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

[PeterPan]

I think birth control should be sold over-the-counter without a prescription and poor women should be able to take it up to the pharmacy window & have Medicaid or Title X billed for the cost (barrier contraceptives too). If a woman has a legitimate medical reason for taking it like endometriosis or whatever, her doctor can write a prescription and the cost covered at whatever the normal prescription co-pay is.

 

Just as a total aside, I've always assumed that the changing of meds from prescription to OTC had less to do with what was safe/dangerous vs. deciding who was going to pay for what. So if they do increase HSA access to all, it would make it easy to make these common items OTC. Just thinking. 

[bolt.]

Yes, we still paid for insurance through DH's work.

Yes, we were surprised how lacking in services our area was. No, I will not be going into detail because whenever I do I am told I am wrong. Gets old. No, I never indicated that our care here has movie star qualities; that's absurd.

It's ok that there are flaws. I did say many of them look familiar. That's ok too.

Positives and negatives, every country's got 'em.

End.

I'm sorry. I can see that you've been questioned enough about this!

[TranquilMind]

We have government healthcare. Medicaid, Medicare, Tricare. The government hasn't stepped and and taken their twinkies.

 

True.  Then why has this Medicare not been extended to everyone? 

 

I'd really like to know, other than the obvious, that people paid in for 65 years before being able to collect. 

Insurance companies who fund political campaigns could tell you a thing or two.

 

https://www.opensecrets.org/lobby/indusclient.php?id=F09

 

[TranquilMind]

Just as a total aside, I've always assumed that the changing of meds from prescription to OTC had less to do with what was safe/dangerous vs. deciding who was going to pay for what. So if they do increase HSA access to all, it would make it easy to make these common items OTC. Just thinking. 

Everything should be over the counter.   Everything.  I can understand some monthly limits on easily abused drugs but other than that, I can decide what to use and when. 

 

 

 

 

[Guest]

Everything should be over the counter. Everything. I can understand some monthly limits on easily abused drugs but other than that, I can decide what to use and when.

Do you wag or do you use a lab?

[TranquilMind]

Do you wag or do you use a lab?

 

What?  What does "Do you wag or do you use a lab" mean? 

No idea. 

 

[Guest]

The VA, and Tricare prime/standard/remote are all different things, just to be clear.

[Guest]

Do you wag or do you use a lab?

Like chemo and everything??

 

ETA-quoted the wrong person. Fat fingers. That question is for TM.

Edited January 13, 2017 by Moxie

[AmandaVT]

That's an interesting discussion to have. I read recently online (not sure how true obviously) that the *majority* of the coverage increases were actually people going onto medicare and that only like 1% were actually increasing access to private coverage. I don't know how people feel about medicare who are on it. My dad has full military coverage, and they're moving him over to medicare as well now that he's of age. It's all peter pays paul and paperwork and a logistical nightmare. 

 

I don't know anyone on medicaid who jumps for joy over it or thinks it's ideal. The stories are hear are lack of access, having to search for doctors who will take it, limits that affect ability to receive reasonable basic coverage, etc.

 

My dad, who has 100% disability and a very old gold pass, meaning they'll do EVERYTHING for him, like way beyond what current service members get, still has fidgety coverage. That type of coverage depends on the state structure, and in one state he gets amazing coverage and unlimited service and in the state where we live I can't even bring him here. He would literally have to go between 5 major hospitals, all at least 2-3 hours apart, to get complete coverage. And it would be limited. It's ASTONISHING. I would like to move my dad closer, and I can't because the vet system in our state is unworkable for him.

 

I grew up on military medical and still deal with it through my dad. I know what happens when theres's lack of competition, lack of incentive to do well, lack of innovation. 

 

But, again, that's a debate our culture is having. I agree it's very complicated. 

 

 

I believe Medicaid coverage very much depends on your state. In VT, it is very "normal" for people to be covered by Medicaid/Dr. Dynasaur. Over 50% of the kids in VT are covered by those programs. So basically, every Dr takes Medicaid here and there is no discrimination against Medicaid. Medicaid also pays out approximately the same as the commercial insurance companies like BCBS and Cigna, so there's no downside to accepting Medicaid patients here. In many ways, it's better than the commercial insurance companies from a billing perspective, they pay quickly and regularly, claims are very straightforward, we have a dedicated Medicaid representative that I can call when I have a more involved question, etc.

[Guest]

What? What does "Do you wag or do you use a lab" mean?

No idea.

 

Do you guess or do you use a lab to confirm your selection of the proper meds for the patient?

You claim meds should be otc. How do you select What is being taken and in what strenghth? Totally agree with poster asking about drugs such as chemo treatments, where knowledge is necessary to prescribe the right med. And how do you handle interactions?

Edited January 13, 2017 by Heigh Ho

[Spryte]

FWIW, I was a college student and on BCP's because hormone swings triggered basilar arterial migraines. My parent's health plan covered the migraine meds, and covered most of the ER visits necessitated by the migraines that the meds couldn't control, but the BCP could, but wouldn't cover the BCP. All I can say is that I'm glad the university's health clinic stocked low cost BC for students-which I'm sure the state helped pay for in some way.

 

Yep.  I had endometriosis and adenomyosis - the pain was unbearable, and my life was severely impacted.  My BCP to treat it were never covered by insurance.  The only way I could afford them from the time I was 20 till my hysterectomy (yes, it was that severe) at 27, was PP.   PP actually diagnosed it, and was incredibly helpful and kind in helping me treat it, and directing me to specialists when they felt I needed another opinion.  Those other opinions resulted in the same treatment, basically, so I filled it through PP.  Because I could only afford that.  I was in school those years, and had no insurance that would cover Rxs.  

 

 

 

 

And as an aside - I have obviously always had infertility issues, and clearly after age 27 - having children was not an option.  I still had to pay what every other woman of child-bearing age does for insurance, because that's how insurance works.  

[Pam in CT]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

 

 

Thus far a series of employer-based systems have mostly worked for us, though the time and bandwidth effort going into management / recordkeeping / phone calls / changing health care providers due to changing systems has been pretty onerous pretty much any time we've had any kind of issue beyond routine preventative care... and of course when you're actually seriously sick or dealing with a seriously sick family member is precisely when you DON'T have time or bandwidth to spend on such management.

 

The patchwork of employer-based systems that existed prior to ACA definitely did not reach 90% of the population.

[TranquilMind]

Do you guess or do you use a lab to confirm your selection of the proper meds for the patient?

You claim meds should be otc. How do you select What is being taken and in what strenghth?

 

Oh, that word "wag" threw me off.  A typo, I guess.

 

I take very little.  If I need to take an antibiotic, I figure out what antibiotic treats what, run it by the doctor (since I have to get it from him at the present time) and I'm right 99.9% of the time.  Why can't I just do that myself?   I can read.  If it is more complicated, I can still go to a doctor, right? 

 

(I self treated on something else and had labs done to verify.   Levels on everything were perfect.  This is not rocket science, in most cases.)

 

I totally believe they should be OTC. 

 

Edited January 13, 2017 by TranquilMind

[Guest]

Yep. I had endometriosis and adenomyosis - the pain was unbearable, and my life was severely impacted. My BCP to treat it were never covered by insurance. The only way I could afford them from the time I was 20 till my hysterectomy (yes, it was that severe) at 27, was PP. PP actually diagnosed it, and was incredibly helpful and kind in helping me treat it, and directing me to specialists when they felt I needed another opinion. Those other opinions resulted in the same treatment, basically, so I filled it through PP. Because I could only afford that. I was in school those years, and had no insurance that would cover Rxs.

 

 

 

 

And as an aside - I have obviously always had infertility issues, and clearly after age 27 - having children was not an option. I still had to pay what every other woman of child-bearing age does for insurance, because that's how insurance works.

Hence the point that people Want some options for genetic issues. Me, I want people with severe myopia, a genetic issue,to have IOC or PRK covered. Right now it is not. I will trade fertility treatments and transgender surgery in return, since I didn't get those, which are all much more expensive but are covered.

[Tanaqui]

The enormous rise in antibiotic-resistant diseases is why you can't treat yourself.

[TranquilMind]

The enormous rise in antibiotic-resistant diseases is why you can't treat yourself.

 

Heh heh.  This enormous rise in antibiotic-resistant diseases happened while DOCTORS prescribed all the antibiotics. 

I can do better.  I already do better in my own life. 

[Miss Peregrine]

The enormous rise in antibiotic-resistant diseases is why you can't treat yourself.

Who's overprescribing?

[Guest]

Oh, that word "wag" threw me off. A typo, I guess.

 

I take very little. If I need to take an antibiotic, I figure out what antibiotic treats what, run it by the doctor (since I have to get it from him at the present time) and I'm right 99.9% of the time. Why can't I just do that myself? I can read. If it is more complicated, I can still go to a doctor, right?

 

(I self treated on something else and had labs done to verify. Levels on everything were perfect. This is not rocket science, in most cases.)

 

I totally believe they should be OTC.

 

 

Good luck with that.

[SparklyUnicorn]

Hence the point that people Want some options for genetic issues. Me, I want people with severe myopia, a genetic issue,to have IOC or PRK covered. Right now it is not. I will trade fertility treatments and transgender surgery in return, since I didn't get those, which are all much more expensive but are covered.

 

I think there is definitely a lot of unfairness in terms of what is covered or not.  Maybe it comes down to who successfully puts enough pressure on those that have the power to regulate.

 

Why, for example, aren't dental procedures covered?  Why is the coverage that is out there so dismal?  They act like your teeth have nothing to do with your health, but that's just not the case.

[TranquilMind]

Good luck with that.

Oh I know. 

My common sense will not win out here. Too much money and power at stake. 

[goldberry]

Yeah, just on the flip side, it frustrates me to no end that I would have to pay for maternity care I don't want and can't use (because, um, hello, infertility) till I'm in my 50's just because some politician decides everyone MUST have it.

 

 

The concept of group health insurance is that healthy people, people who don't have certain conditions, pay for those who do not.  The group covers the individual.  If you could wait until you knew exactly what coverage you needed, and buy only that, then the whole concept of insurance goes out the window.    

 

 

OhElizabeth, since my parents turned 50 they have had 3 surgeries between them (they are just 56).  Can I say that I don't want to have to pay to have your old joints worked on, all I need is maternity coverage (which is much cheaper than multiple surgeries)?  Can I say taht my BP is good, so I don't want to have to compensate toward your furture heart attack?  

 

 

OhElizabeth, your comment is either indicative of a serious lack of knowledge about how insurance works, or incredible selfishness, or both.  If it is the first, you should educate yourself.  If it is the second or third, then maybe self-reflection is in order.

Edited January 13, 2017 by goldberry

[Guest]

Common sense requires experience. You do not have enough to select the meds for more serious conditions, nor do you have the interaction info at hand. Money and power have nothing to do with that.

[TranquilMind]

Common sense requires experience. You do not have enough to select the meds for more serious conditions, nor do you have the interaction info at hand. Money and power have nothing to do with that.

I have access to all of the experience I need. 

And if it is really serious, of course, I would see someone who is board-certified in those conditions. 

[Miss Peregrine]

Common sense requires experience. You do not have enough to select the meds for more serious conditions, nor do you have the interaction info at hand. Money and power have nothing to do with that.

Doctors change meds all the time, it's trial and error. How often do pharmacits discover the interactions after the dr. prescribed?

[Lang Syne Boardie]

I don't disagree that it's a debate being had. I just don't happen to have that opinion. Every time I watch people ahead of me in line with stacks of Twinkies and pop while overweight, clearly not making good choices, choices that WILL affect their long-term health, it confirms to me that I don't want universal health care as a right. If I have to pay for your healthcare, I can also dictate the choices you make that affect your health. 

 

And I agree, that's a total debate our society can have about who pays for what and what freedoms people are willing to give up on the way to getting what they want. 

 

Do you give a pass to vegans who get cancer, or skinny people who get melanoma, are these people worth compassion and sharing between mankind, or do you have other categories of people who you think aren't good enough for medical care?

 

Second question, do you think if the low-income, fat people have access to medical care, they might meet doctors who will send them to dieticians, or have access to yearly physicals, or anything that might improve their information so that they can get better, or would you rather they just die and decrease the surplus population?

[TranquilMind]

Do you give a pass to vegans who get cancer, or skinny people who get melanoma, are these people worth compassion and sharing between mankind, or do you have other categories of people who you think aren't good enough for medical care?

 

Second question, do you think if the low-income, fat people have access to medical care, they might meet doctors who will send them to dieticians, or have access to yearly physicals, or anything that might improve their information so that they can get better, or would you rather they just die and decrease the surplus population?

 

Where did I say some people "aren't good enough for medical care"?  Did not happen.

I'm not Ebenezer Scrooge.  ;)

 

I'm also not delusional.  Some people will not change habits regardless. Some will.  It all depends upon motivation.   

 

If you think people are fat because they don't have access to yearly physicals and don't see dieticians, I really don't know what to say about that.   I certainly know lots of average size people who never see the doctor and lots of fat people who do all the time. 

 

[Lady Florida.]

Do you give a pass to vegans who get cancer, or skinny people who get melanoma, are these people worth compassion and sharing between mankind, or do you have other categories of people who you think aren't good enough for medical care?

 

Second question, do you think if the low-income, fat people have access to medical care, they might meet doctors who will send them to dieticians, or have access to yearly physicals, or anything that might improve their information so that they can get better, or would you rather they just die and decrease the surplus population?

 

Or non-smokers who get lung cancer and teetotalers who end up with liver failure.

 

All of the above scenarios require empathy.

[Spryte]

Hence the point that people Want some options for genetic issues. Me, I want people with severe myopia, a genetic issue,to have IOC or PRK covered. Right now it is not. I will trade fertility treatments and transgender surgery in return, since I didn't get those, which are all much more expensive but are covered.

 

But trading isn't how the insurance industry works.  

 

I'm sure you'd also trade the 4 laparoscopic surgeries I had done for the endo, plus the hysterectomy.    Why would you want your insurance company to cover those since you don't have those issues, right?  Is that what you're saying?  If I'm misinterpreting you, then apologies.  I have not read this thread in its entirety.

 

We don't get to trade.  Though I agree that treatment for genetic issues should be covered.  I have severe myopia, and would benefit from prk as well, but honestly - that's not even on my radar as mine is correctible with lenses.  If a person's vision is not correctible at all, without surgery, then yes - it does seem it should be covered.  

 

Though you *can* do a form of mental gymnastics, and tell yourself that your dollars don't go to cover treatments you don't want covered.  The chances that your actual dollars cover X treatment (insert whatever it is you don't want to see covered) is slim.  

 

BTW, fertility treatments are not covered by my insurance company anyway. I don't think it covers transgender surgery either.  

[happypamama]

Creekland, I am so, so sorry about your mom. That's really awful.

 

Carrie, I'm sorry to hear about your husband too. I hope it is not cancer!

 

Umsami, interesting that in Egypt poor people go to a teaching hospital because it's cheaper. I guess that's the equivalent of people here going to a dental school for treatment? But to be treated by a teaching hospital here is totally different. The best hospital in our area is a teaching hospital. Every day, a team of an attending doctor, a fellow, and a resident, plus other people, looked at my son's numbers and conferred. They discussed back and forth pros and cons. The older doctor brought his years of experience, and the thirty-something fellows brought latest research. Same with me when they were trying to figure out what was wrong with my pregnancy and body. It was a different approach from the hospital where my DH spent a couple of days after his back injury; that was also a very good hospital, but more of the "I'm the doc, and this is my plan" approach. Not a big deal for his situation, but for complicated situations, I'm really glad we were at a teaching hospital. Anyway, just interesting in how it varies according to country (and possibly within country? IDK).

 

I don't care if they kill the ACA because it seems to have helped some people and hurt others, but we need to replace it with something. Just like it was wrong for Mylan to jack up the epipen prices, it's wrong to prohibit children and pregnant women from getting lifesaving care because of cost. Reducing whatever bloat jacks up costs would be a good start. People should be able to afford a reasonable hospital stay for a birth or simple appendectomy without being bankrupted. It shouldn't cost $65 (what my family doc charges without insurance) to have your sore throat evaluated for strep or to make sure that sore ear on your child isn't a ruptured eardrum or to check that the sore ankle isn't actually fractured. I guess I would overall support a way to make basic checkups or sick visits reasonably affordable. Something between "free" (no cost to patient) and exhorbitant. I have no problem paying for routine maintenance on my vehicle, with insurance covering major accidents, but changing the oil and buying tires are the kinds of things that aren't horribly expensive and can be planned for. So maybe if we could make an ear infection check a reasonable price, whatever would both cover the doctor's time/expense but also be not horrible for a parent, yet still making sure parents have some skin in the game so they don't drag a kid in for the first sniffle, would be good.

 

And hahahaha, you never know where you're going to end up, so I'd be very cautious of electing not to have certain coverages. My family is generally healthy. We have a couple of very minor health issues, like asthma, that require nothing more than some fairly inexpensive inhalers and one PCP checkup a year, and none of them have ever required hospitalization. We've never even had a kid break a bone! I've had five babies out of the hospital (including a breechie) with no complications or anything. *Nothing* suggested that I might have anything more than "eh, you're a little older" during pregnancy. And then I ended up with unexpected appendix surgery last year at 38. Then DH broke his back (literally), in a freak accident for something he doesn't do often (i.e. it's not like when he was in the field every day and was statistically more likely to have an injury). Then I went from ridiculously low risk pregnancies to the highest of the high risk pregnancies. I spent six out of eight nights in the hospital when my pregnancy abruptly ended in an emergency c-section at 26 weeks and a 1 pound infant who spent almost three weeks fighting in the nicu. I saw more doctors in one month than I saw in my entire life or in fifteen years of parenting five other kids, no exaggeration. Every one of those things was statistically unlikely, and we NEVER would have seen them coming. Please be careful when you choose what coverages you don't want.

Edited January 14, 2017 by happypamama

[Lang Syne Boardie]

Where did I say some people "aren't good enough for medical care"?  Did not happen.

I'm not Ebenezer Scrooge.  ;)

 

I'm also not delusional.  Some people will not change habits regardless. Some will.  It all depends upon motivation.   

 

If you think people are fat because they don't have access to yearly physicals and don't see dieticians, I really don't know what to say about that.   I certainly know lots of average size people who never see the doctor and lots of fat people who do all the time. 

 

 

Hi, TM, if you'll notice I quoted OhElizabeth and not you. You are different people, right? Not the same poster with two accounts?

Edited January 13, 2017 by Tibbie Dunbar

[Lady Florida.]

 

 

 

And hahahaha, you never know where you're going to end up, so I'd be very cautious of electing not to have certain coverages. My family is generally healthy. We have a couple of very minor health issues, like asthma, that require nothing more than some fairly inexpensive inhalers and one PCP checkup a year, and none of them have ever required hospitalization. We've never even had a kid break a bone! I've had five babies out of the hospital (including a breechie) with no complications or anything. *Nothing* suggested that I might have anything more than "eh, you're a little older" during pregnancy. And then I ended up with unexpected appendix surgery last year at 38. Then DH broke his back (literally), in a freak accident for something he doesn't do often (i.e. it's not like when he was in the field every day and was statistically more likely to have an injury). Then I went from ridiculously low risk pregnancies (I had a breech birth at home with zero complications a few year ago) to the highest of the high risk pregnancies. I spent six out of eight nights in the hospital when my pregnancy abruptly ended in an emergency c-section at 26 weeks and a 1 pound infant who spent almost three weeks fighting in the nicu. I saw more doctors in one month than I saw in my entire life or in fifteen years of parenting five other kids, no exaggeration. Every one of those things was statistically unlikely, and we NEVER would have seen them coming. Please be careful when you choose what coverages you don't want.

 

:grouphug: My heart still breaks for you when I think of what you just went through. But yes, you are a prime example of the how the unexpected can happen. That last sentence is so powerful coming from you.

[Reefgazer]

Well, I admit this is one aspect of military care that most people don't like.  I take whatever doc I am assigned for a visit; I don't care if I see the same doc, but then again, I have no major health issues (knock on wood - I certainly am of the age where they appear).  IF that's an issue for you, military care is going to give you grief.  But I figure that the care is now computerized at Portsmouth and doc #2 can see my comments to Doc #1 and what Doc #1 provided, so that helps with continuity of care.

We lived in VA for years, and at that time, living farther out in the country (where my dad put us so we could have the same rural, happy childhood he grew up with), it wasn't the same as your more positive experience. We had to drive quite a ways to a clinic, seldom saw the doctor, and certainly had no personal relation or continuity of care. It was pretty basic and sterile. It was pretty scary as a kid to go to the doctor in that environment.

 

I'm really interested to see the privatization efforts they make with the VA and the medical system. I don't know what it will mean. I'm just curious to see, as I'm still pretty invested, as I want to be able to bring my dad closer and get him complete care locally.

 

[SparklyUnicorn]

Where did I say some people "aren't good enough for medical care"?  Did not happen.

I'm not Ebenezer Scrooge.  ;)

 

I'm also not delusional.  Some people will not change habits regardless. Some will.  It all depends upon motivation.   

 

If you think people are fat because they don't have access to yearly physicals and don't see dieticians, I really don't know what to say about that.   I certainly know lots of average size people who never see the doctor and lots of fat people who do all the time. 

 

 

I just don't know how much control we have over these things.  It's not always a moral failing.  But I might be misunderstanding where you are going with this.

[Reefgazer]

A pharmacist can handle interaction info, and are cheaper to pay than physicians.  They give vaccines, and can do simple things like BP monitoring.  I would like to see a nurse practitioner in every pharmacy to do simple things like walk in BP, walk in sugar monitoring, dispense BC, treat simple sprains and cuts, etc..., and be available to be used as a patient sees fit.  Once you have, say, a blood pressure med prescribed and stabilized by a nurse practitioner or doctor, an OTC BP monitor and meds should be easily available.  I can see this wouldn't work for everything, but for many things it would, and it would clear doctor appointments for those with acute and/or (as yet) undiagnosed issues. 

Do you guess or do you use a lab to confirm your selection of the proper meds for the patient?
You claim meds should be otc. How do you select What is being taken and in what strenghth? Totally agree with poster asking about drugs such as chemo treatments, where knowledge is necessary to prescribe the right med. And how do you handle interactions?

 

[Spryte]

I just don't know how much control we have over these things.  It's not always a moral failing.  But I might be misunderstanding where you are going with this.

 

Agreed.  I am one with many, many preexisting conditions - and none are due to moral failings or lifestyle choices.  So is my child.

 

Neither of us have our issues - which are often life-threatening, esp with no meds - from living unhealthy choices or smoking or eating too much.  

[Guest]

Doctors change meds all the time, it's trial and error. How often do pharmacits discover the interactions after the dr. prescribed?

Trial and error is not the same as guess and check.

 

If We take out the population that deliberately won't tell one doctor what another has prescribed and they are taking, how much work is left for the pharmacist?

 

That falls under the responsibility portion of the discussion...patients need to not run up the tab with unnecessary duplication of services.

[SparklyUnicorn]

Agreed.  I am one with many, many preexisting conditions - and none are due to moral failings or lifestyle choices.  So is my child.

 

Neither of us have our issues - which are often life-threatening, esp with no meds - from living unhealthy choices or smoking or eating too much.  

 

Well and even if you had issues from eating too much or smoking, the fact you ate too much or smoked could be looked at as being difficult for you to control for reasonable reasons.  For example, if something is telling you that you feel starved all the time or if you eat because it soothes you mentally.  Is it fair to say you just aren't trying hard enough to do better?  It might be 10,000 times harder for you to do better than the guy next to you.  A lot of people start smoking when young and get addicted.  And so on....

This is not to say we have no personal responsibility, but it's hard to always do stuff right sometimes.

[Reefgazer]

No kidding.  This is going to sounds so Ellis Island, but I had a boil on my finger a year or so ago that would not go away for anything.  Everyone (except my 90 year old dad) told me it required an antibiotic, but I really don't like taking meds unless I have exhausted all other options.  Dad told me to put a poultice on it.  Say what?!?!?  He told me to go find one in an independent drug store.  I just looked at him like he was nuts, because...poultice.  So he told me how to make one of a saturated salt solution, and that boil went away  -  without adding to any antibiotic resistance. 

Heh heh.  This enormous rise in antibiotic-resistant diseases happened while DOCTORS prescribed all the antibiotics. 

I can do better.  I already do better in my own life. 

 

[Miss Peregrine]

Trial and error is not the same as guess and check.

 

If We take out the population that deliberately won't tell one doctor what another has prescribed and they are taking, how much work is left for the pharmacist?

 

That falls under the responsibility portion of the discussion...patients need to not run up the tab with unnecessary duplication of services.

Is there no database of meds tied to an individual? When my dh had surgery the nurse came in with a list of meds prescribed to him (different doctors ) and asked about them.

[Spryte]

Well and even if you had issues from eating too much or smoking, the fact you ate too much or smoked could be looked at as being difficult for you to control for reasonable reasons.  For example, if something is telling you that you feel starved all the time or if you eat because it soothes you mentally.  Is it fair to say you just aren't trying hard enough to do better?  It might be 10,000 times harder for you to do better than the guy next to you.  A lot of people start smoking when young and get addicted.  And so on....

This is not to say we have no personal responsibility, but it's hard to always do stuff right sometimes.

 

Yep, I'm with you.  Treatment should be covered.  Period.   I'm not going to make judgments about how a patient got to the point where they are.  There are way too many factors at play, even if I wanted to be the moral judge.  Which I don't.  

[umsami]

In Egypt (at least when I was last there), one can go to the pharmacist and get most meds.   (no hard drugs... no chemo...etc.)

 

Of course, the pharmacists won't just give you xyz.... they actually use their training to help you choose the med that would be right, and urge you to see a doctor if x, y, or z happens... if you've been on the same dose of whatever for a chronic condition and aren't getting follow-up....etc.

 

I could see something like that working with some things in the US.

 

But it has its downside....and in our society....it would likely require malpractice insurance for pharmacists.

Antibiotic resistance is an issue.  Yes, doctors prescribed them but often under pressure from patients.  The whole direct=to-consumer advertising of drugs has made patients go in and "demand 'certain drugs....and doctor shop if they don't get them.  Like most things, good and bad.  Just as with Google, it can be wonderful or horrible.  I gave my DH  a mug that says "Please Do Not Confuse Your Google Search With My Medical Degree."  Because yes, there really is a difference.  Training, experience, understanding how things interact all matter too.

 

But yeah...we need to reign in pharmaceutical costs among many other costs.

[SparklyUnicorn]

Is there no database of meds tied to an individual? When my dh had surgery the nurse came in with a list of meds prescribed to him (different doctors ) and asked about them.

 

Even though more and more stuff is being linked up, it's still not perfect.  Every doctor I go to asks for stuff that is out there somewhere in someone's computer system, but none of them are linked up. 

 

The doc yesterday said he'd send over a transcript of the visit to my regular doc.  He's the first doctor who ever mentioned he'd do that.  I like that so I don't have to repeat myself, but other doctors didn't do that and I had to repeat myself. 

[Guest]

But trading isn't how the insurance industry works.

 

I'm sure you'd also trade the 4 laparoscopic surgeries I had done for the endo, plus the hysterectomy. Why would you want your insurance company to cover those since you don't have those issues, right? Is that what you're saying? If I'm misinterpreting you, then apologies. I have not read this thread in its entirety.

 

We don't get to trade. Though I agree that treatment for genetic issues should be covered. I have severe myopia, and would benefit from prk as well, but honestly - that's not even on my radar as mine is correctible with lenses. If a person's vision is not correctible at all, without surgery, then yes - it does seem it should be covered.

 

Though you *can* do a form of mental gymnastics, and tell yourself that your dollars don't go to cover treatments you don't want covered. The chances that your actual dollars cover X treatment (insert whatever it is you don't want to see covered) is slim.

 

BTW, fertility treatments are not covered by my insurance company anyway. I don't think it covers transgender surgery either.

What I said was that people want some choice when it comes to genetic conditions. I am happy to pay for your genetic Condition treatment, but I want mine covered too,.especially since mine is necessary to life. If i pay a lot for yours, and you refuse to help me in return, i have nothing left oop to pay for mine.Being severly myopic and astigmatic limits my ability to pursue employment.I proposed to waive my coverage for two genetic conditions that don't impair employability in return for including coverage for one that does. You intrepreted that as doing exactly what you have done...exclude one to cover another at the excluded persons expense. Why aren't you willing To pony up for me?

[creekland]

Equally, it boggles MY mind how one can think they aren't responsible for their own birth control.  Like seriously. 

 

Even in my teens, I would have never even imagined this was someone else's responsibility to provide me with birth control. 

 

 

Spoken as someone with means to provide birth control for themselves and/or the willpower to not engage in Tea.  That's a nice Ideal World.

 

In the Real World there are many who have trouble paying bills, so things like bc aren't so easily affordable and not everyone shares the "wait until marriage" for Tea ideology.

 

In the Real World I want babies who are wanted - and paying for birth control is one GOOD way to avoid abortions later - abortion being one thing my pro-life self hates.

 

We live in the Real World.  I don't mind birth control being free.  I wish more folks would use it if they aren't ready for a baby.

 

I don't disagree that it's a debate being had. I just don't happen to have that opinion. Every time I watch people ahead of me in line with stacks of Twinkies and pop while overweight, clearly not making good choices, choices that WILL affect their long-term health, it confirms to me that I don't want universal health care as a right. If I have to pay for your healthcare, I can also dictate the choices you make that affect your health. 

 

And I agree, that's a total debate our society can have about who pays for what and what freedoms people are willing to give up on the way to getting what they want. 

 

I'll admit to not knowing if you have religious beliefs or not (because I don't keep a list and my memory is pretty shot at this point), but your view goes directly against my Christian faith.  I just can't see Jesus saying, "Sorry.  You've sinned and don't deserve my helping you out."

 

But I digress based upon my personal faith.  I cannot agree with you at all.  I want basic health care for all - even the woman caught in adultery.  I'm not without sin so I'm certainly not throwing the first stone!

 

I'd love to know what you think caused my mom's cancer.  As I said before, we're baffled.  Only 1 person out of 100 who get cancer get hers and she didn't check any of the boxes that align with it being a lifestyle choice.

 

That's...breathtakingly myopic and judgemental.

 

So, you know that person's health status? As in, why they are overweight? Are you a doctor that can diagnose folks in the grocery story line? Because not everyone who is overweight makes poor health choices, or at least makes poor choices on a regular basis. Also, you have a magic crystal ball that tells you why they are buying those pops and twinkies? Like, maybe it's for a party. Maybe it's grandma's favorite treat, and she's terminal, so you know what? We buy grandma stacks of twinkies and pop (like the McDonald's burgers and fries and beer we bought our friend dying of cancer when all she wanted was burger, fries, and a beer).

 

These things are almost never so black and white.

 

I don't really expect people to care about each other anymore, I really don't. But don't expect me not to be very, very angry about how people do treat each other. It's a disgrace.

 

Agreed.  The whole attitude of "I've got mine, sucks to be you!" or "you deserve it because you're a lifestyle sinner" boggles my mind.  I simply can't relate - even if those beliefs are widely held and demonstrated.

[happypamama]

Reefgazer, I agree with you. I like the NP model that is emerging as the standard here. Urgent care, even the ER, uses NPs as much as possible. I love that a simple UTI doesn't necessarily need a doctor.

 

And fwiw, a $30 OTC blood pressure cuff saved my life. :) Wish I were exaggerating. It also helped that I was already encouraged to be an active participant in my own health management, which isn't always a standard perspective, so I was on top of things like Hershey's syrup on ice cream. I'm 150% in favor of people keeping tabs on themselves and really getting to know their bodies and being hands off with unnecessary medical interventions and checkups thet tell you nothing -- but I'm also 150% in favor of medical interventions that save lives and am honored to have received them.

 

I have a lot of conflicting thoughts about insurance and healthcare, but I want to tell the Republican Party something. You say you're prolife. Great! So am I. I don't support abortion in any case, except maaaaaybe when termination would save the life of a mother who already has other children. (I was almost in that situation. I'm extremely glad I did not have to make that choice.). But simply not aborting children is only the first step. You have to provide a way to support them post-birth. For some, that means finding ways for parents to afford their practical needs. And for others, it means providing healthcare. We watched people live a prolife approach these past few weeks. At every step, they said, "We will do whatever we can for as long as we can." Nobody ever said, "He's so unlikely to make it that we don't want to spend the money." Even when they told us he was very sick before he was born, they said, "We are prohibited from terminating at this stage unless your health is in danger, and right now, it isn't [that did change a few days later], so we aren't even going to mention it, and let's talk about what we can do to give him the best chances." To me, that is living prolife. I don't care how the Republicans or anyone else make it happen, but I want those attitudes everywhere. If there is something you can do, you do it.

 

(Uh, sorry, I'm apparently using this thread as a therapy session haha. But I think people need to hear from people who have been through extreme situations, whether that's health or a single mom with no education and a minimum wage job. What do people need in a practical sense and what can we do to make those things happen?)

Edited January 13, 2017 by happypamama

[SparklyUnicorn]

What I said was that people want some choice when it comes to genetic conditions. I am happy to pay for your genetic Condition treatment, but I want mine covered too,.especially since mine is necessary to life. If i pay a lot for yours, and you refuse to help me in return, i have nothing left oop to pay for mine.Being severly myopic and astigmatic limits my ability to pursue employment.I proposed to waive my coverage for two genetic conditions that don't impair employability in return for including coverage for one that does. You intrepreted that as doing exactly what you have done...exclude one to cover another at the excluded persons expense. Why aren't you willing To pony up for me?

 

I agree.

[ktgrok]

If I were designing a system from the ground up, I would scrap the 4 years of college + 4 years of med school and have a 6 year combined program that admits students either right out of high school (if they've done well on enough AP or IB exams) or from community college. No general ed requirements, only the classes needed to become a physician. It would be free in exchange for a service obligation as a primary care doctor for a certain number of years in a location with shortages. If the individual wanted to become a specialist, there would be an option for getting specialist training after the initial service obligation was up, but that would incur additional years' service obligation.

 

I would also reform the malpractice system to make it more like workers' comp, where there is a standardized award system but still some flexibility for unusual circumstances.

 

I would ban direct-to-consumer advertising of pharmaceuticals and strictly regulate marketing to physicians.

 

I would eliminate restrictions on telemedicine and increase the use of electronic monitoring of symptoms & side effects. For a while, I was having to bring my child in for a blood pressure and weight check at the pediatrician's office every 3 months in order to get her ADHD medication refill. What a waste of money. I should be able to stop by a pharmacy, have her step on a scale & use the automatic BP monitoring station there, then have the results automatically analyzed to make sure everything is fine.

 

Yes to pretty much all of this!!! 

[ktgrok]

I'd still want to have a provider asking questions and talking to the mom (my own prenatal appointments are 1 hour long with my midwife) but it could be done via phone. Or, again, in a group setting for most of it. Think of Call the Midwife, with the clinics they run. It's a particularly good model for chronic conditions, such as diabetes, heart disease, etc. 

Yep, no reason standard prenatal care could not be accomplished in a group format.

 

There could be an opportunity afterwards for whoever had personal questions or more complicated needs to see a provider politely. At least 50% of women could probably leave after the group appointment.

 

(also, those appointments that are just "urine sample, blood pressure, listen to the heartbeat" could totally be done at home with mom forwarding her information to the provider; travelling to the office, sitting in the waiting room, then getting a total of 90 seconds with a provider for those monthly appointments is nonsense and a wase of everyone's time and resources)

 

[Lady Florida.]

Heh heh.  This enormous rise in antibiotic-resistant diseases happened while DOCTORS prescribed all the antibiotics. 

 

 

Yes doctors are partly to blame, but so are patients. For years patients would demand antibiotics when they weren't called for. Doctors, wanting to keep patients happy, prescribed them (although for years doctors didn't know about resistance either). Doctors should have said no, but often when they did patients would just keep doctor shopping until they found someone who would prescribe them. 

 

We've finally reached a point where we don't ask for antibiotics (most of us even avoid them whenever possible) but it took at least a generation or two. I can't tell you how many times my mother would try to get me to go to the doctor and ask for antibiotics for myself or ds, even though I knew they weren't called for. Her generation came of age alongside the development of modern antibiotics. They were miracle drugs. Before that a simple infection could be dangerous. Patients helped create the problem.

Edited January 13, 2017 by Lady Florida.

[ktgrok]

This is true. I looked into it a lot recently. 

I will when I get to a computer. Routine screening mammography does not save money and only possibly saves lives. One good place to read more is the website Science Based Medicine and use the tag mammography.

The issue is still complicated and we don't know everything, but it appears that mass screening over diagnose while also saving a few lives. We as a society (or individuals) need to decide whether the benefits outweigh the associated risks and costs.

ETA: part of the issue is that catching cancer early is not as effective as we would all like it to be. Aggressive cancers tend to kill no matter how early they are caught and less aggressive cancers don't lead to death even if they are not caught until much later. So having a mammogram to detect cancer before symptoms are present isn't necessarily helpful.