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

[ktgrok]

I'm not saying this. 

 

I think we as Americans will have to give up some of our frills and subsidize education for medical students.   I hate to be personal, but you've been very open about your recent surgery.  Should we as a country have to pay for your surgery as a group so that you can have another child?  I'm thinking it wasn't the main goal but your weight loss was a factor.  In a one payer system is this a frill or a necessity?  Again, I'm sorry to ask, but it's pertinent ( IMHO) to the discussion,  What are we as a nation able to provide to its citizens? 

 

Well, in other countries with single payer, some people do qualify for bariatric surgery as a covered expense, if the benefits to their health will be greater than the cost of the surgery. (There is a show called Fat Doctor that shows people getting the surgery as covered by the NHS). There is a longer wait time in many cases, but if it wills save the medical system money in the long term, by less diabetes, less heart disease, less blood pressure medication, etc it is covered. 

 

That said, for those that don't meet the cut yet or want to do it sooner and not wait, you can pay out of pocket. (which, by the way, is actually about the same amount of money as I paid WITH health insurance, or a bit cheaper! I did price what it would be to fly to the UK and have it done there, on a cash basis). 

 

I'd be okay with that system if it meant every single freaking child with asthma got treated. 

[ktgrok]

Katie's surgery was primarily for her long-term health.  I wouldn't call it a frill.

 

Yes. As much as I like wearing normal sizes, I had the surgery because I have a family history of diabetes and early (like in their 40s) heart attacks. My dad, his twin, and his father all had their first heart attacks before age 50. 

 

And to clarify, I was ABLE to conceive and have another baby even at my highest weight...I'm one of those super fertile people. I just was unwilling to have another baby at that weight, as I didn't think it prudent. It does significantly help fertility for many people though, but that wasn't my reasoning. I can look at my husband wrong and get pregnant, lol. 

[ktgrok]

I'm completely fine with giving up some of the frills. Many of them actually come about because hospitals are competing with each other for patients and profits. In my area, for instance, there's a race to see who can have the fanciest and nicest birthing center to lure expectant mothers. I also have no problem with majorly changing our medical education system.

 

But if we can't fundamentally agree that healthcare is a right and that we are all willing to be in it together and that some are going to pay more so that others can have care, as those in countries with universal healthcare have done, then I don't really think any of the other details matter. But that's just my personal opinion.

 

Yes! We have hospitals here competing on the best gourmet meals for after birth (steak, lobster, etc), massage services, and my personal favorite, MARBLE COUNTERTOPS in the bathrooms!!!

 

Meanwhile, evidence based medicine, which saves both money and lives, is ignored. Because that's not what brings in the customers...I mean patients. 

[ktgrok]

There are always going to be people who really just can't absorb any costs other than food, shelter, and transportation to work, but I'd like to see that pool smaller.

 

And I'd like to see it nonexistent. NO number of kids or humans in general that can't afford medical treatment is okay to me. 

[creekland]

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.  

 

Some of it may be as I don't know everyone's situation.

 

I can say for mine - and those I know IRL personally using our Health Share - most hospitals and doctors lower their rates for us considering us cash pay customers.  This ranges from 10% - 50% reduction of the bill pending who is doing the reduction.  When I, personally, asked about it I was told they reduce it TO the rate insurances pay them, but not lower OR they reduce it due to not needing office staff time dealing with insurance.

 

Then - the highest part of my bills (the brain tumor part) went through Johns Hopkins and they reduce nothing (unless one is low income and fills out their paperwork proving so - we did not, of course).  Our health share paid what the wealthy folks from other areas of the world coming there for health care pay.  We're even classified there as "International Self-Pay."  Hubby and I joke about them considering north of the Mason-Dixon line as "International."

 

Personally, since the majority of folks choosing health share look into it to start with due to the cost difference (and not being able to afford insurance), I don't think you have to worry about subsidizing too many wealthy people.  We only found out (and joined) health share due to hubby going into business for himself and insurance was out of our price range back them (comparatively).  We took a gamble (because I didn't want "nothing" - too risky) and that gamble has worked out incredibly well financially for us - not that we earned a thing off of it - but it saved us thousands in OOP costs and higher monthly premiums.  None of that came as a cost to YOU.  It came out of insurance company profits.

 

I have since moved away from JH and most likely won't go back due to their charging more for health share folks.  It seems right to me that we ought to pay what insurances pay and not personally subsidize everyone as if we're all wealthy sheikhs, 'cause most aren't.  If I need somewhere more specialized again, I'll have to decide if the extra is worth it or whether it's better to try other places like Hershey or Mayo or similar (places that supposedly work well with Health Share).

 

But again, I'd prefer a universal system where none of this mattered.

[lovinmyboys]

I don't think it is a sure thing that market forces won't work in health care. Some of it is an inelastic demand curve, but not all of it. David Brooks wrote an opinion piece in the NY TImes two days ago that argued that market forces have been shown to work in at least a few areas of healthcare. For instance, the cost of lasik eye surgery has fallen from about $2000 to less than $300. He also cited the Medicare prescription plan that introduced competition. He linked a few studies that I didn't read. David Brooks is conservative, but I believe he endorsed Obama and he is not a Trump supporter.

 

Instead of arguing over who pays for healthcare we really need to figure out how to get costs down. That involves hard choices. What is "good enough" health care? Even in the great country that got a man on the moon, there is not enough money for everyone to have "the best" healthcare.

 

I can easily think of times that my family has been "over treated" and "good enough" would have been fine. When my son broke his arm, he was sent to the children's hospital and saw a specialist, when he really didn't need to. A surgeon was called in for routine stitches. I had an ultrasound and biopsy on something that had very little risk of being dangerous. My son had a ct scan after a head injury. Just observing him in the ER for a few hours would have most likely been sufficient. My son has his tonsils out and a child life specialist visited him and billed us. I think that was nice for him, but mostly overkill. (I have four kids. These were all for different kids).

 

Then there are all the screenings (Pap smear, mammogram, colonoscopy, prostate) where the science is mixed or shows a small benefit. If these are done for everyone, they don't save money. You have to screen usually thousands of people to find one case. Instead, maybe we should screen less frequently, or only those with risk factors. BTW, I am talking about screening, not turning people away who have symptoms. A women with a symptom of breast cancer needs a mammogram. It is not so clear that women with no symptoms do.

 

End of life care costs so much. It isn't an easy topic. People usually want to live as long as they can at whatever cost. Is it worth millions of dollars for an extra few months? Is that sustainable for everyone.

 

I don't have answers to all these issues. I just think controlling costs is a bigger issue than who pays.

[SparklyUnicorn]

I so so agree on working to keep costs down.  This is my biggest beef with Obamacare.  What have they done to keep costs down?  Nothing as far as I can tell.  So prices will keep going up and up and up.  They are already ridiculous. 

 

 

I don't think it is a sure thing that market forces won't work in health care. Some of it is an inelastic demand curve, but not all of it. David Brooks wrote an opinion piece in the NY TImes two days ago that argued that market forces have been shown to work in at least a few areas of healthcare. For instance, the cost of lasik eye surgery has fallen from about $2000 to less than $300. He also cited the Medicare prescription plan that introduced competition. He linked a few studies that I didn't read. David Brooks is conservative, but I believe he endorsed Obama and he is not a Trump supporter.

Instead of arguing over who pays for healthcare we really need to figure out how to get costs down. That involves hard choices. What is "good enough" health care? Even in the great country that got a man on the moon, there is not enough money for everyone to have "the best" healthcare.

I can easily think of times that my family has been "over treated" and "good enough" would have been fine. When my son broke his arm, he was sent to the children's hospital and saw a specialist, when he really didn't need to. A surgeon was called in for routine stitches. I had an ultrasound and biopsy on something that had very little risk of being dangerous. My son had a ct scan after a head injury. Just observing him in the ER for a few hours would have most likely been sufficient. My son has his tonsils out and a child life specialist visited him and billed us. I think that was nice for him, but mostly overkill. (I have four kids. These were all for different kids).

Then there are all the screenings (Pap smear, mammogram, colonoscopy, prostate) where the science is mixed or shows a small benefit. If these are done for everyone, they don't save money. You have to screen usually thousands of people to find one case. Instead, maybe we should screen less frequently, or only those with risk factors. BTW, I am talking about screening, not turning people away who have symptoms. A women with a symptom of breast cancer needs a mammogram. It is not so clear that women with no symptoms do.

End of life care costs so much. It isn't an easy topic. People usually want to live as long as they can at whatever cost. Is it worth millions of dollars for an extra few months? Is that sustainable for everyone.

I don't have answers to all these issues. I just think controlling costs is a bigger issue than who pays.

 

[lovinmyboys]

And with maternity care, I think everyone should get prenatal care. But seeing a midwife is probably fine (and would save money). OBs would be for higher risk moms. Reducing c sections would save money.

 

Really, there are a lot of places we can save money in health care and medical organizations are trying. There is an initiative called "Choosing Wisely" that has the goal to "advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures." ENTs are working to reduce the number of kids getting tonsils out and ear tubes in. Radiologists are working to reduce the amount of radiation used by studying and publishing better guidelines for when CT scans are indicated. Over 70 specialties are involved.

Edited January 15, 2017 by lovinmyboys

[FaithManor]

I am incredibly behind reading this thread due to not being on the computer yesterday and something like 400+ new posts on it, but got this far... so am answering it for my school and what is taught there...

 

We teach ALL of what you mentioned - grain, unnatural diets, etc. They watch the "controversial" shows like Food, Inc, Supersize Me, etc, and discuss implications.

 

Like any other class, I certainly can't say all kids learn everything (or care to try), but many learn a TON and modify their choices because of it. When teaching Bio and the body, I hear quite a bit of what they've taken in. The discussions are definitely worthy. We've had several end up interesting in pursuing these studies in college afterward.

 

I'm sure at some schools all of this gets glossed over - not at the one I work at.

I am so glad you school tries. Our ps does not. The health class is extremely poor and very few students take it since it is not required nor popular.

[creekland]

I am so glad you school tries. Our ps does not. The health class is extremely poor and very few students take it since it is not required nor popular.

 

I've been impressed what our school does too - far more than the "excellent" school I went to in my high school days.

 

Health is a mandatory course for 9th graders.  Fitness and Wellness is mandatory for 11th graders.  (Driver's Ed is the 10th grade course - book work, etc - not "in car" version.)

 

They can't "make" kids learn or change or whatever, but they can at least provide the information and ample discussion options.

 

My youngest son went through these classes.  I've been impressed by them.  I hear tons of good info at least getting processed by the next generation.

[purplejackmama]

I am so glad you school tries. Our ps does not. The health class is extremely poor and very few students take it since it is not required nor popular.

I agree!! Our PS just repeat more of the "standard American diet" garbage with no regards to real health. This is very encouraging to hear of schools thinking outside the box and recognizing a carb-heavy diet isn't at all healthy.

[FaithManor]

A few years ago DHs company switched to a HSA and high deductible plan. The deductible was about 10% of his take home pay. Plus we paid the premium. How much money should families spend on health insurance? How much do they spend in other countries?

 

I read today that it costs 2.5 billion dollars to bring a new drug to the market. Should drug companies pass that cost to consumers in the form of $30k - 100k a year drugs?

Oh they have their ways! The drug (hormone) used to stop infantile spasms was purchased by an American drug company from a German company in the late 50's for approximately $58,000. There are 6000 children a year who need it. It costs about $25.00 a dose to manufacture and insure. The drug company charges $21,000 per dose (usually daily shots for 30 days is required to stop the seizures). For 6000 children, that is 3.78 billion a year for 4.5 million of cost. 840% mark up. They have gazzillions of drugs for which they have recouped their costs by bizarre numbers and yet continue this kind of pricing.

 

Epi pens, cycstic fibrosis meds,...lots and lots of drugs that have paid for themselves many, many years ago but continue to be priced to the moon and back.

 

Thid is what happens under unregulated capitalism. But hey, people may die not being able to afford epipens however, it is really important that we remember the CEO got a huge, multi-milliond dollar bonus after the price hike.

 

No morals.

 

As for the infantile spasms drug, it is not coveredby insurance. Period. Insurance companies refuse to pay or negotiate on it so parents are ar the mercy of hospitals and charities to provide it. Amazingly, that actually happens. U of Michigan Medical Center for instance gets money from Shriners for Michigan children who need it.

[Lady Florida.]

 This is my biggest beef with Obamacare.  What have they done to keep costs down?  Nothing as far as I can tell.  So prices will keep going up and up and up.  They are already ridiculous. 

 

And that's because of how many groups were allowed input. Costs could have been kept down if the legislation had been written differently. As others said upthread, the ACA was supposed to be a starting point, with improvements added along the way. But certain members of Congress didn't want that. I can't say more without making it political.

[FaithManor]

Given how many politicans have investments with pharma and medical hardware companies, it should be no surprise that nothing was done to contain costs. This would hurt their own portfolios and sent their ceo friends' annual bonuses.

[Carrie12345]

I've been impressed what our school does too - far more than the "excellent" school I went to in my high school days.

 

Health is a mandatory course for 9th graders.  Fitness and Wellness is mandatory for 11th graders.  (Driver's Ed is the 10th grade course - book work, etc - not "in car" version.)

 

They can't "make" kids learn or change or whatever, but they can at least provide the information and ample discussion options.

 

My youngest son went through these classes.  I've been impressed by them.  I hear tons of good info at least getting processed by the next generation.

 

I'm supposed to be teaching nutrition in our co-op next year.  It's going to be a great course, if I do say so myself!  But I have to admit, I'm pretty worried about push back from shake/smoothie/powder/oils/supplements crowd. Not everyone wants to hear what they need to hear.

[SparklyUnicorn]

And with maternity care, I think everyone should get prenatal care. But seeing a midwife is probably fine (and would save money). OBs would be for higher risk moms. Reducing c sections would save money.

 

Really, there are a lot of places we can save money in health care and medical organizations are trying. There is an initiative called "Choosing Wisely" that has the goal to "advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures." ENTs are working to reduce the number of kids getting tonsils out and ear tubes in. Radiologists are working to reduce the amount of radiation used by studying and publishing better guidelines for when CT scans are indicated. Over 70 specialties are involved.

 

Although, I don't think the costs are hugely different because midwives (at least in the state I had my children) have to work under the direction of a doctor.  You also see the doctor for some of your visits.  The doctor also has to show up for the delivery. 

 

I went to a practice that had midwives and doctors.  They gave you a flat rate price and you could choose who you wanted (doctor or midwife) to see as your main person.  So I'm inclined to believe they charged the same irregardless.  It might keep costs down overall to have midwives who are being paid less, but this was not a matter of if I chose a midwife I'd get a better rate.

[purplejackmama]

Given how many politicans have investments with pharma and medical hardware companies, it should be no surprise that nothing was done to contain costs. This would hurt their own portfolios and sent their ceo friends' annual bonuses.

Any idea how many are tied to Big Pharma? How can you even find out a honest answer? I would estimate almost ALL of them!

[lovinmyboys]

Given how many politicans have investments with pharma and medical hardware companies, it should be no surprise that nothing was done to contain costs. This would hurt their own portfolios and sent their ceo friends' annual bonuses.

I think this opinion is why people are worried about "government healthcare." How can the government be trusted?

[Lady Florida.]

Any idea how many are tied to Big Pharma? How can you even find out a honest answer? I would estimate almost ALL of them!

 

They're on both sides of the aisle that's for sure.

[purplejackmama]

They're on both sides of the aisle that's for sure.

Agreed!!

[SparklyUnicorn]

I think this opinion is why people are worried about "government healthcare." How can the government be trusted?

 

Yep.  And I don't think this is about me needing a tinfoil hat (which is the usual accusation).  Interests aren't always in the right place. 

[Dmmetler]

And with maternity care, I think everyone should get prenatal care. But seeing a midwife is probably fine (and would save money). OBs would be for higher risk moms. Reducing c sections would save money.

 

Really, there are a lot of places we can save money in health care and medical organizations are trying. There is an initiative called "Choosing Wisely" that has the goal to "advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures." ENTs are working to reduce the number of kids getting tonsils out and ear tubes in. Radiologists are working to reduce the amount of radiation used by studying and publishing better guidelines for when CT scans are indicated. Over 70 specialties are involved.

FWIW, I am as high risk as it is possible to get after my first pregnancy. With DD, onceI'd ended up in the hospital at 26 weeks due to a BP spike, my insurance company put me on daily phone monitoring with an OB nurse. I was already monitoring BP and protein at home, but she would call daily and just chat with me and see how I was feeling and doing, as well as monitoring those numbers more closely than "if this goes over this level, go to L&D".

 

It was the insurance company daily nurse call that picked up that I was going into crisis, even though my levels hadn't changed much. She sent me into L&D at 34 weeks. I was in early labor (for me, that's a concern, because I have so much damage from the 22 week c-section delivery) . Less than 12 hours later, I had an emergency C-section. Not only did labor continue to progress, but I went from borderline pre-eclamptic, where I'd been for months, to full blown severe PE overnight.

 

My gut feeling is that it cost the insurance company less to have a nurse call and chat with me for 10 minutes or so a day for that couple of months and monitor my test results than for one visit to the perinatologist-and certainly less than having multiple "BP goes up, severe headache, seeing spots, go to L&D, spend the night in the hospital, stabilizes, go home"-which, almost invariably, came after I'd had to go in for a regular OB or perinatal appointment.

[happypamama]

Although, I don't think the costs are hugely different because midwives (at least in the state I had my children) have to work under the direction of a doctor. You also see the doctor for some of your visits. The doctor also has to show up for the delivery.

 

I went to a practice that had midwives and doctors. They gave you a flat rate price and you could choose who you wanted (doctor or midwife) to see as your main person. So I'm inclined to believe they charged the same irregardless. It might keep costs down overall to have midwives who are being paid less, but this was not a matter of if I chose a midwife I'd get a better rate.

Totally depends on your state and what they license. My first two births cost about $4500 each and included CNMs, a birth center in one case and a homebirth in the other. That included all prenatal care, all bloodwork, all care during labor, and all postpartum followup care. The midwives did practice with doctor backup, but we never saw the doctor unless there was a specific concern; it was all the midwives, all the time, and the midwives were the ones there during labor.

 

I used CPMs for the rest of my pregnancies. Those didn't use backup doctors, and care was on a flexible schedule, tailored to my specific needs and desires. (I declined glucose testing, for instance, because I don't feel it's a useful test *for me,* and the midwives concurred.). I paid much lower fees for those births and still got excellent care, and most importantly, except for the one that ended badly, outcome of healthy Mom and healthy baby was the same as with my first two births. (The one that ended badly ended badly because of factors no one, not the midwife and not the high risk specialists, could change. They did achieve a healthy Mom though.). I'd like to see freestanding birth centers more prevalent because they're a good hybrid of home and hospital. I'd like to see CPMs fully legal in every state. I'd like women to be able to choose testing based on risk factors and personal history. I think many women don't need to see an OB for their prenatal or labor/birth care, so I'd like to see a midwifery model as the general standard, until something looks troublesome. I think that would save money for everyone.

[SparklyUnicorn]

FWIW, I am as high risk as it is possible to get after my first pregnancy. With DD, onceI'd ended up in the hospital at 26 weeks due to a BP spike, my insurance company put me on daily phone monitoring with an OB nurse. I was already monitoring BP and protein at home, but she would call daily and just chat with me and see how I was feeling and doing, as well as monitoring those numbers more closely than "if this goes over this level, go to L&D".

 

It was the insurance company daily nurse call that picked up that I was going into crisis, even though my levels hadn't changed much. She sent me into L&D at 34 weeks. I was in early labor (for me, that's a concern, because I have so much damage from the 22 week c-section delivery) . Less than 12 hours later, I had an emergency C-section. Not only did labor continue to progress, but I went from borderline pre-eclamptic, where I'd been for months, to full blown severe PE overnight.

 

My gut feeling is that it cost the insurance company less to have a nurse call and chat with me for 10 minutes or so a day for that couple of months and monitor my test results than for one visit to the perinatologist-and certainly less than having multiple "BP goes up, severe headache, seeing spots, go to L&D, spend the night in the hospital, stabilizes, go home"-which, almost invariably, came after I'd had to go in for a regular OB or perinatal appointment.

 

I had something similar, but I admit I more resented it.  I thought it was odd for an insurance company to be calling me all the time.  Probably I'm a bit jaded though because I worked for insurance companies and yes they save a crap load of money.  Which is not a bad thing, but it's hard to be thought of in those terms when you are going through something difficult with your health. 

[AmandaVT]

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

 

DS's well child visit was $314 in November.

[displace]

I think there are so many ways to save money from waste. For-profit insurance companies make how much per year in profit? Imagine if those funds were used for prevention instead! And multiply by X number of for-profit insurance companies.

 

As for discounts: I hear people discussing getting cash discounts. It works differently for different places. In a doctor's office, where a visit may be just a visit (no use of medicines or other cost equipment), a doctor can wave or decrease fees and they agree to have a lessened profit for the office. In a hospital, those costs are "written off", but the hospitals don't have a lessened income. They charge more to other people for similar services (that a company may or will pay).

 

Medicare payment tends to be haggled by groups of doctors. They threaten to refuse all Medicare patients unless payments are increased. Medicare payment tends to become "standard" for payment in a lot of places. Medicaid is much less reimbursed and thus much less accepted.

Edited January 15, 2017 by displace

[Laura Corin]

Although, I don't think the costs are hugely different because midwives (at least in the state I had my children) have to work under the direction of a doctor.  You also see the doctor for some of your visits.  The doctor also has to show up for the delivery. 

 

I went to a practice that had midwives and doctors.  They gave you a flat rate price and you could choose who you wanted (doctor or midwife) to see as your main person.  So I'm inclined to believe they charged the same irregardless.  It might keep costs down overall to have midwives who are being paid less, but this was not a matter of if I chose a midwife I'd get a better rate.

 

The way it works in the UK is that most care is done by midwives, who have a three-year degree in that speciality.  Nurses who want to retrain for midwifery follow a shortened path.  They refer to doctors as necessary.  When I had Calvin in London, I saw my GP when I realised I was pregnant and he referred me to the midwifery team.  The next time I saw a doctor was when I needed stitching for a minor tear.  Some midwives are trained to stitch, but it so happened that the one on shift when Calvin was born was not.

[SparklyUnicorn]

The way it works in the UK is that most care is done by midwives, who have a three-year degree in that speciality.  Nurses who want to retrain for midwifery follow a shortened path.  They refer to doctors as necessary.  When I had Calvin in London, I saw my GP when I realised I was pregnant and he referred me to the midwifery team.  The next time I saw a doctor was when I needed stitching for a minor tear.  Some midwives are trained to stitch, but it so happened that the one on shift when Calvin was born was not.

 

Midwives are way nicer.  They spend a lot more time with you.  During the point leading up to delivery they are there with you a lot.  The doctor is there right when the baby crowns and that's about it.  The rest of it is done by nurses and the midwife.  But the law was such that the doctor HAD to be there at that point. 

[SparklyUnicorn]

If we are talking about waste reduction, the 100,000 support staff comes to mind.  In practices with multiple doctors there are multiple assistants.  Each doctor often has their own.  I get that there are various things that they don't have time for, so they need some support staff, but really do they need to have someone call you in from the waiting room?  The doctor is too above that?  And you go in there and they ask you questions just to have the doctor come in and ask you the same questions.  The doctor has no time to read the responses you gave so why are they doing this twice? 

[displace]

I think we can have universal health care, but I'm sure there are a ton of challenges. The US is huge and there are a lot of people, lots of cities, lots of rural areas, and not enough physicians, clinics, nurses, staff, etc. Just the logistics of space and people probably make coverage more difficult than any European country.

 

And to totally sidetrack back to public school health and nutrition. The schools may be preaching one thing, and may be offering healthier choices than a generation ago, but they are not currently offering or truly encouraging healthy choices in the majority of the US. Not to mention rampant foods/snacks as educational rewards (at least where I live). What kind of message are we sending to our children? To be rewarded in school for good behavior with candies and treats, given out by teachers who are supposed to be educating our children. They are simply teaching children positive reinforcement with food. They're encouraging unhealthy eating choices daily. I realize this is probably a classroom by classroom situation. But wouldn't a better policy be to exclude this type of thing in all public schools? If it's happening in one school, it's probably happening in others. Along with chocolate milk, juice, etc.

[displace]

If we are talking about waste reduction, the 100,000 support staff comes to mind. In practices with multiple doctors there are multiple assistants. Each doctor often has their own. I get that there are various things that they don't have time for, so they need some support staff, but really do they need to have someone call you in from the waiting room? The doctor is too above that? And you go in there and they ask you questions just to have the doctor come in and ask you the same questions. The doctor has no time to read the responses you gave so why are they doing this twice?

I don't have time to address this much right now. But, it's not usually about somebody being "above" doing something. It's about cost and profit. If a physician, who costs the most and also brings in the most income, spends an extra five minutes going to retrieve patients in the waiting room, over the day that could potentially be a lot of lost profit. But, if you pay somebody else less money just to show them where the room is, that's the cost saver. As for paperwork, that's a whole different story.

[SparklyUnicorn]

I don't have time to address this much right now. But, it's not usually about somebody being "above" doing something. It's about cost and profit. If a physician, who costs the most and also brings in the most income, spends an extra five minutes going to retrieve patients in the waiting room, over the day that could potentially be a lot of lost profit. But, if you pay somebody else less money just to show them where the room is, that's the cost saver. As for paperwork, that's a whole different story.

 

Yeah I really don't understand how this could actually save money. 

 

Part of me realizes though that this does create jobs for people.  So I also don't like the idea of taking jobs away either.

[ktgrok]

If we are talking about waste reduction, the 100,000 support staff comes to mind.  In practices with multiple doctors there are multiple assistants.  Each doctor often has their own.  I get that there are various things that they don't have time for, so they need some support staff, but really do they need to have someone call you in from the waiting room?  The doctor is too above that?  And you go in there and they ask you questions just to have the doctor come in and ask you the same questions.  The doctor has no time to read the responses you gave so why are they doing this twice? 

 

Actually, that's more cost efficient. The doctor should only be doing the stuff doctors are required for, and a much lesser paid staff member doing the the other stuff. While that nurse is calling you back (0r assistant these days) the doctor is in with another patient. It frees his time to see more patients. And yes, he SHOULD be reviewing the history the nurse/assistant took. 

[Laura Corin]

Midwives are way nicer.  They spend a lot more time with you.  During the point leading up to delivery they are there with you a lot.  The doctor is there right when the baby crowns and that's about it.  The rest of it is done by nurses and the midwife.  But the law was such that the doctor HAD to be there at that point. 

 

That was the case in Hong Kong too.  In fact there the doctor has to deliver the baby - midwives aren't allowed to.

[Dmmetler]

That's one reason why I think it makes sense to have routine medical care managed by nurse practioners and PA's, maternity largely managed by midwives and OB specialist nurses, and so on-it leaves the doctors to handle the things that truly require a doctor.

 

I don't think it needs a pediatrician to give my 12 yr old a physical and sign her camp form and update her immunizations, for example. She is generally a healthy kid. But under our insurance, we would have to pay for the clinic that has the NP model for regular care that advertises $75 Sports/Camp physicals out of our HSA. A pediatrician, though, is covered at 100% for a well child visit-one of the few things that is.

[Guest]

 

 

I have since moved away from JH and most likely won't go back due to their charging more for health share folks. It seems right to me that we ought to pay what insurances pay and not personally subsidize everyone as if we're all wealthy sheikhs, 'cause most aren't. If I need somewhere more specialized again, I'll have to decide if the extra is worth it or whether it's better to try other places like Hershey or Mayo or similar (places that supposedly work well with Health Share).

 

 

I returned to more local care to avoid the drive in to the city....but I found I am being charged the same as my name brand knowledgeable city practice with extensive base on patients like me charges. Was asked to do a 5k test just so they have a baseline. I know what that is...a practice who wants me to subsidize care for others. I would like the subsidization to be shared by all, not by fees generated from patients.

[FaithManor]

I think this opinion is why people are worried about "government healthcare." How can the government be trusted?

Doctors are often also heavily invested in Big Pharma and it takes quite a lot of cognitive dissonance to believe corporate america is any less corrupt. For that matter so are non profits because dh and I have worked between us for five and the level of mismanagement and corruption is staggering. So exactly what the hay do people against big, bad government suggest because it takes a bizarrely naive eye to think that there is another option out there that is any less depraved? At least if the American public wised up and actually voted with a conscience, started raising hell with their state legislatures to do more with accountability in order to produce less corrupt individuals to run for federal office, one could potentially do some weeding out and get some decent humans in charge. There is NOTHING the American public has any control over at all in corporate and non profits. Nothing. Putting my healthcare in their hands is scarier than a government that potentially turns over every four years and scums could at least be voted out of office.

 

Mostly though, Americans, no matter how low it goes, want to maintain the status quo. Fear of change is worse than all other consequences combined. I see this so much in the Baby Boomer generation for whom, by in large, life has been pretty good - not looking at individual circumstances just demographic statistics - and they kind of don't care what happens to anyone else as long as their apple cart is not upset. I see it so much in my parents and all their friends. It is sad but not one of them would change a thing even if that meant watching their grandkids die. It is a very narcissistic generation and to some degree I often feel that a little of that rubbed off on my generation. We aren't nearly as bad. We are all here discussing this issue, everyone agrees healthcare is the mega problem, giant elephant in the room, and most do not want to see people suffer and die for lack of access, but it is my children's generation - the ones in their teens and twenties who are inheritting the world the baby boomers handed to them - that are seeing things for what they are and want change, are willing to change, open to giving things a try because the country is bottoming out. Hopefully they keep that outlook long enough to end up in charge of things. Question is: will the US at that point sink so far that they can't fix it without some kind of horrible catastrophe as the cataclysmic impetus for an about face?

[Frances]

I don't think it is a sure thing that market forces won't work in health care. Some of it is an inelastic demand curve, but not all of it. David Brooks wrote an opinion piece in the NY TImes two days ago that argued that market forces have been shown to work in at least a few areas of healthcare. For instance, the cost of lasik eye surgery has fallen from about $2000 to less than $300. He also cited the Medicare prescription plan that introduced competition. He linked a few studies that I didn't read. David Brooks is conservative, but I believe he endorsed Obama and he is not a Trump supporter.

 

Instead of arguing over who pays for healthcare we really need to figure out how to get costs down. That involves hard choices. What is "good enough" health care? Even in the great country that got a man on the moon, there is not enough money for everyone to have "the best" healthcare.

 

I can easily think of times that my family has been "over treated" and "good enough" would have been fine. When my son broke his arm, he was sent to the children's hospital and saw a specialist, when he really didn't need to. A surgeon was called in for routine stitches. I had an ultrasound and biopsy on something that had very little risk of being dangerous. My son had a ct scan after a head injury. Just observing him in the ER for a few hours would have most likely been sufficient. My son has his tonsils out and a child life specialist visited him and billed us. I think that was nice for him, but mostly overkill. (I have four kids. These were all for different kids).

 

Then there are all the screenings (Pap smear, mammogram, colonoscopy, prostate) where the science is mixed or shows a small benefit. If these are done for everyone, they don't save money. You have to screen usually thousands of people to find one case. Instead, maybe we should screen less frequently, or only those with risk factors. BTW, I am talking about screening, not turning people away who have symptoms. A women with a symptom of breast cancer needs a mammogram. It is not so clear that women with no symptoms do.

 

End of life care costs so much. It isn't an easy topic. People usually want to live as long as they can at whatever cost. Is it worth millions of dollars for an extra few months? Is that sustainable for everyone.

 

I don't have answers to all these issues. I just think controlling costs is a bigger issue than who pays.

While I think bringing costs down is a good goal, I really don't think the market will work in most cases. I live in a pretty major population area, and lasik eye surgery around here is much closer to the $2k than $300. Also, what about dental work? Most people don't have dental insurance and at least in populated areas there are plenty of dentists, but except for cheap or free X-rays and cleanings to get people in the door, most people I know find dental and orthodontic work pretty expensive. And many, many people struggle to afford any dental care at all.

 

Also, I think most of the examples you sight about specialists being unnecessarily used are related to the way we do medical education in this country and many doctors being paid on a fee for service basis rather than salaried and healthcare systems trying to maximize profit. Most medical school graduates go into specialties due to debt and because it pays more. When specialists are used, insurance can be billed more than for seeing a general practitioner or physician assistant.

 

In talking to my aunt who is the CEO of hospital, she said one of the major changes she has seen with the ACA is giving more of the power and decision making back to primary care doctors and away from specialists because money is given out in ways that incentivize keeping patients healthy and catching things early. I know the small clinic my husband and I have as a medical home is down to one MD and the rest are nurse practitioners and physician assistants. Of course we can get referrals to specialists when necessary, but this model is obviously costing less. But of course many people newly insured under the ACA had lots of deferred healthcare to catch up on, so it's understandable that there weren't immediate cost savings.

 

I completely agree about end of life care and posted earlier in the thread about the importance of people planning before they ever face it. There has at least been some progress in this area with Medicare and the ACA paying for planning consultations, but much more can be done.

 

Also, most countries that have universal healthcare use some system of price control and bargaining with pharmaceutical and medical supply companies. That's why it's often cheaper to buy drugs in other countries or travel for knee replacement surgery. In some cases, the higher prices we pay here are basically subsidizing cheaper care in other countries.

 

I agree with you that more needs to be done to lower costs, but I think going to some sort of universal healthcare system and incorporating many of the cost saving measures used in other countries is our best chance of getting there.

Edited January 15, 2017 by Frances

[Pawz4me]

Mostly though, Americans, no matter how low it goes, want to maintain the status quo. Fear of change is worse than all other consequences combined. I see this so much in the Baby Boomer generation for whom, by in large, life has been pretty good - not looking at individual circumstances just demographic statistics - and they kind of don't care what happens to anyone else as long as their apple cart is not upset. I see it so much in my parents and all their friends. It is sad but not one of them would change a thing even if that meant watching their grandkids die. It is a very narcissistic generation and to some degree I often feel that a little of that rubbed off on my generation. We aren't nearly as bad. We are all here discussing this issue, everyone agrees healthcare is the mega problem, giant elephant in the room, and most do not want to see people suffer and die for lack of access, but it is my children's generation - the ones in their teens and twenties who are inheritting the world the baby boomers handed to them - that are seeing things for what they are and want change, are willing to change, open to giving things a try because the country is bottoming out. Hopefully they keep that outlook long enough to end up in charge of things. Question is: will the US at that point sink so far that they can't fix it without some kind of horrible catastrophe as the cataclysmic impetus for an about face?

 

This is painting with an unbelievably broad brush. Some of us (one being me!) are baby boomers with teenagers and young 20 somethings. Are your children somehow more special than mine? Likely they/we are no different than you. Keep in mind that the boomers are a very diverse group in many ways, and the age range is large. I'm a 54 yo boomer with one kid in college and one heading there in the fall. I likely have much more in common with you than with your parents or any 70 something on the other end of the boomer generation. The "blame the boomers" meme is silly and simplistic.

Edited January 15, 2017 by Pawz4me

[historically accurate]

 

In talking to my aunt who is the CEO of hospital, she said one of the major changes she has seen with the ACA is giving more of the power and decision making back to primary care doctors and away from specialists because money is given out in ways that incentivize keeping patients healthy and catching things early. I know the small clinic my husband and I have as a medical home is down to one MD and the rest are nurse practitioners and physician assistants. Of course we can get referrals to specialists when necessary, but this model is obviously costing less. But of course many people newly insured under the ACA had lots of deferred healthcare to catch up on, so it's understandable that there weren't immediate cost savings.

 

 

My gp is retiring this year *sniff, sniff*. His office is replacing him with a PA. They are basically funneling those of us who are fairly healthy to the NP (added 2 years ago) or the new PA. 

[kiwik]

Along the lines of not knowing the future... I had to edit my post to change "no type of cancer does" to "no type of cancer did" run in my family. If you've happened to read a couple of other threads I've posted on, you might know my mom is now dealing with esophageal cancer - adenocarcinoma - and it's spread to her liver (all news we found out in varying stages from Nov - Jan).

 

Who gets this? It's only 1% of cancer diagnoses, so not many people. MEN get it 3-4 time more than women. Smokers and heavy drinkers get it as do heartburn sufferers.

 

http://www.cancer.org/cancer/esophaguscancer/detailedguide/esophagus-cancer-key-statistics

 

https://www.cancer.gov/types/esophageal

 

My mom ticks NONE of those boxes. She's female. She's never smoked (nor did my dad or her parents or workplace atmosphere - no major secondhand smoke exposure). She has a glass of wine occasionally, but I've never seen her tipsy much less drunk. She didn't have any symptoms of heartburn - nothing more than the occasional "after Thanksgiving dinner" version anyway. No one in her family had cancer (not that we know of anyway - in history - who knows)? She had NO symptoms of this (it was discovered due to a heart issue she had).

 

So you tell me how she drew her "lucky" straw... we're baffled.

 

Fortunately, she has decent medical insurance - but only if Medicare sticks around. (or something equally as good with no gaps)

 

One might be able to predict they won't have a baby (hubby sure isn't likely!), but I don't mind paying for those out of our monthly shares... one can't know their future - nor can one just "live right" and know they'll "miss" the bad stuff. I wish it worked that way, but it doesn't - not guaranteed anyway. (sigh) And I'd give a ton to have her "paying in getting nothing for her money." She's 73 - not bad, right? Well, her mom lived to 94 and her dad to 88. None of her 5 siblings have passed away or are likely to (unless something sudden). We're kinda feeling cheated out of 15-20 years and that will include things like seeing my youngest graduate from college and any great grandkids, etc. All for a cancer she isn't supposed to be a candidate for.

 

What would be worse? Having to pay the bills on top of the rest of it... or knowing some things couldn't happen because we couldn't afford it.

 

No one facing health issues should have to worry about the financial end of it - not in a first world country.

My sympathies. We had the same thing with my grandmother. She was a bit older but well short of where we expected. I still feel cheated as I expected to have her wise advice and love for my kids at least during their preschool years.

[TranquilMind]

Honey, they aren't. All the ACA provides for is reimbursement for your physician if you should choose to make an appointment to get guidance on different end of life treatment scenarios. In other words, the doctor will get paid for his time. It is there to encourage physicians to take the time to have these important discussions with their patients. Because, whether or not you realize it, these discussions are important. In the end, the patient and family decide. Period, full stop.

But doctors will talk to you any time you see them during the course of the care.  They are still getting paid. They never see you without getting paid.  They decide how to code it to accommodate the charge they want to make.

 

You act like they are doing anything free right now and the ACA needs to make special accommodation so they will get paid.

 

Watch someone die, and see how many suddenly swarm into your room - who have absolutely no role at the time - so they can put a final charge on the bill. 

 

[TranquilMind]

Yet a physician intubated my 86 year old father because no paperwork came with him when he was transferred from rehab, they said it wasn't complete.  Then the doctor was reluctant to remove the tube. We, the family, insisted.  Where was the common sense you are so adamant exists? Have you ever, in your life, had to make a real life and death decision like we did that day? Trust me, we would have much preferred that all of the paperwork be in order so that we didn't have to make that decision. Had my father met a long time ago with his physician and discussed this, all of the paperwork for the DNR would have been in order and complete. So, no, don't tell me that this is something that just naturally happens, because it does not. 

 

Yes, I have made real life and death decisions, more than once.    I know whereof I speak. 

 

We prepared our paperwork in advance in more recent case and the patient had a DNR order.   In previous cases, they were long enough ago that these decisions were made logically and in real time in discussion with doctors who used to see you and the patient every day, back in the day. 

 

You have to retain your own copies, not trust them to have anything. This was harder to do a long time ago, but today we can carry copies on our phones.   But it is not a absolute necessity that you hold the Health Care POA or the patient's doctor have issued a DNR.  I provided my Health Care POA more than once to expedite matters.  The DNR only applies in the hospital setting anyway, not in transport settings (though it is unclear on if this was your situation mentioned above) Rational decisions can be made on the basis of the evidence with the obvious legal decision maker dictated by legal hierarchy.    The family member can decide, as you know. 

 

You basically cannot trust anyone and have to cover all bases yourself.  A hospital setting is the most politely yet doggedly aggressive I have ever had to be to defend the rights of a family member.   If you think yet another government program would change that, you are more optimistic than I am. 

 

Edited January 15, 2017 by TranquilMind

[TranquilMind]

These conversations should take place long before someone is on their death bed. The purpose of them is so that the patient's wishes are honored and so that the family doesn't have to guess at what their family member might want. That is the purpose of allowing reimbursement, so doctors can get paid for office visits that address these situations. 

 

You may have "been there, done that" but there are so many complicated scenarios that people should think through. I'm sure you haven't encountered all of them. I also find the "been there, done that" attitude to be particularly dismissive of the person who is actually dying. They should be given an opportunity to indicate their own choices as much as possible. 

 

For example, there's the issue of intubation. It can play out in many ways: 

chance of meaningful recovery

chance of recovery with severe physical limitations

chance of recovery, but patient is impaired by Alzheimers/dementia and no longer recognizes family and friends

no chance of meaningful recovery 

 

Then, put "feeding tube" in the place of intubation.

Put "hydration" in the place of intubation. 

 

Each of these things (intubation, nutrition and  hydration) can prolong life, but they work differently and have different consequences. They are all worth separate consideration.

 

Then, start thinking about what you consider to be a meaningful recovery. What does that mean to you? 

Walking, talking, able to feed self, able to communicate without talking, hearing, bathing, toilet, reading?

Of course these conversations "should" take place long before they are relevant.  But it doesn't always happen.  It mostly doesn't happen. 

I'm not sure how you are linking experience to a dismissiveness of the person who is dying.  That's simply a false assertion there. 

Yes, they are hard decisions and you never know if you are making the right one on the spot.  You just have to pray and hope, and take a step.    Yes, I've been involved in the nutrition and hydration removal as well.  Not a good scene. 

 

Sure, you think you can decide all these things ahead of time, but there are so many variables and you never know what will apply at the time.  And you may well make different decisions for yourself than you would make for an elderly person, or a child. 

It's all very difficult.

[TranquilMind]

You have a fundamental misunderstanding of the ACA provision. It is voluntary. It is not a program. It is a private appointment with their own personal doctor that allows them to learn and make educated choices before the need arises. It is pre-planning. It allows them a modicum of control over the end of their life. 

 

Please, get your facts straight before you start saying something isn't necessary. 

 

I already addressed this.  So long as it is voluntary, do what you want.  The thing is the ACA itself  isn't voluntary.   So pardon my skepticism that any particular part will remain voluntary. 

 

You act like someone would be unable to get information on end of life decisions but for the ACA provision to pay for it.  This just isn't true. 

[TranquilMind]

DS's well child visit was $314 in November.

Yikes! 

[TechWife]

But doctors will talk to you any time you see them during the course of the care.  They are still getting paid. They never see you without getting paid.  They decide how to code it to accommodate the charge they want to make.

 

You act like they are doing anything free right now and the ACA needs to make special accommodation so they will get paid.

 

Watch someone die, and see how many suddenly swarm into your room - who have absolutely no role at the time - so they can put a final charge on the bill. 

 

Yes, they will talk to you anytime during the course of care. The purpose of this reimbursement provision is that you don't have to be sick to have these conversations. You can go to the doctor specifically to discuss end of life care and be assured s/he will spend time with you because they are now getting paid for their time. Physicians do code things so that they get paid, but they also don't commit fraud. If you present in the office for something that is not billable, they cannot and will not bill the visit. They have to back up their bills with charting. It is not random. Before ACA, a physician appointment solely to discuss end of life counseling was not covered. Now it is.  Why do you have a problem with that? Is it all about the money? Money isn't everything, especially when you are the "next of kin" making decisions. 

 

As for your last sentence, I have watched both of my parents die. My dad died three months ago and my mom died seven weeks later. We were not "swarmed" at the time of death. It was handled by the staff with a great deal of respect and dignity. We saw no one other than their nurses. There was absolutely no attempt to "pad the bill." I'm sorry if your experience wasn't like that,  maybe you should look for different providers. 

[TechWife]

Yes, I have made real life and death decisions, more than once.    I know whereof I speak. 

 

We prepared our paperwork in advance in more recent case and the patient had a DNR order.   In previous cases, they were long enough ago that these decisions were made logically and in real time in discussion with doctors who used to see you and the patient every day, back in the day. 

 

You have to retain your own copies, not trust them to have anything. This was harder to do a long time ago, but today we can carry copies on our phones.   But it is not a absolute necessity that you hold the Health Care POA or the patient's doctor have issued a DNR.  I provided my Health Care POA more than once to expedite matters.  The DNR only applies in the hospital setting anyway, not in transport settings (though it is unclear on if this was your situation mentioned above) Rational decisions can be made on the basis of the evidence with the obvious legal decision maker dictated by legal hierarchy.    The family member can decide, as you know. 

 

You basically cannot trust anyone and have to cover all bases yourself.  A hospital setting is the most politely yet doggedly aggressive I have ever had to be to defend the rights of a family member.   If you think yet another government program would change that, you are more optimistic than I am. 

 

 

Did you see the benefit of having paperwork prepared beforehand with your most recent "case?" 

 

I, too, kept all of my paperwork with me. It was the responsible thing to do. I also identified myself to the staff immediately. 

 

Not all states manage POA's in the same manner, nor do they manage advance directives or DNR/DNI orders in the same way. In the state of Georgia, a physician must sign a DNR for it to be valid. It may not be that way in your state, but I assure you that it is in Georgia. 

 

A signed DNR applies in all settings - home, rehab facility, nursing home, during transport, hospital, Disney World.  It is a DNR and it is always valid. If the person rendering care does not know that there is a DNR in place, they must render aid. If the paperwork is not in order or not present and there is no next of kin available, then medical professionals must render aid. If they are presented with an 86 year old man with dementia, pneumonia and a collapsing airway, the rehab doesn't send paperwork in the ambulance and the next of kin is in the waiting room trying to get permission to go back to the ED, then medical professionals must render aid. Common sense doesn't enter into the picture. It must be done. 

 

Sometimes, many times, there is no time for a discussion with next of kin. Sometimes doctors have seconds or minutes to make these decisions. There is no ongoing discussion about care because care is initiated as a trauma. 

 

For the last time, this is not a government program. Why do you keep saying that? It is simply allowing physicians to bill for and get paid for talking with their patients about end of life decisions. 

[TechWife]

Of course these conversations "should" take place long before they are relevant.  But it doesn't always happen.  It mostly doesn't happen. 

I'm not sure how you are linking experience to a dismissiveness of the person who is dying.  That's simply a false assertion there. 

Yes, they are hard decisions and you never know if you are making the right one on the spot.  You just have to pray and hope, and take a step.    Yes, I've been involved in the nutrition and hydration removal as well.  Not a good scene. 

 

Sure, you think you can decide all these things ahead of time, but there are so many variables and you never know what will apply at the time.  And you may well make different decisions for yourself than you would make for an elderly person, or a child. 

It's all very difficult.

 

It didn't happen because doctors didn't get paid to do it. Do you see the connection? Now that doctors are getting paid to do it (at least for now), we will see an increase in the number of people who do take the time to have these conversations with their physicians. Physicians will probably actually ask their patients to think some things through. 

 

It isn't the experience that is dismissive. It's the "been there, done that" that is dismissive.  I will never use such a phrase to describe the moments when we were giving permission for my father's breathing tube to be removed. We were choosing between life and death. It isn't a time that can be reduced to a cute little phrase that will fit on a t-shirt. 

 

The knowing someones' wishes ahead of time is what makes the decisions easier when the variables have to be taken into account. It is a hard thing to do and I have done it twice in the past few months. Difficult doesn't even begin to describe it. 

Edited January 15, 2017 by TechWife

[scholastica]

It didn't happen because doctors didn't get paid to do it. Do you see the connection? Now that doctors are getting paid to do it (at least for now), we will see an increase in the number of people who do take the time to have these conversations with their physicians. Physicians will probably actually ask their patients to think some things through. 

 

It isn't the experience that is dismissive. It's the use of the casual phrase "been there, done that." I will never use such a phrase to describe the moments when we were giving permission for my father's breathing tube to be removed. We were choosing between life and death. It isn't a time that can be reduced to a cute little phrase that will fit on a t-shirt. 

 

The knowing someones' wishes ahead of time is what makes the decisions easier when the variables have to be taken into account. It is a hard thing to do and I have done it twice in the past few months. Difficult doesn't even begin to describe it. 

 

Not liking that this happened to you. Liking what you said about the difficulty. I'm sorry for all you and your family went through this fall. :grouphug: