I hate the ACA

[maize]

There is also the possibility the chiro has been involved with Medicare fraud in the past and an no longer accept Medicare.

 

My main issue with what the chiro is claiming is that Medicare patients cannot legally seek non-covered services elsewhere, which has never been the case and is not something this person could have ever been told as it is pure nonsense.

Though from what I have read chiropractors are not legally allowed to opt out of Medicare (MD's and DO's can).

[ChocolateReignRemix]

Also FAQ FOR chiropractors:

https://www.kmcuniversity.com/medicare/faq

 

If you go to The official Medicare website and look up chiropractic care, it lists covered services and states that patients would pay out of pocket for other services. There is nothing--NOTHING--indicating any patient could not go to any chiropractor and pay for a service they desire. If it is a Medicare covered service the provider is required to bill Medicare--perhaps yours does not want to do that. Which would be entirely on their shoulders not Medicare's.

 

Slight correction: the bolded is only true if the chiro is a participating provider.  If they are non-participating, the patient simply pays for the service as the provider cannot bill Medicare.

[ChocolateReignRemix]

Though from what I have read chiropractors are not legally allowed to opt out of Medicare (MD's and DO's can).

 

They can choose to be a non-participating provider, which means they do not accept Medicare for any services. 

[FaithManor]

My mother is 77 and my dad is 85. They are on Medicare and a supplemental insurance that costs $400 per month. In the last year, my dad has had a triple by-pass and hip surgery. If Medicare was going to ration, they would have rationed him. Can you imagine if he had been on an insurance plan before ACA? Even if he could have gotten insurance the moment he started having real problems he would have been dropped. Medicare is a miracle. My mother has had multiple health problems. Stroke, broken arm, multiple stays in hospital, a couple of weeks in a rehab. Between the two, they have probably cost $200,000 in the last year and Medicare has taken care of them wonderfully. No rationing! Next month, my dad will have cataract surgery. My parents are currently enjoying life. Viva Medicare! Let's make Medicare for all!

Same here. My parents have probably taken a quarter to half million in healthcare out of medicare. His open heart and original lung cancer surgeries came in over $175,000. Obviously a bizarre amount more than they ever paid in, and they rarely have a hiccup of any kind.

 

But according to them,they deserve it! Sigh....everyone else without insurance??? Well,to listen to them talk none of the younger generation deserves what they have. Only them. Their generation was better, earned the privilege of taxpayer provided insurance. My family would not be able to have that level of care. Our crappy for profit insurance company would absolutely refuse to cover it, do everything it can to stop it. We die? The CEO and company wins!

 

And my parents and their friends are perfectly okay with it!!! So long as they get what they want, the rest of us can rot. No compassion. I am seeing this widespread among the elderly here. Sigh....hope it is just a local thing because the resentment here between my generation, my kids' generation, and my parents' is positively malignant and not good for the country. Sigh...

 

At any rate the government being too inefficient and corrupt to administrate a single payer system is an invalid argument. The level of profound inefficiency, corruption, and malevolence within the corporate, for-profit insurance industry equals if not surpasses the US government. While millions of lives are saved through medicare provided healthcare that same number or more of privately insured patients die of rationed healthcare, denials of procedure approvals, denials of life saving meds, etc. in order to enrich pockets of corporate greed mongers. The paperwork and hoop jumping medical providers go through in order to be paid is far worse for private insurance than for medicare. The argument against a single payer system based on government corruption and inefficiency is unsupportable in the face of the grim reaper behemoth we face called "the insurance industry".

[Carol in Cal.]

Rational, well-educated people can still make mistakes. How could they even enforce "people on Medicare can't be treated here even if they pay out of pocket"? Do you people in California have bar codes on your arms or something?

The vast majority of Americans 65 and older are in Medicare, so as soon as a doctor sees that someone is in that age group or approaching it it's time to have that conversation, about how this treatment does or does not coordinate with Medicare. 

 

Alternative practitioners often are paid outside of the insurance systems, so they have these kinds of convos all the time.  My naturopath, for example, gives out superbills to patients but doesn't bill insurance and doesn't expect insurance to respond to those claims.  Neither does my former chiro.  It's a more common conversation than not in alternative medical circles.

[ChocolateReignRemix]

The vast majority of Americans 65 and older are in Medicare, so as soon as a doctor sees that someone is in that age group or approaching it it's time to have that conversation, about how this treatment does or does not coordinate with Medicare. 

 

Alternative practitioners often are paid outside of the insurance systems, so they have these kinds of convos all the time.  My naturopath, for example, gives out superbills to patients but doesn't bill insurance and doesn't expect insurance to respond to those claims.  Neither does my former chiro.  It's a more common conversation than not in alternative medical circles.

 

But if they aren't a Medicare provider, there should be no conversation.  They are not contractually held to any Medicare rules if they have not contracted to be paid by Medicare.

 

Can you explain the bolded?  Are you saying your naturopath bills insurance companies that he/she does not have a relationship with?  If so, why?  There is no way those would be covered.

Edited December 27, 2016 by ChocolateReignRemix

[Carol in Cal.]

 The argument against a single payer system based on government corruption and inefficiency is unsupportable in the face of the grim reaper behemoth we face called "the insurance industry".

Heh.

 

I hate the medical insurance industry so much.  Trying not to pay r us should be their motto.  Post-claims underwriting.  All kinds of carp.

 

But haven't you noticed, every time there is a radical shift in how things work, prices go up insanely and service levels drop?  And haven't you noticed that the government is *never* responsible?  *NEVER!*? 

 

At least now there is an avenue of recourse, however inadequate; and some checks and balances, however tattered.  I have yet to see a description of single payer for this country that doesn't involve the fox watching the henhouse.

[ChocolateReignRemix]

OK, let me give you an example of what I mean.

 

An elderly lady, a little 'off' lived in our neighborhood in a house that was basically falling down around her.  Every time it rained she would be observed carrying huge washbuckets of water, presumably leaked in through the roof, outside to dump them out.  Her home was ground zero for mice for the neighborhood to such at extent that we saw them inside, between her window and her shade during the day.  The front yard was so overgrown that people on her block didn't realize that she had a garage door up front.  The chimney was pulling away from the side of the house.   

 

I researched the ownership of the house--it was owned by a trust that was administered by her nephew--because I was really worried about her safety.  Everyone in the area kind of quietly watched out to see if she was around.  If she didn't appear for a few days someone would go knock on the door to make sure she was not fallen or trapped.  No one wanted to be all up in her business, but the safety issues were kind of shocking.  We knew that she wanted to live there because it was where she and her husband had lived for many years.

 

So I talked with someone at the city about it, anonymously.  I described the situation, and she told me that if the city got into that house it would be red-tagged as not habitable, that the trustee would be subject to landlord laws around habitability, and that he would be forced to repair it.  She pushed me really hard to tell her where it was.  She argued that if there were big active roof leaks there was a danger of an electrical fire, with tragic possible results.  But, KEY POINT, she could not say that the woman would not end up homeless.  She kept saying that there were city programs for senior housing that would apply while repairs were done.  But when I asked her, can you guarantee that she will be able to go into senior housing or some temporary placement the day that you redtag her home?  the answer was no.  And we didn't even discuss the complication of her big pet dog. 

 

See, in Germany that wouldn't happen.  The city official or social worker would have TAKEN RESPONSIBILITY to ensure that the move was seamless.  Anything less would have been inhumane.  But here, we do inhumane things all the time to our most vulnerable people, and so no, I don't trust that mindset with medical care for all.  It's not a question of inadequate funding as much as it is an attitude of lack of responsibility.

 

The person you spoke with could not make any legal guarantees as they have no way of knowing what the exact situation is and cannot go only on the word of an anonymous caller.

 

 

 

[Ravin]

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years.  I know that she believes this, and that she is rational in researching things.  And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing.  So I believe her.

 

The fact that she is losing money giving up patients because she believes this doesn't make her correct.

[Ravin]

Some Medicare patients get Medicaid too and there are some instances where providers can't bill a Medicaid patient for anything not covered. Many people confuse Medicaid and Medicare so it is possible that that is the root of her chiro's misinformation. Still, healthcare providers should know better.

 

If you go in and are told it is or will be covered and expect it to be covered, and then it isn't, the provider can't come to you and bill you then. If you go to a provider that doesn't even work with medicaid and self-pay, that is your own business.

[ChocolateReignRemix]

Heh.

 

I hate the medical insurance industry so much.  Trying not to pay r us should be their motto.  Post-claims underwriting.  All kinds of carp.

 

But haven't you noticed, every time there is a radical shift in how things work, prices go up insanely and service levels drop?  And haven't you noticed that the government is *never* responsible?  *NEVER!*? 

 

At least now there is an avenue of recourse, however inadequate; and some checks and balances, however tattered.  I have yet to see a description of single payer for this country that doesn't involve the fox watching the henhouse.

 

I can think of only one radical shift in the past few decades (the ACA). Prior to the ACA, we had 20+ years of insurance premiums increasing at an average of greater than 10%/year, and the number of Americans with coverage was continually shrinking.  Are you really going to try and argue we only have a mess now due to the ACA?  If so...lol.

[maize]

They can choose to be a non-participating provider, which means they do not accept Medicare for any services.

This is not true.

 

This is actually quite a fascinating bunny trail. As best I can understand, chiropractors can choose not to see Medicare patients at all, but if they do treat them they have to sign up with Medicare as either a participating or non-participating provider, and yes non-participating providers are required to bill Medicare for covered services. Non participating status just changes the way billing and payment are handled.

 

Read the links I posted above, or this one:

http://news.meyerdc.com/chiropractors/build-your-practice/medicare-participating-vs-non-participating-provider/

Edited December 27, 2016 by maize

[Carol in Cal.]

Medicare for all article:

 

http://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835

 

Relevant quote:

 

"At the same time, we must also recognize the potential tradeoffs of transitioning to a single payer system. Lengthy wait times and restricted availability of certain healthcare services (such as elective surgery or cosmetic procedures) are important criticisms. Thus, despite its advantages, single payer will not ease the constant tension of balancing access, quality and cost in healthcare. However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system."

 

An anecdote--when I had gall bladder problems, my Kaiser plan termed surgery as elective.  This was despite the fact that when I had attacks I literally could not remain standing (laying on the floor at a grocery store is so fun, ya know?) and they became so unpredictable that I couldn't drive.  Luckily I also had Blue Cross at the time. They viewed the surgery as necessary rather than elective and got it done months and months before Kaiser would have.  I actually got a call from Kaiser to finally set up my first consultation with a surgical department a week or two after having had the surgery elsewhere.  the caller indicated that the process would be the surgical consultation, then a follow up appointment with a surgeon, and then scheduling the surgery for some time after that.  It would have been months longer before I would have had the surgery there.  I'm very thankful that we were blessed with two employer plans at the time, and resisted the pressure to have them both be Kaiser. 

[Guest]

Medicare for all article:

 

http://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835

 

Relevant quote:

 

"At the same time, we must also recognize the potential tradeoffs of transitioning to a single payer system. Lengthy wait times and restricted availability of certain healthcare services (such as elective surgery or cosmetic procedures) are important criticisms. Thus, despite its advantages, single payer will not ease the constant tension of balancing access, quality and cost in healthcare. However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system."

 

An anecdote--when I had gall bladder problems, my Kaiser plan termed surgery as elective. This was despite the fact that when I had attacks I literally could not remain standing (laying on the floor at a grocery store is so fun, ya know?) and they became so unpredictable that I couldn't drive. Luckily I also had Blue Cross at the time. They viewed the surgery as necessary rather than elective and got it done months and months before Kaiser would have. I actually got a call from Kaiser to finally set up my first consultation with a surgical department a week or two after having had the surgery elsewhere. the caller indicated that the process would be the surgical consultation, then a follow up appointment with a surgeon, and then scheduling the surgery for some time after that. It would have been months longer before I would have had the surgery there. I'm very thankful that we were blessed with two employer plans at the time, and resisted the pressure to have them both be Kaiser.

I'm so confused. Why would national healthcare have any effect on cosmetic surgery?? And what does rationing by an insurance company have to do with national healthcare??

[ChocolateReignRemix]

Medicare for all article:

 

http://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835

 

Relevant quote:

 

"At the same time, we must also recognize the potential tradeoffs of transitioning to a single payer system. Lengthy wait times and restricted availability of certain healthcare services (such as elective surgery or cosmetic procedures) are important criticisms. Thus, despite its advantages, single payer will not ease the constant tension of balancing access, quality and cost in healthcare. However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system."

 

An anecdote--when I had gall bladder problems, my Kaiser plan termed surgery as elective.  This was despite the fact that when I had attacks I literally could not remain standing (laying on the floor at a grocery store is so fun, ya know?) and they became so unpredictable that I couldn't drive.  Luckily I also had Blue Cross at the time. They viewed the surgery as necessary rather than elective and got it done months and months before Kaiser would have.  I actually got a call from Kaiser to finally set up my first consultation with a surgical department a week or two after having had the surgery elsewhere.  the caller indicated that the process would be the surgical consultation, then a follow up appointment with a surgeon, and then scheduling the surgery for some time after that.  It would have been months longer before I would have had the surgery there.  I'm very thankful that we were blessed with two employer plans at the time, and resisted the pressure to have them both be Kaiser. 

 

I bolded another relevant sentence for you.  You may also want to read the other issues with our current system which are noted in your link.

 

[maize]

The one FAQ I linked above did mention some kind of a workaround in which if a patient requests that their information not be shared with any other organization the chiropractor could treat them as self pay. Sounded a bit complicated, and the patient has to initiate (chirp cannot suggest); Carol may want to take a look at that for her situation but I think I'd want a lawyer's opinion of I were the chiro.

[ChocolateReignRemix]

This is not true.

 

This is actually quite a fascinating bunny trail. As best I can understand, chiropractors can choose not to see Medicare patients at all, but if they do treat them they have to sign up with Medicare as either a participating or non-participating provider, and yes non-participating providers are required to bill Medicare for covered services. Non participating status just changes the way billing and payment are handled.

 

Read the links I posted above, or this one:

http://news.meyerdc.com/chiropractors/build-your-practice/medicare-participating-vs-non-participating-provider/

 

I stand corrected, as I misread something else. 

 

This likely resolves the mystery of the chiro has discussed previously.  I am now betting on previous Medicare fraud.

[Ravin]

Medicare for all article:

 

http://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835

 

Relevant quote:

 

"At the same time, we must also recognize the potential tradeoffs of transitioning to a single payer system. Lengthy wait times and restricted availability of certain healthcare services (such as elective surgery or cosmetic procedures) are important criticisms. Thus, despite its advantages, single payer will not ease the constant tension of balancing access, quality and cost in healthcare. However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system."

 

An anecdote--when I had gall bladder problems, my Kaiser plan termed surgery as elective.  This was despite the fact that when I had attacks I literally could not remain standing (laying on the floor at a grocery store is so fun, ya know?) and they became so unpredictable that I couldn't drive.  Luckily I also had Blue Cross at the time. They viewed the surgery as necessary rather than elective and got it done months and months before Kaiser would have.  I actually got a call from Kaiser to finally set up my first consultation with a surgical department a week or two after having had the surgery elsewhere.  the caller indicated that the process would be the surgical consultation, then a follow up appointment with a surgeon, and then scheduling the surgery for some time after that.  It would have been months longer before I would have had the surgery there.  I'm very thankful that we were blessed with two employer plans at the time, and resisted the pressure to have them both be Kaiser. 

 

 

There are already wait lists for elective surgery, and for seeing specialists, in many places. This has far more to do with the availability of said surgeons and specialists than how they are paid.

 

Elective is not the same thing as not medically necessary--an elective procedure can be medically necessary but not a life or death emergency, therefore elective.

Edited December 27, 2016 by Ravin

[Carol in Cal.]

I'm so confused. Why would national healthcare have any effect on cosmetic surgery?? And what does rationing by an insurance company have to do with national healthcare??

Cosmetic surgery is usually not covered by insurance unless it's reconstructive, I don't think.  So I assumed that that was what they were referring to.

 

But the devil is always in the details, right?  Look at my example.  Kaiser called my surgery elective, which meant that they could postpone it for months, during which I couldn't function.  Literally couldn't drive or be in public alone, let alone work.  At least I had recourse to my other insurance (very priviledged for sure) or to the state department of insurance.  What would be the recourse under single payer?  I shudder to think...

 

Medicare is mostly a retiree medical program now, so I imagine that things like this are less serious than they would be for working people.  That's something to consider if we think about expanding it.

 

Honestly what I wish they had done instead of the ACA is expand Medicare down to about age 55 (which would have covered a lot of the uninsurable folks), implemented an expanded Medicaid or shared risk pool program for younger uninsurables, and extended the availability of private vision, dental, and drug coverage in some way.  But Medicare for all is a bridge too far IMO.

[maize]

I stand corrected, as I misread something else.

 

This likely resolves the mystery of the chiro has discussed previously. I am now betting on previous Medicare fraud.

Or just not wanting to deal with billing, which can be a major hassle. I've known medical providers who do that.

 

Either way though it is primarily on the chiro's shoulders.

[Carol in Cal.]

There are already wait lists for elective surgery, and for seeing specialists, in many places. This has far more to do with the availability of said surgeons and specialists than how they are paid.

But see, in my case the issue was whether to call something elective surgery or not.  That was quite debatable. 

If you just have one insurer, how do you debate that?

 

It sounds so benign to delay or ration or even not cover elective surgery.  You hear that term, and picture someone wanting a nose job so they can get a better movie deal.  But it can be pretty insidious when it's, say, my case, or cosmetic surgery for the badly burned, or things like that.  The devil is always in the details.

[ChocolateReignRemix]

Cosmetic surgery is usually not covered by insurance unless it's reconstructive, I don't think.  So I assumed that that was what they were referring to.

 

But the devil is always in the details, right?  Look at my example.  Kaiser called my surgery elective, which meant that they could postpone it for months, during which I couldn't function.  Literally couldn't drive or be in public alone, let alone work.  At least I had recourse to my other insurance (very priviledged for sure) or to the state department of insurance.  What would be the recourse under single payer?  I shudder to think...

 

Medicare is mostly a retiree medical program now, so I imagine that things like this are less serious than they would be for working people.  That's something to consider if we think about expanding it.

 

Honestly what I wish they had done instead of the ACA is expand Medicare down to about age 55 (which would have covered a lot of the uninsurable folks), implemented an expanded Medicaid or shared risk pool program for younger uninsurables, and extended the availability of private vision, dental, and drug coverage in some way.  But Medicare for all is a bridge too far IMO.

 

What's the current recourse for everyone who doesn't have any insurance or only has one provider who decides a procedure is elective?

 

FTR, the ACA did expand Medicaid coverage, except some states sued to block that provision. 

 

[Carol in Cal.]

A separate issue is that a lot of people don't want to break the law.  I imagine that that applies to the OP.  It's kind of surprising to me that people here were actually arguing that she should go ahead and do so because she won't be financially penalized.  Um, really?  That's your advice?

[ktgrok]

There are already wait lists for elective surgery, and for seeing specialists, in many places. This has far more to do with the availability of said surgeons and specialists than how they are paid.

 

 

 

Not to mention, longer waits, if there are longer waits, are because everyone gets care, even the poor. Are people really trying to say, they'd rather poor people not' get care so that the rich can have shorter wait times? How awful. 

[maize]

Cosmetic surgery is usually not covered by insurance unless it's reconstructive, I don't think. So I assumed that that was what they were referring to.

 

But the devil is always in the details, right? Look at my example. Kaiser called my surgery elective, which meant that they could postpone it for months, during which I couldn't function. Literally couldn't drive or be in public alone, let alone work. At least I had recourse to my other insurance (very priviledged for sure) or to the state department of insurance. What would be the recourse under single payer? I shudder to think...

 

Medicare is mostly a retiree medical program now, so I imagine that things like this are less serious than they would be for working people. That's something to consider if we think about expanding it.

 

Honestly what I wish they had done instead of the ACA is expand Medicare down to about age 55 (which would have covered a lot of the uninsurable folks), implemented an expanded Medicaid or shared risk pool program for younger uninsurables, and extended the availability of private vision, dental, and drug coverage in some way. But Medicare for all is a bridge too far IMO.

But why in the world do you keep bringing up the shortfalls of a private insurance company (Kaiser) as evidence that a government option would be worse than private? I can see no logic at all here.

 

Our private system is definitely broken.

 

Most people cannot afford two private options; your double insurance scenario would actually be much more available with a primary government, secondary private system (as many Medicare patients have).

Edited December 27, 2016 by maize

[ChocolateReignRemix]

Or just not wanting to deal with billing, which can be a major hassle. I've known medical providers who do that.

 

Either way though it is primarily on the chiro's shoulders.

 

Possible, but the claim that she cannot legally provide a service makes me question the chiro's honesty.

[ChocolateReignRemix]

A separate issue is that a lot of people don't want to break the law.  I imagine that that applies to the OP.  It's kind of surprising to me that people here were actually arguing that she should go ahead and do so because she won't be financially penalized.  Um, really?  That's your advice?

 

If their income is low, there is no penalty.

[Ravin]

But see, in my case the issue was whether to call something elective surgery or not.  That was quite debatable. 

If you just have one insurer, how do you debate that?

 

It sounds so benign to delay or ration or even not cover elective surgery.  You hear that term, and picture someone wanting a nose job so they can get a better movie deal.  But it can be pretty insidious when it's, say, my case, or cosmetic surgery for the badly burned, or things like that.  The devil is always in the details.

 

Elective usually means "not an emergency" rather than "not medically necessary."

[Daria]

But see, in my case the issue was whether to call something elective surgery or not.  That was quite debatable. 

If you just have one insurer, how do you debate that?

 

It sounds so benign to delay or ration or even not cover elective surgery.  You hear that term, and picture someone wanting a nose job so they can get a better movie deal.  But it can be pretty insidious when it's, say, my case, or cosmetic surgery for the badly burned, or things like that.  The devil is always in the details.

 

Elective surgery is surgery where choosing the date is possible.  It doesn't mean the surgery isn't important, even critical, it just means that the condition it treats isn't immediately threatening to life or limb.

 

For example, my son had a g-tube placed when he was a toddler.  We didn't place it for kicks, he was having life threatening feeding problems, but with other medical interventions, we were able to delay the surgery long enough to do some intensive antibiotic treatment to make sure his lungs could handle the anesthesia and he would survive.  Therefore it was considered elective.

 

On the other hand, my goddaughter was mauled by a dog.  She needed surgery right away to stop the blood loss.  They couldn't even wait long enough for the typical 12 hour presurgery fast, they wheeled her in right from the E.R..  That what not considered elective.

[Daria]

OK, let me give you an example of what I mean.

 

An elderly lady, a little 'off' lived in our neighborhood in a house that was basically falling down around her.  Every time it rained she would be observed carrying huge washbuckets of water, presumably leaked in through the roof, outside to dump them out.  Her home was ground zero for mice for the neighborhood to such at extent that we saw them inside, between her window and her shade during the day.  The front yard was so overgrown that people on her block didn't realize that she had a garage door up front.  The chimney was pulling away from the side of the house.   

 

I researched the ownership of the house--it was owned by a trust that was administered by her nephew--because I was really worried about her safety.  Everyone in the area kind of quietly watched out to see if she was around.  If she didn't appear for a few days someone would go knock on the door to make sure she was not fallen or trapped.  No one wanted to be all up in her business, but the safety issues were kind of shocking.  We knew that she wanted to live there because it was where she and her husband had lived for many years.

 

So I talked with someone at the city about it, anonymously.  I described the situation, and she told me that if the city got into that house it would be red-tagged as not habitable, that the trustee would be subject to landlord laws around habitability, and that he would be forced to repair it.  She pushed me really hard to tell her where it was.  She argued that if there were big active roof leaks there was a danger of an electrical fire, with tragic possible results.  But, KEY POINT, she could not say that the woman would not end up homeless.  She kept saying that there were city programs for senior housing that would apply while repairs were done.  But when I asked her, can you guarantee that she will be able to go into senior housing or some temporary placement the day that you redtag her home?  the answer was no.  And we didn't even discuss the complication of her big pet dog. 

 

See, in Germany that wouldn't happen.  The city official or social worker would have TAKEN RESPONSIBILITY to ensure that the move was seamless.  Anything less would have been inhumane.  But here, we do inhumane things all the time to our most vulnerable people, and so no, I don't trust that mindset with medical care for all.  It's not a question of inadequate funding as much as it is an attitude of lack of responsibility.

 

Why didn't you invite her to stay with you for a few days, or chip in with these other concerned neighbors and pay for a hotel for the night?

 

 

[Carol in Cal.]

Elective surgery is surgery where choosing the date is possible.  It doesn't mean the surgery isn't important, even critical, it just means that the condition it treats isn't immediately threatening to life or limb.

 

For example, my son had a g-tube placed when he was a toddler.  We didn't place it for kicks, he was having life threatening feeding problems, but with other medical interventions, we were able to delay the surgery long enough to do some intensive antibiotic treatment to make sure his lungs could handle the anesthesia and he would survive.  Therefore it was considered elective.

 

On the other hand, my goddaughter was mauled by a dog.  She needed surgery right away to stop the blood loss.  They couldn't even wait long enough for the typical 12 hour presurgery fast, they wheeled her in right from the E.R..  That what not considered elective.

I understand this, but it's one of those things that people hear but the English of it is different from the medicalese of it.  Delaying or denying elective surgery doesn't sound bad if 'elective' has the connotation of 'optional', which the English meaning of it would imply, but if it (correctly) has the connotation of 'not an emergency but still necessary', then delaying, or worse, denying it sounds a lot more alarming. 

[Carol in Cal.]

But why in the world do you keep bringing up the shortfalls of a private insurance company (Kaiser) as evidence that a government option would be worse than private? I can see no logic at all here.

 

 

I did explain this.

 

Once again, I had recourse.  It's not clear that I would have under single payer.  The article even cites delays in 'elective surgery' as one reasonable concern with Medicare for all.

 

It's important for people to understand that 'elective' in this context doesn't mean 'unnecessary' or 'optional' or even 'not urgent'. 

[Carol in Cal.]

Why didn't you invite her to stay with you for a few days, or chip in with these other concerned neighbors and pay for a hotel for the night?

 

 

1.  She didn't want to leave.  She didn't want to let anyone in her home, ever, because she was afraid of being forced to leave.  After some discussion, a little group of us decided to watch for 'signs of life' more closely, but not to rock the boat by turning this in, out of respect for her wishes.  Some of us started feeding stray cats in the hopes that they would keep the mice down.  We started bringing her things more often.  When she (very rarely, like maybe annually) had visitors from the other side of the family, we befriended them as much as possible in hopes that they could take action on her behalf.

 

2.  She would have had to give up her dog, which was her only companion at that stage, permanently.

 

3.  There was no timeline guarantee at all.  The city folks could not say whether it would be 2 days or 2 years before they got her into some kind of housing placement.  None of us knew of any private charity programs that applied in this case, because there was no substance abuse, no minor children, and no domestic violence.  We knew we could get her on a charitable food program, but senior housing was slow and unpredictable with no committed time table.  None of us had a trailer she could camp out in even.  And she would not have been safe in a tent.

 

There just wasn't anything workable, and she was going to hate us for turning her house in which would have made housing her really, really difficult. 

[Laura Corin]

 

 

But haven't you noticed, every time there is a radical shift in how things work, prices go up insanely and service levels drop?  And haven't you noticed that the government is *never* responsible?  *NEVER!*? 

 

At least now there is an avenue of recourse, however inadequate; and some checks and balances, however tattered.  I have yet to see a description of single payer for this country that doesn't involve the fox watching the henhouse.

 

Once it's single payer, there's nowhere for the government to hide.  They can't blame the insurers.  It's just them.  

 

There is massive pressure on the UK government for the NHS to provide everything.  Which is an issue, but a potentially productive one.

[maize]

I did explain this.

 

Once again, I had recourse. It's not clear that I would have under single payer. The article even cites delays in 'elective surgery' as one reasonable concern with Medicare for all.

 

It's important for people to understand that 'elective' in this context doesn't mean 'unnecessary' or 'optional' or even 'not urgent'.

The same article goes on to state: "However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system" in other words, under our current system these problems are even worse; based on evidence from countries with single payer systems there is a good chance we would actually see an improvement in wait times :) That would be awesome, right?

 

As for having recourse to secondary insurance--there is a thriving secondary insurance industry in every country I have lived in that had a government single payer system. You are aware that under our current system there are still many people without any insurance, and that most of those who do have insurance do not have secondary insurance? Most people who have Kaiser have only Kaiser. Secondary insurance would become more affordable if there were primary government insurance for everyone; this would allow a lot more people the type of recourse you want.

 

There is nothing at all in your arguments this far that points to our current mess of a system as being superior. You are so afraid of potential failings of a government system that you seem ready to overlook the extremely real failings of the system (more of an un-system) we currently have.

[Corraleno]

Those who find it to be a huge PITA to apply for Medicaid under the current system may be interested to know that the proposed head of Medicaid/Medicare in the incoming administration was the architect of Indiana's Medicaid expansion program, which requires poor people to make monthly payments in order to qualify. The penalty for missing a payment is losing benefits, or even losing insurance entirely for 6 months. This is to "empower" the poor to "be more responsible."

 

Because apparently just trying to survive month to month and keep a roof over your head and food on the table does not encourage responsibility or motivate poor people to get out of poverty in the way that losing access to healthcare does. 

[Tanaqui]

Oh, geez.

[Laura Corin]

1.  She didn't want to leave.  She didn't want to let anyone in her home, ever, because she was afraid of being forced to leave.  After some discussion, a little group of us decided to watch for 'signs of life' more closely, but not to rock the boat by turning this in, out of respect for her wishes.  Some of us started feeding stray cats in the hopes that they would keep the mice down.  We started bringing her things more often.  When she (very rarely, like maybe annually) had visitors from the other side of the family, we befriended them as much as possible in hopes that they could take action on her behalf.

 

 

My decision about my mother (living in unsafe housing) was to respect her wishes, just as you did.  Until I realised that the state of her house caused a risk to her (80yo) neighbour, whose house directly abutted her one.  She had the right to endanger herself, but not her neighbour.  My decision would have been the same whether or not there was alternative housing for her to go to - she didn't want to go, and her choice was paramount in so far as it did not endanger other people.

[maize]

This conversation is so depressing.

[maize]

I used to work for a provider that provided a service that was not covered by Medicare. The decision by our executive committee to not provide it to Medicare beneficiaries on a self pay basis. We were never accused of Medicare fraud and we were a Medicare participating provider because the other services we provided were covered by Medicare. No one wanted to risk getting in trouble with Medicare so the self pay payments were not worth the trouble.

This sounds like a decision made out of fear and possible lack of understanding of Medicare rules. Was an attorney consulted?

[Tanaqui]

Relevant quote:

 

"At the same time, we must also recognize the potential tradeoffs of transitioning to a single payer system. Lengthy wait times and restricted availability of certain healthcare services (such as elective surgery or cosmetic procedures) are important criticisms. Thus, despite its advantages, single payer will not ease the constant tension of balancing access, quality and cost in healthcare. However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system."

 

Carol, multiple people have already pointed out that italicized contradicts what you bolded. Do you plan to answer them?

[LucyStoner]

You are being kind and generous, but even with the bolded being true (I don't believe it as non-covered services are specifically listed as a patient's responsibility, and legally the government cannot restrict your access to uncovered services), someone promoting themselves as an authority should know the difference between Medicare and Medicaid.

For MediCAID my state, this issue has come up for me twice.

 

1. The state would not allow my mother (or anyone else

on her behalf) to pay out of pocket for medication her Medicaid didn't cover. We had to, joining with her oncologist who was diverting all his samples to her, basically beg the drug company to furnish it for her while she was an end stage cancer patient. My husband, who did some pharmacy billing for nearly 9 years as part of his job confirms this is true in specific instances. They can't take self pay in those instances without risking their contract with Medicaid. Note this is not related to Medicare- my mom died at 55 and was never on Medicare. Between me and my husband we verified and reconfirmed this information because we would have preferred to just pay at the pharmacy than spend hours wrangling with the drug companies charitable program on her behalf. (This was back when our income was higher and we could afford to make that offer.)

 

2. The boys rack up mega bills with ABA and other ASD related providers. We have employer provided primary insurance and Medicaid (via SCHIP) for secondary insurance. If an ABA provider is contracted with Medicaid, they are not allowed to bill us directly for whatever is not covered after our private insurance pays, even if Medicaid will not cover it. The only thing they may bill Medicaid clients for is missed appointment fees. This has at times complicated where we could obtain such services, even though we qualify for Medicaid under SCHIP which allows a much higher income level and could generally afford to pay the difference out of pocket.

 

I manage a small trust for my father's benefit and pay out of that for things Medicare doesn't cover all the time (including alternative and complementary medicine services) so I do grasp Medicare patients can pay out of pocket for uncovered charges.

 

And frankly, a lot of HCPs have a limited understanding of billing particulars unless they do their own billing. That they should know and not spread rumors/myths about Medicare doesn't mean that they do know. My husband has had to furnish providers with specific codes to facilitate their billing more than a few times because many just don't know what's up or down billing wise.

Edited December 27, 2016 by LucyStoner

[Carol in Cal.]

The same article goes on to state: "However, Oberlander suggests these issues are much smaller in countries with single payer healthcare when compared to the current U.S. system" in other words, under our current system these problems are even worse; based on evidence from countries with single payer systems there is a good chance we would actually see an improvement in wait times :) That would be awesome, right?

 

Sure, so who knows what is right?  We have the same source citing concerns and reassurances, and no actual facts.  One thing I have observed all my life, though, is that every time a big systematic change in regulations occurs, prices go up and availability becomes more limited.  This is true in the ACA--although there are some (and I'm SO happy for them) who have gotten insurance who couldn't before, there are also many who could afford medical care before and now cannot.  It's true of every example of deregulation that I can recall.  These changes are always sold based on cost savings and efficiencies, and then prices go up.  So I lean toward the skeptical side of that kind of argument.  Plus, whenever actuaries are involved and they don't have real numbers to work with, as for the mandatory insuring of previously uninsurable people, they make horrendous assumptions about costs because they have to.  So that drives up costs as well.

 

As for having recourse to secondary insurance--there is a thriving secondary insurance industry in every country I have lived in that had a government single payer system. You are aware that under our current system there are still many people without any insurance, and that most of those who do have insurance do not have secondary insurance? Most people who have Kaiser have only Kaiser. Secondary insurance would become more affordable if there were primary government insurance for everyone; this would allow a lot more people the type of recourse you want.

 

I am well aware of just how fortunate I was to have both Kaiser and Blue Cross.  I am not cavallier about this.  And I'm familiar with, for instance, the Medicare supplement policy systems which are highly regulated but are offered by private insurers.  There is nothing in a big changed single payer system to make that happen, but it would be nice if it did.  A smaller Medicare expansion would arguably work better in that regard.

 

There is nothing at all in your arguments this far that points to our current mess of a system as being superior. You are so afraid of potential failings of a government system that you seem ready to overlook the extremely real failings of the system (more of an un-system) we currently have.

Nope, I don't overlook anything, but I think drastic changes lead to drastic problems, every time, and I think the government is not responsible/trustworthy enough to be the only one in charge.  I'd rather have seen them approach the ACA more incrementally, and using its failure as an excuse to do something even bigger is disturbing at best, particularly since we now know for sure that it was sold to us with lies.  Why in the world would we trust the feds after that?

Edited December 27, 2016 by Carol in Cal.

[maize]

Nope, I don't overlook anything, but I think drastic changes lead to drastic problems, every time, and I think the government is not responsible/trustworthy enough to be the only one in charge. I'd rather have seen them approach the ACA more incrementally, and using its failure as an excuse to do something even bigger is disturbing at best, particularly since we now know for sure that it was sold to us with lies. Why in the world would we trust the feds after that?

We already have problems more drastic than those of any country that implements a single payer system. Why do you assume that the drastic problems we have are better than the drastic problems you foresee (which do not exist in other single payer systems)?

 

The implementation of Medicare did not cause drastic healthcare problems for the tens of millions of people enrolled. Why would it cause drastic problems for you and I if we were also enrolled?

 

ACA has been a fiasco in many ways precisely because it did not depart radically from our private insurance system--it tried to fix just a few of the many gaping holes in a system that was too profoundly broken to begin with to be fixed. The private model is not and never has been a safety net--it is a perk of privilege. I personally am not comfortable with necessary medical treatment being available only to the privileged. Are you?

 

If not, how do you propose to create an actual functioning medical system for everyone, employed or not, healthy or not, able to pay or not?

Edited December 28, 2016 by maize

[ChocolateReignRemix]

I used to work for a provider that provided a service that was not covered by Medicare. The decision by our executive committee to not provide it to Medicare beneficiaries on a self pay basis. We were never accused of Medicare fraud and we were a Medicare participating provider because the other services we provided were covered by Medicare. No one wanted to risk getting in trouble with Medicare so the self pay payments were not worth the trouble.

If the service was not covered by Medicare, how could you get in trouble with Medicare?

[ChocolateReignRemix]

For MediCAID my state, this issue has come up for me twice.

 

1. The state would not allow my mother (or anyone else

on her behalf) to pay out of pocket for medication her Medicaid didn't cover. We had to, joining with her oncologist who was diverting all his samples to her, basically beg the drug company to furnish it for her while she was an end stage cancer patient. My husband, who did some pharmacy billing for nearly 9 years as part of his job confirms this is true in specific instances. They can't take self pay in those instances without risking their contract with Medicaid. Note this is not related to Medicare- my mom died at 55 and was never on Medicare. Between me and my husband we verified and reconfirmed this information because we would have preferred to just pay at the pharmacy than spend hours wrangling with the drug companies charitable program on her behalf. (This was back when our income was higher and we could afford to make that offer.)

 

2. The boys rack up mega bills with ABA and other ASD related providers. We have employer provided primary insurance and Medicaid (via SCHIP) for secondary insurance. If an ABA provider is contracted with Medicaid, they are not allowed to bill us directly for whatever is not covered after our private insurance pays, even if Medicaid will not cover it. The only thing they may bill Medicaid clients for is missed appointment fees. This has at times complicated where we could obtain such services, even though we qualify for Medicaid under SCHIP which allows a much higher income level and could generally afford to pay the difference out of pocket.

 

I manage a small trust for my father's benefit and pay out of that for things Medicare doesn't cover all the time (including alternative and complementary medicine services) so I do grasp Medicare patients can pay out of pocket for uncovered charges.

 

And frankly, a lot of HCPs have a limited understanding of billing particulars unless they do their own billing. That they should know and not spread rumors/myths about Medicare doesn't mean that they do know. My husband has had to furnish providers with specific codes to facilitate their billing more than a few times because many just don't know what's up or down billing wise.

Your state law regarding not allowing purchases on non-covered drugs is unconstitutional.

[Daria]

1.  She didn't want to leave.  She didn't want to let anyone in her home, ever, because she was afraid of being forced to leave.  After some discussion, a little group of us decided to watch for 'signs of life' more closely, but not to rock the boat by turning this in, out of respect for her wishes.  Some of us started feeding stray cats in the hopes that they would keep the mice down.  We started bringing her things more often.  When she (very rarely, like maybe annually) had visitors from the other side of the family, we befriended them as much as possible in hopes that they could take action on her behalf.

 

2.  She would have had to give up her dog, which was her only companion at that stage, permanently.

 

3.  There was no timeline guarantee at all.  The city folks could not say whether it would be 2 days or 2 years before they got her into some kind of housing placement.  None of us knew of any private charity programs that applied in this case, because there was no substance abuse, no minor children, and no domestic violence.  We knew we could get her on a charitable food program, but senior housing was slow and unpredictable with no committed time table.  None of us had a trailer she could camp out in even.  And she would not have been safe in a tent.

 

There just wasn't anything workable, and she was going to hate us for turning her house in which would have made housing her really, really difficult. 

 

And these are very valid reasons.  

 

But many of them apply to the government as well.   No one in the government, in the U.S. or Germany is going to categorically state that someone is not going to become homeless.  It's possible that she would have refused to enter a group housing situation had it been offered, just like she would have refused to move to her home.  It's possible that they could have forced the issue, but that would have taken time, and psychological evaluations, and wouldn't have been a sure thing either.

[Carol in Cal.]

And these are very valid reasons.  

 

But many of them apply to the government as well.   No one in the government, in the U.S. or Germany is going to categorically state that someone is not going to become homeless.  It's possible that she would have refused to enter a group housing situation had it been offered, just like she would have refused to move to her home.  It's possible that they could have forced the issue, but that would have taken time, and psychological evaluations, and wouldn't have been a sure thing either.

They could not guarantee her a bed for the nights and a place to stay during the day.  Period.  Not responsible enough to turn her in.

[Carol in Cal.]

 

The implementation of Medicare did not cause drastic healthcare problems for the tens of millions of people enrolled. Why would it cause drastic problems for you and I if we were also enrolled?

 

Because it's too big a change too fast, because it doesn't cover dental and vision care, because drug coverage is separate, because suddenly we would go from a minimal amount of money per paycheck to a much larger one to pay for it since currently everyone pays into it but only the olders get it, because delaying care is often less of a big deal when employment is not in the picture, and again, most importantly, because it's too big a change too fast.

 

 I personally am not comfortable with necessary medical treatment being available only to the privileged. Are you?

 

Of course not, and I have said that many times in this thread.  To ask me that at this point borders on being insulting.

 

If not, how do you propose to create an actual functioning medical system for everyone, employed or not, healthy or not, able to pay or not?

Answered upthread.

[Carol in Cal.]

My decision about my mother (living in unsafe housing) was to respect her wishes, just as you did.  Until I realised that the state of her house caused a risk to her (80yo) neighbour, whose house directly abutted her one.  She had the right to endanger herself, but not her neighbour.  My decision would have been the same whether or not there was alternative housing for her to go to - she didn't want to go, and her choice was paramount in so far as it did not endanger other people.

We would have done the same thing had that been the case here.

In this particular case, though, the homes were detached and spaced out so there wasn't much danger to neighbors.  

 

Someone, I never found out who, complained to the city code enforcement about the overgrown yard.  The trustee came and basically cut everything down, and pulled the decades old ivy off of the chimney.  

 

Unfortunately it was the ivy that was holding the chimney onto the house.  It gradually but perceptibly started to pull away.  THEN it was a danger to the neighbors, and THEN I participated in calling it in.  But we still didn't talk about the mice to the city.  The fire department came out and yellow taped the area where it would fall and contacted the trustee, who came out again, very pissed off, and took the chimney down and boarded up the hole where it had been.  

 

It was always hard to decide what to do about this stuff.  Ugh.  Poor woman.  As long as her brother-in-law was the trustee he did a decent enough job of upkeep, but once his derelict absentee son took over it all went downhill.