Free Birth Control; Children Up to 26; Pre-Existing Conditions; Free Mammograms, etc. If these matter to you...

[Barb_]

:iagree: Liking this was not enough. I don't know what people are so afraid of. I would rather the decision of what to cover be made be a non-profit entity any day. Sure it can still get screwed up, but the chances are better. Right now, there is a *stated interest* in making money off health care decisions. It can't get any worse than that.

Exactly!

[ChocolateReignRemix]

I don't know. As a Christian myself, I cannot fathom it. I literally cannot even BEGIN to understand. 

 

Why worry about the sick and the hungry when more important issues like who-is-peeing-in-which-potty are what really matter? 

[goldberry]

This part of the thread has been very eye opening for me. I did not realize that various Health Share minsteries were negotiating directly with doctors and hospitals to lower prices for members. If so, then it seems that they are passing costs off to others on health insurance plans. And all that without commensurate regulation. Very interesting!

 

This is not an accurate representation.  The charge that goes to individuals is always grossly inflated.  You know already that insurance plans do not pay that grossly inflated number that is first thrown out there.  When I have had to negotiate for cash (which has to be paid in full), or seen a healthshare negotiated cost, usually the lowest you can get is about 40% off the bill.  And the reason for that is that is what the insurance companies end up paying.  I have never seen a negotiated payment go lower than what an insurance company would pay.

 

So no, it's not the negotiated payments that pass off the costs.  It's still the people that can't or don't end up paying anything, or make payment plans that will never cover the amount.

[ChocolateReignRemix]

I think there are people who "abuse the system," going to the ER for tylenol or to urgent care for parenting advice, but I'd really like to know two things:

 

1. How much of this has to do with low education level or low cognition? Maybe there should be another level of support somewhere, some sort of community center for group classes...I really don't care about people who feel they can't ask questions or learn in a group setting, who must have one-on-one attention or else they are receiving substandard care. For parenting classes and a quick clinic, this might be a really good way to do it. We have a local pharmacy trying to fill this gap, but for reasons unknown the paperwork is so onerous that the clinic doesn't get much use, but it's a start.

 

2. How big a problem is it really?

 

I ask because in my city, the bus service has been deemed one of the worst in the nation, and wait times at the ER (10 miles east of my house) can be 6-8 hours. Last time I was there, people were on pallets in the hallways and the doctors and nurses were trying to maneuver around them like we were in a war zone. Housekeeping could not keep up with that volume of traffic. The restrooms were disaster areas as the staff tried to focus on biohazard situations in the exam cubicles. And then when an area had to be cleared because of a person with an active case of crawling cockroaches (literally pouring out of his clothes), I thought it looked like an absolute fire hazard. Nobody with a brain in their head is going to sit in that scenario, holding a screaming baby, hoping for attention.

 

And then 20 miles west, out in the country, again, travel to the rural hospital is extremely difficult without any public transportation at all, and the wait times are very long. And there, if you do need something more than stitches or a broken bone set, you're going to be sent to the city, anyway. With no idea how long you'll be waiting, no money to stay anywhere, no hotels within walking distance of the hospital so you'll need more cab fare...

 

I think the face of the poor is different, in different parts of the country. In some places, the children are just going without health care because it is NOT convenient, or sometimes even possible, for poverty-stricken parents to get to the facilities and hope they went to the right place.

 

Regarding #1, there is also a mental illness aspect to some of these situations as well.

 

[goldberry]

I'm out of likes, sorry. But thanks for the heads up

 

Barb, see my post above.  I just recently joined a healthshare that negotiates, but they actually told me that I might could get a better deal going directly.  Dealing directly with cash up front you can usually get up to 40% if you push enough. You are still not paying less than an insurance company payment.

[TranquilMind]

The number of people on this site that have opened up about health care costs for an unplanned illness or accident, mental health, disabilities, etc etc is enough of a cross sample to realize the seriousness of affordable complete coverage. It saddens me how little we think of those who have less. Doctors in our area say the ACA has saved as well as improved lives. 

 

But we have nothing close to affordable coverage right now for most people (excluding the few that did get helped because they were uninsurable before)  Nor have we, for awhile.  That needs to change. 

 

[ChocolateReignRemix]

I think these are all terrific ideas. The problem is, the national conversation isn't about what we can add to make citizens' lives better. It's not about creativity and new ideas. It's about what we they can take away. Your idea of skin in the game is definitely not what they're alluding to. We can agree to disagree on the $65 well-child visit, but I would be willing to suck that up if any of your ideas were actually in play. They are not. It is all going to get worse for Americans, much worse. Don't let them fool you you with self-righteous talk of personal responsibility. They are distracting us.

 

I agree with some of the suggestions in her post, and shockingly most could be addressed in a national health plan model more easily than out current insurance model.

 

[Guest]

Until I read this thread, I thought that money from my taxes and insurance payments was being used to reimburse hospitals for care provided to people who were actually poor or indigent.

 

Now, I know that a portion of this money is going to people using health sharing systems, and then negotiating away significant portions of their bill. As a agnostic tax payer, it seems that I'm subsidizing the care of people who are wealthier than I am, and that this is being justified with a Biblical passage that seems, to me, to be about Christians voluntarily helping Christians.

 

ETA to be more clear in the first line.

Wow, that's pretty damn insulting given how much of our income we have paid not only into insurance but into actual medical expenses. You seem to be failing to understand that discounts are negotiated for group insurance as well and it is usually cash payers who cover that gap, as we have in every prior treatment. Note also endowment and private charity.

 

People wealthier than you? Maybe, maybe not. We are those tax payers who ended up priced out of our insurance and with almost no options and had to find a way to make it work for our family in the post-ACA world when we couldn't spend hundreds per week on maintaining insurance that left us unable to pay for basic treatment and care in meeting our deductible. Now we pay out of pocket for a those basics, pay into a group for catastrophic coverage, and work as individuals to manage the cost of procedures.

 

My health share covers maternity and postpartum complications like this 100%. But we went to the hospital first to see what we could do to limit our bill as much as possible. We qualified, based on income and need, for their charity, because we just exceeded the Medicaid limits and they were aimed at preemies more than sick babies in terms of length of hospital stay.

 

You can criticize and needle me as much as you want, but it says a lot more about you than me. I'm glad that after paying all but the basic 15% prompt pay discount for multiple births and treatments, this hospital was finally able to help us out a bit. First time in eleven years of living here we have qualified for their assistance.

[goldberry]

Quality urgent care would need to be accessible, then.

 

We once called ahead (in the car) to make sure our UC could do ds's stitches.  They said yes, took a look at him, and directed us to the ER.

 

None of our area UCs are 24 hrs, either.

 

I always wonder why the need for more urgent cares to avoid ER visits is never addressed.  The urgent care in our area is only open until 7 I think and closed on Sundays.  ??  There have been two occasions I would have been happy to go there but was forced to go to the ER instead.

[goldberry]

Oh, Amen!!

 

My sister is a palliative care doctor. She has a boat load of stories about people wanting to keep a very old or very sick relative alive as long as possible, at any expense. She has to be the bad guy and explain that keeping Mom alive for another week while she is swollen with cancer is literally torturing her. As a society, we need to get comfortable with death and stop spending thousands warding off death for a few days.

 

I've told this story before. My Aunt had a massive stroke. There was no question that it would end her life. Everyone knew she was going to die. But the hospital kept her in ICU with full time nurse watching her for over a week. Why?? She should have been sent home to pass away quietly in her own bed but we are no longer comfortable enough with dying to allow that.

 

But end of life discussions = death squads/killing grandma.  Not allowed!

[AmandaVT]

Quality urgent care would need to be accessible, then.

 

We once called ahead (in the car) to make sure our UC could do ds's stitches.  They said yes, took a look at him, and directed us to the ER.

 

None of our area UCs are 24 hrs, either.

 

Or any urgent care - it's only been in the past couple of years that we've had an Urgent Care clinic within 3 counties of us. We've had no choice but to go to the ER for things on the weekends that could have easily been taken care of at an Urgent care clinic. Thankfully, we finally have 2 in our county now, but that's a very recent thing here.

[TranquilMind]

This is what I keep hearing from many people.

 

Out of pocket does not mean what you think it means.

 

And...

 

Insurance itself is quite expensive.

 

And then the deductible is so high that it's useless. 

 

Often the argument is made that 'high deductible plans' shouldn't be allowed because they discourage people from accessing care.  The argument is also made that if you add the premiums and deductible together, people's payments for accessing medical insurance have not changed very much.  However, what that argument misses is that the older high deductible plans were fairly inexpensive, and were not used annually or even biannually, but mostly in the event of a catastrophic situation.  People who chose those now have far higher premiums and these are in effect year in and year out.  So the overall effect on disposable income is significant.  Their other option is to break the law by failing to arrange coverage.  This really puts people between a rock and a hard place if they can't afford the new premiums but want to be law-abiding citizens, something that I think is a good thing to want.

THIS!

 

[goldberry]

Why worry about the sick and the hungry when more important issues like who-is-peeing-in-which-potty are what really matter? 

 

And THAT is what is giving Christians a bad name.  Most of us don't give a rat's patooty about bathrooms!

[Guest]

Inspired by this thread, I did a bit of googling, and it looks like some ministries actually negotiate for their members. I was not aware of this. I thought it was just a cost sharing arrangement.

Some offer it as a courtesy but most do not. The negotiating is still on the individual patient account, and usually done by the individual. We haven't even talked with CHM yet, every bill and transaction has been handled by us thus far except what we had already worked out for maternity and the home birth, much of which needs reimbursing now that everything went crazy. They're there to help out with the expenses we cannot weather as an individual family out of pocket, but not much beyond that. For a lot of families these miniature function like catastrophic insurance. And yes, when we had our pre ACA catastrophic and an HSA as negotiated individually as well and shopped around for the least expensive care or particular doctors. Now we still do the same thing, but we can submit expenses beyond a certain amount or for a group of health related incidents and get reimbursed for those costs after several months. There is no guarantee of coverage but contractually they will pretty much always assist with things like maternity. It depends on the group.

 

I don't love paying so much out of pocket for most health care, but because we aren't paying prohibitively high monthly premiums we can move money earmarked for that and use it for actual care, which is a much more sensible solution. What we pay into the cost share functions almost identically to how catastrophic used to function. But in two years of health care and expenses we have submitted only two incidents for reimbursement from the group. The rest has been entirely out of pocket from the allergist to the ER. That's also pretty typical. Families budget for medical expenses below the threshold for cost sharing.

 

We have had some good threads on this, I recommend tracking them down.

[TranquilMind]

But end of life discussions = death squads/killing grandma.  Not allowed!

 

Have your OWN end of life discussions.  Why does the government have to mandate, control, and handle EVERYTHING in our lives?

 

Do it yourself.  We have, on both ends.  WE decide, not them, when its our parents (with them) and ourselves. 

 

 

[TranquilMind]

And THAT is what is giving Christians a bad name.  Most of us don't give a rat's patooty about bathrooms!

Of course not.

 

It's a red herring used erroneously to slam Christians.  That's all. 

[happypamama]

Don't let them fool you you with self-righteous talk of personal responsibility. They are distracting us.

Yeah, I'm pretty sure that their idea of personal responsibility isn't the same as mine. ;)

 

Kind of a side topic, because I truly don't know. People, usually women, complain that they want free-to-them birth control. Now, I would far rather encourage abstinence when you're not in a position to afford a baby, but I also know that for a variety of reasons, that isn't realistic, and I would far rather birth control than abortions or neglected children. And I understand that many women don't use them for contraception but for health reasons. So about the BC costs. I gather BCPs are expensive without insurance coverage? I don't use them so I really don't know. Are the pills themselves expensive because they're expensive, or are they expensive because insurance covers them? Could we reduce costs for that sort of stuff so that the majority of women, even college students not making much, could afford to buy them themselves without insurance coverage? Like the Mylan epipen thing, is there artificial and unnecessary bloat built into the costs of BCPs (or anything else)?

[regentrude]

Have your OWN end of life discussions.  Why does the government have to mandate, control, and handle EVERYTHING in our lives?

 

Do it yourself.  We have, on both ends.  WE decide, not them, when its our parents (with them) and ourselves. 

 

Unfortunately, people are not allowed to handle the end of life as they see fit.

 

I am all for governments legalizing physician assisted suicide so that people have a viable choice.

The ironic thing is, however, that the same people who vote against the ACA are also the ones who want to withhold from humans the option to make their own choices about both their reproduction and their end of life.

Edited January 14, 2017 by regentrude

[TranquilMind]

I think these are all terrific ideas. The problem is, the national conversation isn't about what we can add to make citizens' lives better. It's not about creativity and new ideas. It's about what we they can take away. Your idea of skin in the game is definitely not what they're alluding to. We can agree to disagree on the $65 well-child visit, but I would be willing to suck that up if any of your ideas were actually in play. They are not. It is all going to get worse for Americans, much worse. Don't let them fool you you with self-righteous talk of personal responsibility. They are distracting us.

Where are you guys getting this $65 well child visit?  It was $110 here, last I noted. 

 

 

[Guest]

This is not an accurate representation. The charge that goes to individuals is always grossly inflated. You know already that insurance plans do not pay that grossly inflated number that is first thrown out there. When I have had to negotiate for cash (which has to be paid in full), or seen a healthshare negotiated cost, usually the lowest you can get is about 40% off the bill. And the reason for that is that is what the insurance companies end up paying. I have never seen a negotiated payment go lower than what an insurance company would pay.

 

So no, it's not the negotiated payments that pass off the costs. It's still the people that can't or don't end up paying anything, or make payment plans that will never cover the amount.

That's a clearer way to put it. We haven't negotiated anything down beyond the insurance negotiations either, and usually it is still a little higher. Our nicu stay on the hospital end was charity because of our income and circumstances, not the health share or negotiations. Edited January 14, 2017 by Arctic Mama

[TranquilMind]

Unfortunately, people are not allowed to handle the end of life as they see fit.

 

I am all for governments legalizing physician assisted suicide so that people have a viable choice.

The ironic thing is, however, that the same people who vote against the ACA are also the ones who want to withhold from humans the option to make their own choices about both their reproduction and their end of life.

 

Well, yes, you are.  You can handle everything about the natural end of life with cooperative doctors and nurses, as it has always been.  

 

No, you can't mandate someone to specifically assist suicide...that has never been part of the equation for most people.  Most people don't want to do this. 

 

 

[Guest]

I always wonder why the need for more urgent cares to avoid ER visits is never addressed. The urgent care in our area is only open until 7 I think and closed on Sundays. ?? There have been two occasions I would have been happy to go there but was forced to go to the ER instead.

We love our urgent cares, the ones open the latest are in some of the poorer neighborhoods and several of them have multiple locations, weekend hours, etc. We go there all the time because the care has been great and eh cost is reasonable. The ER is only where we head when it is truly an emergency.

 

I would love to see that network expanded for other areas, along with more public health clinics. Those are usually state and city funded and not federal though.

[happypamama]

Where are you guys getting this $65 well child visit? It was $110 here, last I noted.

$65 is what my family quoted for me for an adult checkup for self pay. I love my doctor, but that was a lot of money at that point (it was a few years ago, when DH's industry was really struggling because of the recession, and every penny really counted a TON), just to get weighed and measured and a refill on my occasionally-used inhaler, which is why I went in because although I don't need the inhaler often, when I need it, I need it. It seems like there could be a more cost effective solution.

[TranquilMind]

Under our system, someone with a profit motive gets to decide which care is appropriate for you. People get denied care by their insurance companies everyday. Sometimes it's appealed, and gets covered, but often not. What I don't get is the number of people in this country who don't understand that their care is already being "rationed" and the insurance company already controls their choices. They're so worried about the government doing it and it's being done to them everyday.

 

So true.

 

[FaithManor]

Well child visits are $120 here and routine physicals for adults are close to $200. No discount at local providers for cash pay. We are an underserved area so not enough providers for the patient load. Doctors are overwhelmed so if someone says no to the price, no problem for them. They already have more work than they can handle.

Edited January 14, 2017 by FaithManor

[hepatica]

This is not an accurate representation.  The charge that goes to individuals is always grossly inflated.  You know already that insurance plans do not pay that grossly inflated number that is first thrown out there.  When I have had to negotiate for cash (which has to be paid in full), or seen a healthshare negotiated cost, usually the lowest you can get is about 40% off the bill.  And the reason for that is that is what the insurance companies end up paying.  I have never seen a negotiated payment go lower than what an insurance company would pay.

 

So no, it's not the negotiated payments that pass off the costs.  It's still the people that can't or don't end up paying anything, or make payment plans that will never cover the amount.

 

I am fully aware that large purchasers, be they insurance companies or the state or federal government, negotiate prices. But, they are also subject to a host of regulations. They are not allowed to discriminate on the basis of religion or (post ACA) pre-existing condition, or sex. Health Share ministries do discriminate, and they are not regulated in the same way, so they are able to control their risk pool, if they desire, and they are still negotiating the same prices. Perhaps I am not understanding this, but that seems to explain, at least in part, why they are more affordable. That is not a practice that can be generalized for the entire population. 

 

I am in no way defending the practices of insurance companies here. I think they share way more of the blame than the public places on them. They raise rates, deny coverage, limit choice, and the lion's share of the blame is placed on the regulators and legislators. Insurance companies and pharmaceutical companies and others have come to expect an extraordinary profit margin, and if that margin decreases, even if they are still making enormous profits, they claim they are losing money and need to raise rates or pull out of the system. At least the ACA tried to address this problem by requiring companies to meet a MLR (medical loss ration) standard before they could raise premiums. But, unless healthy people are in the insurance pool, then companies will be spending over 85% of the premiums they take in on care, and they will be able to raise rates. 

 

This is a round about way of saying that as long as there are other entities pulling healthy people out of the insurance pool (and Health Share ministries can do that since they are not required to take anyone) it seems to me they will be contributing, in some way, to rising premium costs. The idea that they can then negotiate the same prices as insurance companies (without being required to meet the same standards) bugs me. I had always assumed that individuals were negotiating, not the group itself. So that was news to me. 

 

I may be completely misunderstanding this, and if so I welcome clarification. 

[Erica in OR]

I also wish the ER had more ability to turn people away while didn't have a true emergency and redirect them to an urgent care. We sat for hours in ER once for stitches for my DS. Another boy and his family were there waiting for Tylenol because he had a fever. They, too, waited for hours. Meanwhile, a member of the family went to the convenience store and bought bags full of snacks to eat while they waited for their "free" Tylenol.

 

This would also assume that your community has an urgent care in the first place. Our city doesn't, along with the surrounding cities/towns in each direction. Wish we did though!

 

Erica in OR

[goldberry]

 The idea that they can then negotiate the same prices as insurance companies (without being required to meet the same standards) bugs me. I had always assumed that individuals were negotiating, not the group itself. So that was news to me. 

 

I may be completely misunderstanding this, and if so I welcome clarification. 

 

Well, as I said, my group negotiates.  But I have negotiated many bills individually.  Online, the advice is that insurance companies get at least 40% off usually, so keep asking until you get close to that.  I have had varying success.  Some will only give 10 or 20%.  Just recently I had my first bill under the healthshare.  I will pay it because it's under my deductible anyway.  The group said, we can call for you, but you probably will get the same results calling yourself.  

 

So to me, the health group is offering that as a courtesy, but not implying that they get any great deals and probably have the same varying results as I do.

[goldberry]

Have your OWN end of life discussions.  Why does the government have to mandate, control, and handle EVERYTHING in our lives?

 

Do it yourself.  We have, on both ends.  WE decide, not them, when its our parents (with them) and ourselves. 

  

I totally agree it's better to do it yourself.  EXCEPT, clearly many people aren't, and the doctors need to be giving straight up and realistic info to people in those situations.  All the people that are not having these discussions are the ones running up the bills for the rest of us.  The government wasn't mandating it, if I recall anyway, just that it should be OFFERED to people.  Which could at least start the ball rolling.  They were not forcing end of life decisions as was portrayed in the media.  THAT was a scare tactic.

[goldberry]

Of course not.

 

It's a red herring used erroneously to slam Christians.  That's all. 

 

If it's a red herring then who are all the people passing and proposing these laws right now?  They are popping up all over the place.  This is a real deal, not a red herring, and if it doesn't represent most Christians then Christians need to start speaking up and saying stop it already, who cares?

 

If Christians don't care to stop it, then they deserve the slam.

Edited January 14, 2017 by goldberry

[goldberry]

Yeah, I'm pretty sure that their idea of personal responsibility isn't the same as mine. ;)

 

Kind of a side topic, because I truly don't know. People, usually women, complain that they want free-to-them birth control. 

 

I don't really know any women pushing for that.  Only that if other things are covered by insurance then BC should be covered also, not necessarily free, but equal to other things.  It's covering viagra, ya know?

 

I think there should be no cost BC available to lower income women, a service that PP always provided.  If they get rid of all the PPs, then they will need to make sure that is still available.  If you want to decrease abortion, it makes sense that no one should not get BC because they can't afford it.

 

I think the Free BC for All is either a strawman or just fringe people.  It would be nice, but I don't hear people arguing for that, just that it be treated equally by insurance and made available low or no cost to low income.

Edited January 14, 2017 by goldberry

[LucyStoner]

I sure do tend to think those opposed to reform are the lucky ones with great insurance. We have " good" insurance that we pay $1200/month for. That doesn't leave much to live on folks! Then there is a $10,000 deductible, then 80/20. I would gladly pay more taxes to have a simpler system. I don't think I'd be paying more. By the way, my Dh works FOR a hospital and that's as good as it gets!

We have a (lower) deductible but most everything is exempt from the deductible. I didn't realize this when the deductible went up. My husband also works at a hospital.

 

I agree that what we are paying for insurance would be less if it were taxes into a simpler system.

[TranquilMind]

I totally agree it's better to do it yourself.  EXCEPT, clearly many people aren't, and the doctors need to be giving straight up and realistic info to people in those situations.  All the people that are not having these discussions are the ones running up the bills for the rest of us.  The government wasn't mandating it, if I recall anyway, just that it should be OFFERED to people.  Which could at least start the ball rolling.  They were not forcing end of life decisions as was portrayed in the media.  THAT was a scare tactic.

 

Do you think it isn't?  I mean, come on.  Doctors tell people every day that grandma only has a 5% chance of life and they can let her go at any time.  They go away and think about it and then do it.    If they just run up bills for a long time, everyone talks to them about the chances. 

 

Nothing is new in this.  We don't need to mandate and run expensive programs to run to simply use common sense. 

 

[happypamama]

I don't really know any women pushing for that. Only that if other things are covered by insurance then BC should be covered also, not necessarily free, but equal to other things. It's covering viagra, ya know?

 

Okay, this makes sense and is very fair. I really haven't researched it, just have heard/seen snippets here and there, because I only have so much energy and time in my day, and because I have some personal concerns about artificial BC. I do agree that if they're going to cover Viagra, they should cover BC! Thank you for the clarification.

[goldberry]

Do you think it isn't?  I mean, come on.  Doctors tell people every day that grandma only has a 5% chance of life and they can let her go at any time.  They go away and think about it and then do it.    If they just run up bills for a long time, everyone talks to them about the chances. 

 

 

 

That is not what is happening in most cases.  Doctors openly admit that they "read" the family and if they are open to hearing that or not.  Also, there is the case of greedy doctors (a few but still) that would rather just keep getting paid.

 

In my FIL's case, his cancer was VERY UNLIKELY to be helped by treatment.  The doctor would never just come out and say that.  The doctor said, "okay, here is the next treatment" and my FIL said okay.  They kept treating him until he died, because FIL was not the type to question the doctors.  The amount of money spent, not to mention loss of life quality, was staggering.

 

That shouldn't be happening.

[TranquilMind]

That is not what is happening in most cases.  Doctors openly admit that they "read" the family and if they are open to hearing that or not.  Also, there is the case of greedy doctors (a few but still) that would rather just keep getting paid.

 

In my FIL's case, his cancer was VERY UNLIKELY to be helped by treatment.  The doctor would never just come out and say that.  The doctor said, "okay, here is the next treatment" and my FIL said okay.  They kept treating him until he died, because FIL was not the type to question the doctors.  The amount of money spent, not to mention loss of life quality, was staggering.

 

That shouldn't be happening.

 

Unless the FIL was incompetent, it was his decision.  I presume your family had conversations with him too.

 

This isn't the doctor's fault here.

 

 

 

I've been there too as a family member, more than once. 

 

[goldberry]

We don't need to mandate and run expensive programs to run to simply use common sense. 

 

 

If a program like this resulted in even a very few families making more common sense decisions, it would pay for itself 100x over.  The cost of a one hour consultation compared to a week of ICU care? Or 10 weeks?  This would not be an "expensive program" by any means, it would be a huge cost saver.

[Barb_]

Okay, this makes sense and is very fair. I really haven't researched it, just have heard/seen snippets here and there, because I only have so much energy and time in my day, and because I have some personal concerns about artificial BC. I do agree that if they're going to cover Viagra, they should cover BC! Thank you for the clarification.

And those who need it most (college and high school students, single moms, drug addicted people, struggling families) are least able to afford to pay out of pocket. Covered birth control reduces abortions, nicu stays, poverty, crime, overcrowding, abuse....

 

There is no reason to oppose it.

[Spryte]

And those who need it most (college and high school students, single moms, drug addicted people, struggling families) are least able to afford to pay out of pocket. Covered birth control reduces abortions, nicu stays, poverty, crime, overcrowding, abuse....

 

There is no reason to oppose it.

Liking wasn't enough. Totally agree.

[Frances]

Do you think it isn't? I mean, come on. Doctors tell people every day that grandma only has a 5% chance of life and they can let her go at any time. They go away and think about it and then do it. If they just run up bills for a long time, everyone talks to them about the chances.

 

Nothing is new in this. We don't need to mandate and run expensive programs to run to simply use common sense.

 

No, it is not being done in any comprehensive way. I'm not for mandating it, but programs like the one in LaCrosse, WI started by a hospital ethicist and supported by both of the major hospital systems in the city, despite costing them revenue, do work to both lower costs and improve the end of life experience for patients and family members. But when it was proposed to have such programs nationally, the "death panels" lies effectively killed it.

[goldberry]

Unless the FIL was incompetent, it was his decision.  I presume your family had conversations with him too.

 

This isn't the doctor's fault here.

 

I've been there too as a family member, more than once. 

 

 

I don't think you realize how many times you deflect away from the point of the conversation.

 

You opened a discussion about why we don't need to specifically offer consultation about end of life choices.  You suggested that people do it themselves.  I am responding with an example of why certain people don't do it themselves, because they are often just not those kind of people, but would respond to a doctor or authority figure wanting to discuss it.  I also suggested that some doctors have a greed factor that discourages them from being honest with the patient, and that is why an objective consultation can be of benefit.

 

I do disagree with your premise that the doctor had no fault because he never was honest with FIL about his chances both with and without treatment.  He had a professional responsibility to be honest and he was not honest by withholding that information.  The response is not about this specific incident though, it was just an example.

Edited January 14, 2017 by goldberry

[Caroline]

And those who need it most (college and high school students, single moms, drug addicted people, struggling families) are least able to afford to pay out of pocket. Covered birth control reduces abortions, nicu stays, poverty, crime, overcrowding, abuse....

 

There is no reason to oppose it.

Exactly!!

[Carrie12345]

It's not about being smart, when I've had a catastrophic plan, it was because it was all we could afford.  It was either that or be uninsured.  I know there are some people that want to choose it to save some money. That wasn't us or a lot of others I know that had catastrophic.  DECENT coverage should be affordable to all.

 

Sorry, that was my snarky response regarding the ignorance about non-catastrophic care needs.  It wasn't about having catastrophic-only coverage, but about people who apparently are too stupid to live healthy enough to avoid costly sins like asthma, or allergies, or Type I diabetes.  Snark, snark, , sarcasm, sarcasm, stink eye, stink eye.

[TranquilMind]

If a program like this resulted in even a very few families making more common sense decisions, it would pay for itself 100x over.  The cost of a one hour consultation compared to a week of ICU care? Or 10 weeks?  This would not be an "expensive program" by any means, it would be a huge cost saver.

 

Who needs a separate 1 hour consultation (or wants to pay for it, or wants to leave the family member to have it)?  Your family member is dying, and people come in and out all the time.  They DO talk about this stuff.   

Been there, done that. 

 

[Frances]

I don't think you realize how many times you deflect away from the point of the conversation.

 

You opened a discussion about why we don't need to specifically offer consultation about end of life choices. You suggested that people do it themselves. I am responding with an example of why certain people don't do it themselves, because they are often just not those kind of people, but would respond to a doctor or authority figure wanting to discuss it. I also suggested that some doctors have a greed factor that discourages them from being honest with the patient, and that is why an objective consultation can be of benefit.

 

I do disagree with your premise that the doctor had no fault because he never was honest with FIL about his chances both with and without treatment. He had a professional responsibility to be honest and he was not honest by withholding that information. The response is not about this specific incident though, it was just an example.

Interestingly, one of the reasons the program in LaCrosse, WI works is because the hospitals are willing to forego some revenue and the doctors are salaried, so fewer end of life services or aggressive treatments do not impact their pay.

[goldberry]

Who needs a separate 1 hour consultation (or wants to pay for it, or wants to leave the family member to have it)?  Your family member is dying, and people come in and out all the time.  They DO talk about this stuff.   

Been there, done that. 

 

 

Just because you don't need it doesn't mean no one needs it.  Just because you handle it individually, doesn't mean everyone does.  Just because they talked to YOU doesn't mean they talk to everyone.

 

Your insistence that everyone has an experience just like you, or a family just like you, is not supported by facts.  The crazy amount being spent on keeping people alive way past the point of common sense indicates that it is not true, and that a program offering (not mandating) consultations like this would be useful and would harm no one.  

[TranquilMind]

No, it is not being done in any comprehensive way. I'm not for mandating it, but programs like the one in LaCrosse, WI started by a hospital ethicist and supported by both of the major hospital systems in the city, despite costing them revenue, do work to both lower costs and improve the end of life experience for patients and family members. But when it was proposed to have such programs nationally, the "death panels" lies effectively killed it.

 

It IS being done. It has always been done.

 

They just don't call it "a program".  They just talk to patients and their families while doing the rounds.  Of course it was far superior when the patient's regular doctor was able to do the rounds and talk to you, rather than just some impersonal hospitalist, who doesn't know you from Adam.

 

One of those lovely people left my mom a pile of nursing home pamphlets that she found when she awakened.  There was absolutely nothing wrong with her but a c. diff infection, courtesy of the hospital and its exceedingly lax standards of cleanliness.  (I had to go to war to get a disinfected porta-potty, and not a dirty one).   But her actual doctor, who knew her, had to jump into the fray and fix that mess.

 

Gee, thanks so much, you ageist Doctor Know-Nothing.   You see an old woman, you immediately assume dementia.

 

This was right after we had gone to hospitalists in this area. 

 

 

Edited January 14, 2017 by TranquilMind

[TranquilMind]

Just because you don't need it doesn't mean no one needs it.  Just because you handle it individually, doesn't mean everyone does.  Just because they talked to YOU doesn't mean they talk to everyone.

 

Your insistence that everyone has an experience just like you, or a family just like you, is not supported by facts.  The crazy amount being spent on keeping people alive way past the point of common sense indicates that it is not true, and that a program offering (not mandating) consultations like this would be useful and would harm no one.  

 

And your insistence that everyone else is not having the experience I had numerous times is without merit.  I'm pretty sure I'm not special, and receiving special treatment.

 

How many times have you been the point person with a dying relative?  I've done it a few times. 

 

Edited January 14, 2017 by TranquilMind

[Frances]

Who needs a separate 1 hour consultation (or wants to pay for it, or wants to leave the family member to have it)? Your family member is dying, and people come in and out all the time. They DO talk about this stuff.

Been there, done that.

 

Please listen to the Planet Money podcast about the program that started in a LaCrosse, WI and see if you still feel this way. The vast majority of people in the city, of all different backgrounds and beliefs, think it is a good idea and participate. And many are spending much, much longer than one hour making decisions about end of life care long before they ever need it. The program is designed to get people thinking and talking about these issues long before it ever becomes reality for them or a family member.

 

And the final result is less money spent on healthcare and better end of life experiences for the patient and family members. I experienced it first hand as my dad died while under the care of one of the medical systems there, although he was at home with hospice.

[TranquilMind]

Please listen to the Planet Money podcast about the program that started in a LaCrosse, WI and see if you still feel this way. The vast majority of people in the city, of all different backgrounds and beliefs, think it is a good idea and participate. And many are spending much, much longer than one hour making decisions about end of life care long before they ever need it. The program is designed to get people thinking and talking about these issues long before it ever becomes reality for them or a family member.

 

And the final result is less money spent on healthcare and better end of life experiences for the patient and family members. I experienced it first hand as my dad died while under the care of one of the medical systems there, although he was at home with hospice.

 

Well, that is totally fine if you are talking about voluntary programs that people themselves decide to participate in to make their own decisions.  I wasn't addressing that at all, and I apologize if I misunderstood you. 

 

People can do what they want.  I don't happen to need anything like that but who cares if others do it. 

 

The patient and family decides when to go to hospice, as has always been true.