[Rover]

Just a thought-why should you and I (assuming you are a safe driver) be charged to subsidize all those other morons who are out there driving irresponsibly? Sure they get charged more-if they decide to pay for insurance, since many just drive anyway without it. But my auto insurance has gone up virtually every year as long as i can remember, even with older cars-and neither Jen or I have had an accident in over 30 years each of driving.

I fully agree with you-people who make poor or dangerous choices should pay a penalty for them. But how do we implement that system for healthcare effectively. how do we decide exactly what unhealthy decisions are? And who makes these decisions? Insurance companies? The US Government? Hard to draw lines in this-is eating one Big Mac bad for you? Two? 300 per year? I like the concept but i cannot wrap myself around how this could be accomplished easily.

It can't be accomplished at all except for the low hanging fruit (smokers, for example or drug users). Offensive linemen in the NFL are obese by body mass standards but are in pretty good shape. You'd also never get away with charging old people extra.

The point of pooling resources seems to me to be that you take the good with the bad but hopefully it all evens out in the end. What I find is people want to set up a system that revolves around them while not realizing that isn't possible.

Besides, cracking down on fraud would possibly be a lot more lucrative to the long term health of the system.

 

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember, if you're employed you can afford Health Care if they offer it. Otherwise forget it. And that's the perfect solution.

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

It can't be accomplished at all except for the low hanging fruit (smokers, for example or drug users). Offensive linemen in the NFL are obese by body mass standards but are in pretty good shape. You'd also never get away with charging old people extra.

The point of pooling resources seems to me to be that you take the good with the bad but hopefully it all evens out in the end. What I find is people want to set up a system that revolves around them while not realizing that isn't possible.

Besides, cracking down on fraud would possibly be a lot more lucrative to the long term health of the system.

Rover-I may have disagreed with some of what you have posted in the past-but you just hit a home run here. I agree totally. What we have here in the US is a population that cannot be compared to any other industrialized nation-what works in Japan or Sweden does not mean it can work here. Most important is that everyone has to realize that for every action there is a chain of reactions down the line. Some of the rules, laws, controls put into effect only create incredible problems later on.

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Most important is that everyone has to realize that for every action there is a chain of reactions down the line. Some of the rules, laws, controls put into effect only create incredible problems later on.

Emphasis added!

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Emphasis added!

Emphasis accepted. I have spent virtually my entire adult life in medicine-several fields and several aspects of it. I have come to the conclusion that where we now reached is intolerable, but where we are going is even more so. Hopefully there is an answer but as of now I just do not see it.

 

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

 

[goldy_331]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

You first.

 

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

You first.

Love to.

 

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A tale of two states -- http://washingtonexaminer.com/virgi...land-embraces-it/article/2513512#.UKV1YYd9Kuk

As a Maryland taxpayer, I get used to statements like this....

Maryland, meanwhile, plans to take advantage of the federal government's offer to fully fund the expansion for the first three years. However, the state must pick up 10 percent of the load after that, and it's unclear how the state will pay for it.

At $7,352, Maryland is 11th in the nation in Medicaid spending per enrollee. Virginia is 25th with $5,870 per enrollee.

"We recognize it's not forever, but it gets people under care, under coverage," said Maryland Lt. Gov. Anthony Brown.

"We certainly have a number of years to plan and prepare for the day when it's more like a 50-50 match. But we think it would be foolish for Maryland if we did not participate."

Hint -- in 2014, the current MD administration gets changed due to term limits. Guess who gets stuck with the bill? The new gang (wonder if they can blame their troubles on the previous administration and make it stick)!

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

And keeps medicare costs down significantly if you do it at age 65. Pay in for 30-40 years and then drop dead-no longer will there be as big a shortage in the general fund.

 

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

a question for our in resident medical specialists.

my doc tells me he gets (numbers are rough - I cant remember exactly) 80 cents on the dollar from Blue Cross, 45 from TriCare (military coverage) and 20 cents from medicare. do doctors screen their patients by what insurance coverage they have? do patients with better insurance get better, quicker service?

as an aside, wow, this system is really broken.

The short of it- we do not actively do anything different based on insurance. We do not withhold treatment or not see someone because of their insurance. No one in my practice is treated different as far as getting better or quicker service per our choice. We see people as soon as we can get them in and make recommendations based on what we think is right. Unfortunately what happens after we make recommendations is dependent on what the person can afford/ what the insurance dictates. This means that we frequently spend time much more time discussing what the person can actually afford (see various rants in this and previous threads). We also may have to wait for the bubbleheads with no medical training to OK the prior authorization to pay for the tests we have tried to order.

The system is broken. Reeeeally broken.

 

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The short of it- we do not actively do anything different based on insurance. We do not withhold treatment or not see someone because of their insurance. No one in my practice is treated different as far as getting better or quicker service per our choice. We see people as soon as we can get them in and make recommendations based on what we think is right. Unfortunately what happens after we make recommendations is dependent on what the person can afford/ what the insurance dictates. This means that we frequently spend time much more time discussing what the person can actually afford (see various rants in this and previous threads). We also may have to wait for the bubbleheads with no medical training to OK the prior authorization to pay for the tests we have tried to order.

The system is broken. Reeeeally broken.

All the reasons we stepped back from the practice Les. What we have is now terrible and getting worse rapidly. I truly fear for patients-and we are all patients at some point in time.

 

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A tale of two states -- http://washingtonexaminer.com/virgi...land-embraces-it/article/2513512#.UKV1YYd9Kuk

As a Maryland taxpayer, I get used to statements like this....
Hint -- in 2014, the current MD administration gets changed due to term limits. Guess who gets stuck with the bill? The new gang (wonder if they can blame their troubles on the previous administration and make it stick)!

That's one thing about the loony left: their policies may be stupid, but they themselves are not stupid. They know how to time their dumb ideas to have them collapse when they're out of power.

 

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

That's one thing about the loony left: their policies may be stupid, but they themselves are not stupid. They know how to time their dumb ideas to have them collapse when they're out of power.

I better never hear you ever complain about other people blaming Dubya for anything if you're going to use that argument.

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

It is starting to look like governors can cause PPACA to topple under its own weight (a) by refusing to accept the Medicaid expansion (SCOTUS ruled 7 - 3 in favor of tossing out the provision of PPACA that required states to accept Medicaid expansion or lose all existing Medicaid funding; by overturning this section of the law, SCOTUS said states could keep existing Medicaid funding and also not participate in the expansion if they wanted), and more importantly, (b) by refusing to set up state-run exchanges for health insurance.

The law says that if a state doesn't set up a state-run exchange, the feds will step in and set one up and run it in that state; however, some people say that the actual language of the law says that if the feds set up an exchange in a state, residents of that state won't be eligible for the federal subsidies that are available for participants in state-run exchanges.

As of the original November 16 deadline for a decision, at least 30 states had not opted to develop state-run exchanges. HHS has extended the decision deadline to Dec 14.

If more than half the states decline to set up state-run exchanges, the burden of administration will squarely on the federal government, yet when Democrats controlled both Houses of Congress, they did not provide any funding to the government to run the programs. Now there are intensive negotiations on reducing the rate of growth in federal spending going forward: not quite the ideal time to be adding a huge new staffing requirement to a federal department, eh?


More details here.

It would be ironic indeed for the mandate to be found unconstitutional, for the law to be allowed to stand anyway under an alternate theory (the taxing power) and then for the law to fail anyway after all that because of how incredibly poorly it was drafted.

 

[Rover]

It is starting to look like governors can cause PPACA to topple under its own weight (a) by refusing to accept the Medicaid expansion (SCOTUS ruled 7 - 3 in favor of tossing out the provision of PPACA that required states to accept Medicaid expansion or lose all existing Medicaid funding; by overturning this section of the law, SCOTUS said states could keep existing Medicaid funding and also not participate in the expansion if they wanted), and more importantly, (b) by refusing to set up state-run exchanges for health insurance.

The law says that if a state doesn't set up a state-run exchange, the feds will step in and set one up and run it in that state; however, some people say that the actual language of the law says that if the feds set up an exchange in a state, residents of that state won't be eligible for the federal subsidies that are available for participants in state-run exchanges.

As of the original November 16 deadline for a decision, at least 30 states had not opted to develop state-run exchanges. HHS has extended the decision deadline to Dec 14.

If more than half the states decline to set up state-run exchanges, the burden of administration will squarely on the federal government, yet when Democrats controlled both Houses of Congress, they did not provide any funding to the government to run the programs. Now there are intensive negotiations on reducing the rate of growth in federal spending going forward: not quite the ideal time to be adding a huge new staffing requirement to a federal department, eh?


More details here.

It would be ironic indeed for the mandate to be found unconstitutional, for the law to be allowed to stand anyway under an alternate theory (the taxing power) and then for the law to fail anyway after all that because of how incredibly poorly it was drafted.

Once again you are either drinking Drano or living in a conservative fantasyland world to make up for the humiliation your ideology suffered at the ballot box on Nov 6th. Governors refusing Medicare funding is irrelevant. Everybody needs to get health insurance. If said governors want their lower income residents to pay more for that by forgoing federal dollars, so be it. The law stays the same. My guess is those voters, particularly in Dem leaning states, will be wanting to have a chat with their elected officials come election day...

Second, its of no consequence whether the feds, the state, or a joint fed/state program is run. What we're seeing right now is a capitulation on the GOP side of Congress in regards to raising revenues via higher taxes and lower deductions. With Obama in the drivers seat, GOP has to either accept some tax hikes and cuts to defense spending, or do nothing and get ALL tax hikes and massive cuts to military spending. I'm not sure what reality you're living in, but if the GOP had the ability to defund the law, they would have done so over the past two years when they had some momentum. Not now after they've been publically b ! tch slapped by the voters.

 

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Once again you are either drinking Drano or living in a conservative fantasyland world to make up for the humiliation your ideology suffered at the ballot box on Nov 6th. Governors refusing Medicare funding is irrelevant. Everybody needs to get health insurance. If said governors want their lower income residents to pay more for that by forgoing federal dollars, so be it. The law stays the same. My guess is those voters, particularly in Dem leaning states, will be wanting to have a chat with their elected officials come election day...

Second, its of no consequence whether the feds, the state, or a joint fed/state program is run. What we're seeing right now is a capitulation on the GOP side of Congress in regards to raising revenues via higher taxes and lower deductions. With Obama in the drivers seat, GOP has to either accept some tax hikes and cuts to defense spending, or do nothing and get ALL tax hikes and massive cuts to military spending. I'm not sure what reality you're living in, but if the GOP had the ability to defund the law, they would have done so over the past two years when they had some momentum. Not now after they've been publically b ! tch slapped by the voters.

We got slapped by the major metro areas. The rural US was solidly red.

But back to the gist of your post -- an OpEd in today's WaPo on why the fiscal cliff may not be a bad idea.