Anyone ElseTerrified about Repeal of ACA Bill
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MountainMia: You are so right! Can't find it, can't use it! I hope that just means that they don't have to have *their own* state web site and would, alternatively, use the nationwide "Marketplace" website. But I could be wrong. That would be really bad.
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Court Hears Oral Argument on New Hampshire's Troublesome Section 1115 Medicaid Waiver
July 23rd (2019) oral argument in Philbrick v. Azar
Philbrick concerns the Department of Health and Human Services' approval of a restrictive Section 1115 Medicaid waiver project. That project allows New Hampshire to require adults who qualify for coverage under the Affordable Care Act's Medicaid expansion to meet mandatory work requirements as a condition of coverage and also terminates the Medicaid Act's guarantee of 3-months retroactive coverage.
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Pricing Index Proposal Draws Fire
Industry groups take aim at plan to tie Medicare payments to prices charged overseas
The Trump administration's proposal to base U.S. drug prices on those in other countries would be disastrous for new drug development efforts in the pharmaceutical industry, a healthcare consultant said ... Under the proposal, which the HHS sent to the White House in late June for review, drugs paid for *under Medicare Part B* -- that is, drugs which are administered in the physician's office -- would be reimbursed based on the average cost of the drugs in a group of other Asian and European countries, plus a markup of 26%. The Department of Health and Human Services (HHS) hopes to test the model over a 5-year period beginning in the spring of 2020, starting with 50% of the Part B market and widening from there....the proposal -- {is} known as the International Pricing Index (IPI) ... seven of the 27 drugs in the Part B program are already below the threshold.... That leaves 20 drugs to involve in the pricing scheme....the main argument {against the proposal} is that manufacturers will reduce R&D investments dollar-for-dollar [due to] reductions in reimbursement from Medicare Part B. ... why not reduce executive compensation, their advertising and marketing budgets, or returns to investors?"
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/81140
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Want to Debate Healthcare Economics?
Learn the history
- by George Schwarz
'A new language is infecting the culture of American medicine,' ....'It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.'"
Here is a simple fact: We are not going to control the cost or prices of healthcare in the U.S. until we realize that it is not a commodity. And, frankly, had the political climate been different, that's exactly how we would have dealt with the healthcare "crisis." And, I might add that we've been calling the situation in healthcare a crisis for almost 60 years. Crises don't last that long. This is the lack of political will and corporatization of the country.
How we handle healthcare policy in the future will tell us what our values are as Americans.... Do we live in a country where we recognize the value of community and that working together can make us greater than the sum of our parts? Or, will we continue to weaken our country by denying healthcare through an economic model that rejects the notion that we should be a healthy nation?
{A lengthy, but worthwhile, three part discussion of the history of and prospects for the American healthcare system.}
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/81015
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https://khn.org/news/otis-brawley-ahcj-american-cancer-society/
American Cancer Society's medical director, Dr. Otis Brawley, wrote a book, How We Do Harm. I highly recommend reading it. For those who want a taste of what's written in the book, I recommend reading the above link. While the book was written several years ago, it is as relevant today as when it was written....
And Lumpie...I hate to say this, because it has the Blame the Victim mentality, but as consumers of medical care, we should be playing a greater role in getting the best care and not more care. What I find concerning is that all of these medical specialties get together and create guidelines and then they are not followed.
One example, here in the US, breast cancer screening guidelines, based on different specialties, are all over the place. And, that doesn't include the government's guidelines that pick through the specialists guidelines and have come up with their own that people ignore and worse, most people don't know of their existence!
And then....you have all kinds of INTERNATIONAL guidelines. And, you have individual foreign guidelines...which...you guessed it...American practitioners and patients ignore....
Imagine all of the money that can be saved if Americans FOLLOWED THE AMERICAN GUIDELINES? Perhaps the money that is saved from properly screening could instead be earmarked towards research that could ultimately save even more lives?
And....as Dr. Brawley describes so vividly in his first chapter, how a woman shows up in the emergency room with a brown bag containing her breast, one needs to wonder how that can happen in America. The first reason that pops into one's head why that could happen is that the patient is uninsured. But that was not the case.
Read the book and find out!
Lumpie...what is being left out of your equation is the patient. And.... most politicians who, unfortunately are not scholars, that make health issues, political issues and cannot see the forest from the trees which ultimately fuels ignorance and not solutions!
So...there is more blame to be spread around....and we must transform people and their ideas BEFORE we can figure out how to fix the healthcare nightmare...
Read the book! Very enlightening
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I will push back on that, voraciousreader, at least on the way you've put it. If you expect ME to be the expert and design my care based on best practices of all the specialties, you are expecting too much. If you expect ME to choose the small hospital in town to treat my cancer, because likely they will be less expensive, instead of the big research hospital with a lot of expertise and facilities available, you are expecting something I won't do. If you expect anyone to comparison shop for medical services on price, as if shopping for a replacement part for their car, you're expecting the wrong thing.
I read from the link above, from Dr Brawley's speech. And yes, we have a f'ed up medical complex in this country, and also a culture that doesn't always have the right values. You're not wrong that big transformation is needed. But I don't accept blame.
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voraciousreader: On the one hand, there are, unfortunately, times when there is not much left to be done for a patient. And I very strongly feel that patients need to have a voice in planning for end of life care. Most patients, when asked, say that they do not want extraordinary interventions when the end is inevitable. Hence the extensive debate in recent years on whether physicians, and other appropriate staff, should be compensated for counseling patients about end of life planning (Duh! yes!) On the other hand, if another therapy might work, many patients want to try it. Especially if they are relatively young and healthy excepting one rapidly advancing disease process. We are only beginning to understand why some treatments work when others don't - like how genomics can impact the efficacy of breast cancer treatment. And thank goodness some patients are willing to participate in the clinical trials that advance the next generation of therapies for all of us. Is it "bad" to "waste" a lot of care dollars on end of life care. In some cases, it certainly doesn't make much sense. What about the corollary lifetime limits? Once we have spent too much on you, you are out of time? While it is a way to control costs, many of us are not comfortable with that idea either. I hope that there is a moderating solution and, importantly, that patients have agency in making decisions about their care. I have confidence that most well-informed patients will make prudent decisions. I think that we need a better avenue for opening up these discussion while people are still healthy and way to create a record about preferences and desires. These can be a critical guide when situations change drastically and unexpectedly or may be of help in reflecting upon one's circumstances in the face of declining health.
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Congress Has a Bill for Your Medical Bill
Milton Packer, MD, finds proposed legislation is unlikely to fix anything
When you get the {medical} bill, you may be "surprised." You believed you had comprehensive healthcare coverage, but apparently, it was not comprehensive. You may have thought you had "adequate" medical insurance provided by your employer. But your employer agreed only to pay for medical care under certain limited circumstances, typically defined by a list of certain procedures provided by "in-network" physicians who had negotiated their billing rates in advance. For most people, this provides incomplete (and often inadequate) coverage. The public is not aware that much of the medical care that it will require will not be covered..... When people need urgent or specialized medical care by out-of-network physicians, patients receive bills they did not expect. I am not talking about a lack of healthcare insurance. I am talking about the lack of adequate in-network coverage. It is a universal and well-recognized deficiency of our current healthcare system. Our current healthcare system...deceives people about the quality and scope of their existing healthcare coverage. ...no one should think that this represents the best that we can offer.
{Opinion piece about deficiencies inherent in our current system. Author provides disclosures.}
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Here are the facts, depending on where you live. At 58 I pay about $10,000 (or more) a year premium, for a plan that requires that I pay another $20,000 out of pocket or more, as I do not qualify for a subsidy. I can't find a physician who accepts it, only a low income urban clinic P..A. or nurse, as these are considered PROVIDERS (NOT PHYSICIANs, much less specialists) and it is only accepted at one single hospital in huge city miles and miles from my residence. Do you think I can be sick and have treatment for two consecutive calendar years without declaring bankruptcy?
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Medicare for All: Would Patients and Physicians Benefit or Lose?
Milton Packer issues an urgent call for practitioners to join the debate
{In this opinion piece, a physician points out the numerous shortcomings with our current system and notes that some countries have single payer systems that operate side-by-side with private insurance. He encourages physicians to weigh in on the debate.}
the U.S. healthcare system is more expensive than that of other countries, but we have worse outcomes. Even among those with access to healthcare, most people with chronic illnesses are not receiving adequate care.
according to the National Academy of Medicine, one-third of all healthcare expenditures is a complete waste.
Two-thirds of people who file for bankruptcy cite medical issues as the key contributor to their financial woes. This is not how an advanced civilization should function.
...most physicians now simply serve as subcontractors for the insurance industry. Their decision-making capacities are limited, and they are plagued with administrative chores. Their ability to practice high-quality medicine is severely impaired. This is causing an extraordinary burnout rate (30-50%) and a frightening rate of suicide.
An interesting question is the coexistence of {single payer and} private insurance. In Australia, about half of the public purchases private coverage to receive a better choice of providers and faster services, and the government encourages private coverage through tax breaks.
In the end, the decision will all come down to a question of trust. Who would you choose to provide your healthcare? The U.S. government? Or the current financialized employment-based insurance system that is totally broken?
...the voice of physicians will play the decisive role... They need to make an eloquent case for themselves and for their patients.
https://www.medpagetoday.com/blogs/revolutionandrevelation/80926
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MelissaDallas: I am so sorry. Unfortunately, I know that your situation is not unusual. So many of us are in similar boats. Right now, my premiums + out of pocket are about $15,000. And that is because I qualify for help with co-pays and out of pocket. Otherwise it would be worse. Right now, I am still on COBRA. The amount would go up if I go on an ACA plan plus I fear that fewer things would be covered. If/when I go on Medicare, my state does not require those under 65 to be issued Medigap coverage. I could not begin to cover the 20% out of pocket so I would be confined to an Advantage plan. I have tried to get a clear picture of what my out of pocket expenses would be on such a plan but it is nearly impossible. I have been doing some research and evidently, there are barriers to participating in clinical trials if one is on Medicare. That could be a problem. I may have to consider moving to another state to get a Medigap plan. We have discussed my moving in with family elsewhere, but for now, my plan only offers access to care where I currently live. I know that none of us planned on being in this "boat." We probably thought and hoped that we would be healthy. I am glad much of the public hasn't had to face these issues but it also creates a bubble of denial and inaction when people think they are immune to these problems.
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mountain...going to that research hospital may NOT have the best practices...and I am not advocating for you to know what those best practices are....but what I would expect is that doctor that you are sitting in front of to know what ALL of the guidelines are, explain them, and then, make a recommendation to you.
And Lumpie...that informed patient may not be making the most informed decision....
When we step away and not see the possibilities of what can be with our help...we have only ourselves to blame for the status quo...
Dr. Brawley’s book is How WE do Harm....WE as in EVERYONE....
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melissa...I can only imagine your reaction when all of the Democrat contenders raised their hands, in agreement, to provide illegal immigrants “free” healthcare.....
Considering the government does not generate income, and all this free stuff that it gives out is expensive, I wonder if the end of the road is on the horizon...
Just a thought....
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voraciousreader, feel free to blame yourself.
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mountain...i do blame myself!It is very enlightening!
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and....as long as this issue is politically charged...it will never be fixed. Fairer minds will never be heard....
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VR, when you stated "Democrat contenders," you used a noun, instead of an adjective, to modify a noun. The appropriate adjective is, of course, DEMOCRATIC.
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pup.....and? I had no idea we had the punctuation and grammar police on patrol here at bc.org.....
I thought this was a place to discuss ideas...Despite being a voracious reader... i guess my ideas cannot be legitimized because of my poor language arts skills...
And with my Brooklyn accent, if you heard my voice, you'd think I was a moron.....my bad!
Going forward, healthcare costs are unsustainable and we need to have a serious discussion and plan.
Can anyone explain to me why most US women are advised by their practitioners to begin having mammograms at age 40 whereas in Canada, Northern, Southern, and Western Europe, women at average risk, are asked to begin at 50 and have them every other year? Can anyone explain to me why our death rates from breast cancer are similar? (Pup....may I have permission to use a comma followed by the word “and” when using plural nouns?)
Can anyone explain to me why, despite our population based bc screening, there are still so many women being diagnosed Stage IV right out of the gate? Approximately 6% in US and Europe.....
Does anyone on this thread realize how much money could be saved by doing less imaging and then more money can be spent on research that might lead to better ways of screening? And perhaps more money can be spent on finding better treatments?
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I quite frankly agree that consumers should play a much more active role in their healthcare. The problem is that the consumer is at such a disadvantage trying to do so. It would be like buying a car and having no idea how to put the key into the ignition. And once upon a time, car buyers went into car buying totally ignorant of things like gas mileage car reliability.
The average health consumer has no idea how to choose a cancer treatment protocol, let alone a breast surgeon. And it is advantageous to insurance companies, healthcare providers, pharmaceutical companies and the like to keep the average consumer in the dark. Or at least semi-dark. Pharmaceutical companies love that consumers know the name of their drugs, not so much their efficacy or SE.
I also think people should make an effort to be as healthy as they possibly can be. However, not everyone grows up with the knowledge of how to do that. Not everyone has access to healthy food or healthy lifestyle choices. And of course people can do everything right and still end up sick. As far as imaging- drop the price, screen those who are at risk. Preventative medicine imho is still the best medicine
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VR, I'm sure you know what I'm talking about, and it's not grammar.
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It doesn't help that the "rules" for healthy living, especially nutrition, keep changing!
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Another great book on our health system is An American Sickness by Elisabeth Rosenthal. I have only been able to read pages at a time because it is so distressing.
I would also say that genetics play a greater role than we realize. I competed in triathlons into my 30's, then switched to rollerblading, then indoor cycling. My weight didn't change much until menopause, at which point I looked like all the other women in my extended family. Very frustrating. Unfortunately, I also didn't pay much attention to their health, until I was diagnosed with breast cancer, at about the same age as 2 of my Aunts. Within my Mom's family, 4 of them had breast cancer, one ovarian (a 15 year survivor and still going) and one uterine cancer. My Mom was diagnosed with BC in her 80's, and my sister 3 years before me, in her early 50's. After nursing my kiddos for a combined 2.5 years, I felt I would dodge this particular bullet. HAH. Joke was on me. I missed 2 years of mammograms--my Dad died and we moved. The initial tumor was found on the mammogram, but no full body scan was completed. My consulting specialists now feel that I was de novo Stage IV, but the testing done at the time was not enough to find the mets. I am actually thankful it was found now, since I am unable to tolerate AI's, and am finding Faslodex and Ibrance tolerable.
There should be some way for our healthcare system to provide care for everyone, at an affordable cost, including catastrophic illnesses. But the system cannot be based on greed, which is what it is now.
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Pupmom, I've always been confused about that... which is right, Democrat or Democratic?
I would say that both can be correct, depending on the context. At least that seems to be the case, according to the Democratic National Community. Here is their website, https://democrats.org/
The party is the Democratic Party, not the Democrat Party. The individuals in the party are Democrats, not Democratics. As they say on the DNC website, "Help us elect more Democrats".
Therefore since each candidate is a Democrat (not a Democratic), as group of individuals would they not be "Democrat candidates"? However if the focus is on the party rather than the individual, then they could be called Democratic Party candidates, which could be shortened to Democratic candidates.
But in the scheme of things, in a discussion about healthcare, does it matter anyway?
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Beesie, it's a particularly stupid form of partisan insult. Some Democrats strike back by saying Republics, lol.
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Beesie, just to clarify, "Democrat" is a noun and "Democratic" is an adjective. So they are "Democratic" contenders or candidates. Thanks for asking.
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I used to be upset when someone incorrectly used the term Democrat party. It was meant to be offensive. They know it. We know it. But when I really stopped to think about it, I realized it was more revealing than offensive. It reveals the speaker (or writer) as childish, petty and lacking common decency. It also means they lack a persuasive argument. There's no need to stoop to name calling when you're in the right.
Just my 2 cents.
Trish
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Democrat...Democratic...
I hadn’t realized that the politically correct police were out here in full force...
Getting back to Dr. Brawley....the takeaway from his book is not that we must, not so much, be astute consumers of healthcare, but we should be astute to the question of the cost of screenings and treatments and whether or not they are meaningful to each of us individually....
Soccer...Dr. Brawley’s book speaks to your situation! I am glad you don’t feel guilty about having missed your mammogram. Most population based screening mammograms are way better at finding more easily treated tumors and less able to find those de novo ones. And there are quite a few tumors that don’t appear on the screening mammos and then, voila, six months later, a patient feels a lump and have a diagnostic mammo which confirms an aggressive tumor....
That is why I think we all need to be better at understanding the costs and effectiveness of screening as well as treatments. IMHO, we need less money plowed into the type of screenings that are presently offered and use the difference in finding better screening and treatment methods...
I also think that the present way of disbursing federal tax dollars towards research needs to also be overhauled. Has any of the, whatever you want to call them, contenders offered up a new approach to how the money is disbursed? Transparency? When I read stories like those of Duke University’s FORMER cancer researcher Anil Potti, I am heartbroken. That said, I am encouraged by the NIH’s more recent additional regulations for Duke researchers....hmmmmm....but what about the rest of the schools that it gives funds?
When it comes to healthcare, I think we have many reasons to be terrified...The cost of healthcare can never be fixed until there is transparency and accountability...
Until we, the people, speak up and ask some of the questions that I ask here are asked of our politicians, I am not holding my breath that our broken healthcare system will one day become affordable....
With all of that said, The United States is still innovative when it comes to medical research and I remain hopeful.......
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I understand that "Democrat Party" is offensive. But that doesn't change the fact that people who are candidates for the Democratic Party are Democrats, not Democratics. The DNC websites identifies them that way. Getting your back up when someone uses the wrong party name is fine, but getting your back up over a correct use of the term "Democrat" is silly. Trish, to your point, both sides too frequently are childish and petty on this issue.
MountainMia, person X is a Democrat. Person X is a candidate. Therefore person X is a Democrat candidate. My point was that either term is correct, depending on the context. The confusion seems to stem from the fact the party name is an adjective, and not a noun. Who came up with that?
There are Nurses. There are Practictioners. And there are Nurse Practitioners. Not Nursing Practitioners (or Nursic Practitioners).
It's all silly.
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Surviving Cancer Costs
A new CDC report shows that a quarter of cancer survivors cannot pay their medical bills or need to go into debt to do so. 1 in 3 worries about medical bills.
"Mitigating the negative impact of cancer in the United States will require implementation of strategies aimed at alleviating the disproportionate financial hardship experienced by many survivors," the authors wrote.
https://jamanetwork.com/journals/jama/fullarticle/2738563
JAMA. 2019;322(4):297. doi:10.1001/jama.2019.9666
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Then we should 'document' our immigrants! They work jobs no one wants and pay for the privilege (ie, taxes), but receive no benefits. The original version of the ACA would have allowed undocumented immigrants to purchase insurance on the law's exchanges with their own money, but, to get the bill passed, this version was dropped and illegal immigrants still cannot buy insurance, are excluded from receiving Medicaid/Medicare, and can only legally receive emergency care in some hospitals. These immigrants CAN buy insurance for their children born in the US. My perception is that the Dems who raised their hands on the debate stage were PRO what the original ACA bill represented.
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