If a so-called "reform" bill comes up with these elements - no employer mandate, strong individual mandate, market rates for everything, no real insurance reform - there is no reason to vote for it. It is worse than no bill at all.
I reviewed your comments closely and what I have not seen or heard is anything that includes tort reform. We know that this bilks out billions of dollars that could be used toward delivery of care. Among the issues are costs for repetitive tests, astronomical premiums for malpractice insurance to all providers, not just doctors. All nurses, therapists, hospitals,outpatient service entities must pay these premiums BEFORE the FIRST patient receives any services. In the mix of all those to be paid in the health care delivery/provider cycle is the amount of money that is frittered away to cover litigation costs for this very sophisticated system we call health care. YES, DEFINITELY, we NEED a way to protect patients from unscrupulous practices. BUT, let us LOOK how this present system of "protection" is SUCKING the life out of the costs reduction efforts. A better approach is to put before PEER review entities outside local care to look at complaints, rather than to allow juries that are not knowledgeable about health care practices to make decisions that are just. It could require practitioners to participate on a fair rotation so that no one gains too much power over this entity. And it also has the benefit of being a continuing educational tool for those serving on it. I can tell you that I learn as much from my journals in the review of cases as I do in reading dry research projects. It puts a human face on the case at hand. This takes litigation OUT of the third parties with the possibility of great financial gain! Claims looked at for Buffalo, NY could be reviewed by a PEER Panel in Omaha. Omaha's claims could be reviewed by PEER review panel in Miami. Miami could be reviewed by PEERS in Denver. If all these claims were done ANONYMOUSLY and without monetary gain by the reviewers, but the insurer would have to pay for the costs of helping the patient pay for his health care that was required for "fixing" the error and an award for pain and suffering that could be reasonable for both, we would see very few of these "jackpot" awards going to attorneys and little to the clients. Frivolous suits would be kept to a minimum, especially if appeals were allowed a LIMIT in terms of restitution. This is a huge part of costs and it could be a substantial reduction in pay outs by insurance companies, dollars that would go to payments of real services. Third party rewards for health care that they do not deliver is like a leach sucking the blood out of the host. It did take a while for health care to document this, my God George Washington even used leeches in times of illness, but we have come a long way since then! It is time for the health care system to document this for the health of patients, the delivery system and the economy so that we can use those dollars to deliver health care to the people, who need it and not dollars to those who stand by watch to see if a mistake is made. That is a diagnosis we can make and we can cure it. Other suggestions we have been hearing are not conclusive. Let us get STARTED on the problem we know we can help.
There are needs that require insurance reform, those have a whole host of problems that ARE being talked about, but the tort reform issue seems totally neglected. A neglected patient can not get well, nay the patient who is neglected, has no hope of surviving.
When a very sick patient comes to the hospital with many illnesses, the most manageable problems are tackled first, so that the others CAN be addressed. Let us NOT obfuscate the whole system, when there are AREAS to BEGIN the process. This is a journey, this not parking lot.
Posted by: Lauragail
Thursday, September 10, 2009
September 04, 2009
Follow the bouncing ball here: Health care was a mess, cost way too much, sick people getting dropped by insurance companies and left to die and bankrupted and all that. The obvious solution: Go to a single-payer system, or at least to a universal, subsidized, heavily-regulated private system, like all those other countries who pay half as much or less for better results.
But that would never fly, because the health plans are way too big and employ a lot of people, including a zillion lobbyists, so politically, forget it. We'll back off and cut a deal.
Here's what the new deal was supposed to be: We're not going to wipe out the insurance companies. What we'll do is offer people an alternative insurance plan, a "public option." It will be cheaper because it will only pay 5% over Medicare rates, but doctors and hospitals will be mandated to take it. And it will also be cheaper because it's a government offering, so it takes out no profit, and it won’t have to compete with other insurance companies to pay out as little as possible.
Individuals will have to buy insurance, or they will pay a big fine to the IRS. But there will be these "insurance exchanges," offering lots of plans that will actually compete for the public’s business (instead of the one or two now available in most markets), plus the "public option." Employers will have to offer plans with "essential benefits," meaning good coverage of hospitalization, drugs, outpatient care, mental health care, and so forth. Small employers will have to chip in, too, but they get help with the cost. If the employer doesn't offer a good plan with "essential benefits," the employee will be able to take the money the employer is chipping in, and buy a good health plan on the "exchange."
Sounds like a plan. Health plans couldn’t turn anyone down for "pre-existing conditions," they would have to take everybody. On the other hand, everybody would have to take them, unless the "public option" turns out to be both way cheaper and more reliable.
Of course, along the way, everybody else gets what they want, too, out of this deal. The drug companies, for instance, get told that, no, the government will not negotiate with them for lower prices; any government plan will just pay market prices. And we'll make it harder, not easier, for generics to compete with brand-name drugs. And no organization, company, or government will be able to re-import drugs from overseas, where they cost much less.
Oh, and of course there will be nothing in the bill to make health plans actually honor their contracts, stop refusing to pay for stuff they agreed to pay for, or stop tossing out people who get really sick and spend too much.
Then the details start getting sliced up, and things start turning weird. The Blue Dogs in the House get the Commerce Committee to turn out a bill that says, well, actually, hospitals and doctors should not have to take the public option. It should be voluntary, and they should be paid market rates, that is, what they are paid now. So the savings go out the window. The public option, in this version, is not particularly cheaper than the private plans. And anyway, employers with a less than a $500,000 payroll (which is 87% of all the employers in the nation) would be exempt. They wouldn't have to provide any health care insurance at all. The employees would still have to buy it for themselves, though, or pay a big fine. Of course, they could buy the no-longer-particularly-cheap public option.
Over in the Senate, the key Finance Committee lets it leak that it's probably dropping not only the public option altogether, but employer mandates, too. Employers won't have to offer health plans at all, but the employees have to buy them, whether anyone's offering them a decent plan or not.
Democrat Kent Conrad, on the committee, says nobody will go for a public option plan; instead we'll try co-ops. This idea would consist of trying to start new not-for-profit insurance companies in every market in the country. Doctors and hospitals would not have to sign up with them. The coops would not have their rates tied to Medicare; they would have to pay market rates. Actually, they would have to pay more than market rates, because the doctors and hospitals in those markets are already signed up with the existing insurers and have plenty of business already, thank you very much. So the new coops would have to bid premium rates to get providers to sign up, or they would have to "rent" them (again at a premium) from their competitors. No big deal, though: If it's voluntary and paying market rates, the "public option" would have the same problem - high prices, not many providers, so not many customers.
And then Ted Kennedy's committee turns out a bill that says, well, actually, employers are not really obliged to offer a minimum level of health care insurance - yet the bill keeps the requirement that employees must accept and pay for whatever health care plan their employer offers them, whether it seems an acceptable level of care at an acceptable price or not. So again, savings for the individual go out the window, and now choice of health plans does, too.
If a so-called "reform" bill comes up with these elements - no employer mandate, strong individual mandate, market rates for everything, no real insurance reform - there is no reason to vote for it. It is worse than no bill at all.
I reviewed your comments closely and what I have not seen or heard is anything that includes tort reform. We know that this bilks out billions of dollars that could be used toward delivery of care. Among the issues are costs for repetitive tests, astronomical premiums for malpractice insurance to all providers, not just doctors. All nurses, therapists, hospitals,outpatient service entities must pay these premiums BEFORE the FIRST patient receives any services. In the mix of all those to be paid in the health care delivery/provider cycle is the amount of money that is frittered away to cover litigation costs for this very sophisticated system we call health care. YES, DEFINITELY, we NEED a way to protect patients from unscrupulous practices. BUT, let us LOOK how this present system of "protection" is SUCKING the life out of the costs reduction efforts. A better approach is to put before PEER review entities outside local care to look at complaints, rather than to allow juries that are not knowledgeable about health care practices to make decisions that are just. It could require practitioners to participate on a fair rotation so that no one gains too much power over this entity. And it also has the benefit of being a continuing educational tool for those serving on it. I can tell you that I learn as much from my journals in the review of cases as I do in reading dry research projects. It puts a human face on the case at hand. This takes litigation OUT of the third parties with the possibility of great financial gain! Claims looked at for Buffalo, NY could be reviewed by a PEER Panel in Omaha. Omaha's claims could be reviewed by PEER review panel in Miami. Miami could be reviewed by PEERS in Denver. If all these claims were done ANONYMOUSLY and without monetary gain by the reviewers, but the insurer would have to pay for the costs of helping the patient pay for his health care that was required for "fixing" the error and an award for pain and suffering that could be reasonable for both, we would see very few of these "jackpot" awards going to attorneys and little to the clients. Frivolous suits would be kept to a minimum, especially if appeals were allowed a LIMIT in terms of restitution. This is a huge part of costs and it could be a substantial reduction in pay outs by insurance companies, dollars that would go to payments of real services. Third party rewards for health care that they do not deliver is like a leach sucking the blood out of the host. It did take a while for health care to document this, my God George Washington even used leeches in times of illness, but we have come a long way since then! It is time for the health care system to document this for the health of patients, the delivery system and the economy so that we can use those dollars to deliver health care to the people, who need it and not dollars to those who stand by watch to see if a mistake is made. That is a diagnosis we can make and we can cure it. Other suggestions we have been hearing are not conclusive. Let us get STARTED on the problem we know we can help.
There are needs that require insurance reform, those have a whole host of problems that ARE being talked about, but the tort reform issue seems totally neglected. A neglected patient can not get well, nay the patient who is neglected, has no hope of surviving.
When a very sick patient comes to the hospital with many illnesses, the most manageable problems are tackled first, so that the others CAN be addressed. Let us NOT obfuscate the whole system, when there are AREAS to BEGIN the process. This is a journey, this not parking lot.
Posted by: Lauragail VanOverschelde | September 09, 2009 at 09:36 AM
Verify your CommentPreviewing your CommentPosted by: |
Follow the bouncing ball here: Health care was a mess, cost way too much, sick people getting dropped by insurance companies and left to die and bankrupted and all that. The obvious solution: Go to a single-payer system, or at least to a universal, subsidized, heavily-regulated private system, like all those other countries who pay half as much or less for better results.
But that would never fly, because the health plans are way too big and employ a lot of people, including a zillion lobbyists, so politically, forget it. We'll back off and cut a deal.
Here's what the new deal was supposed to be: We're not going to wipe out the insurance companies. What we'll do is offer people an alternative insurance plan, a "public option." It will be cheaper because it will only pay 5% over Medicare rates, but doctors and hospitals will be mandated to take it. And it will also be cheaper because it's a government offering, so it takes out no profit, and it won’t have to compete with other insurance companies to pay out as little as possible.
Individuals will have to buy insurance, or they will pay a big fine to the IRS. But there will be these "insurance exchanges," offering lots of plans that will actually compete for the public’s business (instead of the one or two now available in most markets), plus the "public option." Employers will have to offer plans with "essential benefits," meaning good coverage of hospitalization, drugs, outpatient care, mental health care, and so forth. Small employers will have to chip in, too, but they get help with the cost. If the employer doesn't offer a good plan with "essential benefits," the employee will be able to take the money the employer is chipping in, and buy a good health plan on the "exchange."
Sounds like a plan. Health plans couldn’t turn anyone down for "pre-existing conditions," they would have to take everybody. On the other hand, everybody would have to take them, unless the "public option" turns out to be both way cheaper and more reliable.
Of course, along the way, everybody else gets what they want, too, out of this deal. The drug companies, for instance, get told that, no, the government will not negotiate with them for lower prices; any government plan will just pay market prices. And we'll make it harder, not easier, for generics to compete with brand-name drugs. And no organization, company, or government will be able to re-import drugs from overseas, where they cost much less.
Oh, and of course there will be nothing in the bill to make health plans actually honor their contracts, stop refusing to pay for stuff they agreed to pay for, or stop tossing out people who get really sick and spend too much.
Then the details start getting sliced up, and things start turning weird. The Blue Dogs in the House get the Commerce Committee to turn out a bill that says, well, actually, hospitals and doctors should not have to take the public option. It should be voluntary, and they should be paid market rates, that is, what they are paid now. So the savings go out the window. The public option, in this version, is not particularly cheaper than the private plans. And anyway, employers with a less than a $500,000 payroll (which is 87% of all the employers in the nation) would be exempt. They wouldn't have to provide any health care insurance at all. The employees would still have to buy it for themselves, though, or pay a big fine. Of course, they could buy the no-longer-particularly-cheap public option.
Over in the Senate, the key Finance Committee lets it leak that it's probably dropping not only the public option altogether, but employer mandates, too. Employers won't have to offer health plans at all, but the employees have to buy them, whether anyone's offering them a decent plan or not.
Democrat Kent Conrad, on the committee, says nobody will go for a public option plan; instead we'll try co-ops. This idea would consist of trying to start new not-for-profit insurance companies in every market in the country. Doctors and hospitals would not have to sign up with them. The coops would not have their rates tied to Medicare; they would have to pay market rates. Actually, they would have to pay more than market rates, because the doctors and hospitals in those markets are already signed up with the existing insurers and have plenty of business already, thank you very much. So the new coops would have to bid premium rates to get providers to sign up, or they would have to "rent" them (again at a premium) from their competitors. No big deal, though: If it's voluntary and paying market rates, the "public option" would have the same problem - high prices, not many providers, so not many customers.
And then Ted Kennedy's committee turns out a bill that says, well, actually, employers are not really obliged to offer a minimum level of health care insurance - yet the bill keeps the requirement that employees must accept and pay for whatever health care plan their employer offers them, whether it seems an acceptable level of care at an acceptable price or not. So again, savings for the individual go out the window, and now choice of health plans does, too.
If a so-called "reform" bill comes up with these elements - no employer mandate, strong individual mandate, market rates for everything, no real insurance reform - there is no reason to vote for it. It is worse than no bill at all.
I reviewed your comments closely and what I have not seen or heard is anything that includes tort reform. We know that this bilks out billions of dollars that could be used toward delivery of care. Among the issues are costs for repetitive tests, astronomical premiums for malpractice insurance to all providers, not just doctors. All nurses, therapists, hospitals,outpatient service entities must pay these premiums BEFORE the FIRST patient receives any services. In the mix of all those to be paid in the health care delivery/provider cycle is the amount of money that is frittered away to cover litigation costs for this very sophisticated system we call health care. YES, DEFINITELY, we NEED a way to protect patients from unscrupulous practices. BUT, let us LOOK how this present system of "protection" is SUCKING the life out of the costs reduction efforts. A better approach is to put before PEER review entities outside local care to look at complaints, rather than to allow juries that are not knowledgeable about health care practices to make decisions that are just. It could require practitioners to participate on a fair rotation so that no one gains too much power over this entity. And it also has the benefit of being a continuing educational tool for those serving on it. I can tell you that I learn as much from my journals in the review of cases as I do in reading dry research projects. It puts a human face on the case at hand. This takes litigation OUT of the third parties with the possibility of great financial gain! Claims looked at for Buffalo, NY could be reviewed by a PEER Panel in Omaha. Omaha's claims could be reviewed by PEER review panel in Miami. Miami could be reviewed by PEERS in Denver. If all these claims were done ANONYMOUSLY and without monetary gain by the reviewers, but the insurer would have to pay for the costs of helping the patient pay for his health care that was required for "fixing" the error and an award for pain and suffering that could be reasonable for both, we would see very few of these "jackpot" awards going to attorneys and little to the clients. Frivolous suits would be kept to a minimum, especially if appeals were allowed a LIMIT in terms of restitution. This is a huge part of costs and it could be a substantial reduction in pay outs by insurance companies, dollars that would go to payments of real services. Third party rewards for health care that they do not deliver is like a leach sucking the blood out of the host. It did take a while for health care to document this, my God George Washington even used leeches in times of illness, but we have come a long way since then! It is time for the health care system to document this for the health of patients, the delivery system and the economy so that we can use those dollars to deliver health care to the people, who need it and not dollars to those who stand by watch to see if a mistake is made. That is a diagnosis we can make and we can cure it. Other suggestions we have been hearing are not conclusive. Let us get STARTED on the problem we know we can help.
There are needs that require insurance reform, those have a whole host of problems that ARE being talked about, but the tort reform issue seems totally neglected. A neglected patient can not get well, nay the patient who is neglected, has no hope of surviving.
When a very sick patient comes to the hospital with many illnesses, the most manageable problems are tackled first, so that the others CAN be addressed. Let us NOT obfuscate the whole system, when there are AREAS to BEGIN the process. This is a journey, this not parking lot.
Posted by: Lauragail VanOverschelde | September 09, 2009 at 09:36 AM
Verify your CommentPreviewing your CommentPosted by: |
Wednesday, September 9, 2009
SEE THE CONECTION WITH AARP HEALTH CARE PLAN
The truth: Daschle is cashing in mightily on his role as "the architect of President Obama's health care plan" in the private sector — and evading lobbyist disclosure by reinventing himself as a highly paid "senior adviser" to D.C.-based law firm/influence-peddling shop Alston & Bird.
Daschle represents mega-insurer UnitedHealth, which opposes the pure public option, and Alston & Bird represents a total of 31 clients from the health care sector. According to D.C. watchdog OpenSecrets.org, "Of the $2,730,000 reported income received from clients, nearly 50 percent of that, $1,070,000, comes from these 31 health care clients."
Daschle represents mega-insurer UnitedHealth, which opposes the pure public option, and Alston & Bird represents a total of 31 clients from the health care sector. According to D.C. watchdog OpenSecrets.org, "Of the $2,730,000 reported income received from clients, nearly 50 percent of that, $1,070,000, comes from these 31 health care clients."
Sunday, September 6, 2009
Medicare Hospital Discharge
Pinpoint another serious problen confronted by members of Mass Senior Action.
Hospitals discharging older patients without any follow up or "transitional" services.
One of every five Medicare beneficiaries is readmitted within 30 days of discharge and one of every three, within 90 days--often becuase of poor communication between patients, care givers, and health care providers.
We need a benefit in Medicare to help people safely transition to home or another setting to prevent costly and unnecessary hospital re-admissions
Hospitals discharging older patients without any follow up or "transitional" services.
One of every five Medicare beneficiaries is readmitted within 30 days of discharge and one of every three, within 90 days--often becuase of poor communication between patients, care givers, and health care providers.
We need a benefit in Medicare to help people safely transition to home or another setting to prevent costly and unnecessary hospital re-admissions
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