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Wait wait wait, hold on. You guys have this mixed up. Medicare and Medicaid are not the same thing. Different programs, different people.
Medicare provides medical benefits to the elderly who have paid Medicare taxes for at least 10 years. Almost without exception anyone working and lucky enough to receive medical benefits from retirement, will have part if not all of those benefits replaced by Medicare once they are old enough. Check this out where you work. Medicare is a "earned" benefit. Most working elderly will be on this program and you will be too one day. You won't be able to get insurance coverage any other way at this age at an affordable rate.
BTW, the states do not fund Medicare.
Medicaid is a program to give benefits to low income people. Its the same idea as food stamps, welfare, etc. It is not earned. This is the program funded by the states. You will find elderly on this program because generally these will be people who have not worked enough to get Medicare.
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It's a big mistake to put both these programs in the same bucket.
To be honest, I don't mind the extra tax on cigs, and alcohol.
I have a problem w/how much tax NC adds on GASOLINE.....its rediculous sinced Im forced to drive (not forced to smoke or drink) that I have to bend over and hold my ankles every time I fill up
No one ever minds the taxes that don't affect them! Lol.
Wait wait wait, hold on. You guys have this mixed up. Medicare and Medicaid are not the same thing. Different programs, different people.
Medicare provides medical benefits to the elderly who have paid Medicare taxes for at least 10 years. Almost without exception anyone working and lucky enough to receive medical benefits from retirement, will have part if not all of those benefits replaced by Medicare once they are old enough. Check this out where you work. Medicare is a "earned" benefit. Most working elderly will be on this program and you will be too one day. You won't be able to get insurance coverage any other way.
BTW, the states do not fund Medicare.
Medicaid is a program to give benefits to low income people. Its the same idea as food stamps, welfare, etc. It is not earned. This is the program funded by the states. You will find elderly on this program because generally these will be people who have not worked enough to get Medicare.
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It's a big mistake to put both these programs in the same bucket.
I wasn't putting them in the same bucket. Nursing home patients can qualify for MEDICAID. I am a licensed nursing home administrator. Trust me on this.
DNR - do not resuscitate
Patient can have a DNR notification added to his/her chart, and can also outline under what conditions the DNR is to be added
Living Wills and Healthcare Directives - patient can outline under what conditions he/she wishes to have extraordinary measures taken (or not taken). In addition, patient can stipulate who can make these decisions on his/her behalf.
OK-all things that I am familiar with.
Although I think DNRs are really so that the staff know what they are doing.Also depends what treatment you class as "resuscitation", so AD are much better IMO.Don't leave family/patients having to make awfully hard decisions in the midst of a crisis.However many people don't want to think about these things in advance ie when they are well, and then once they have onset of vascular dementia or a stroke for eg, they no longer have capacity to set up the AD.
At least I know I will be able to have an advance directive over there too.
Thanks!
Well, I think most of us would agree that of course - good health practices and incorporating good habits into our lives always is a positive. Doubt it will hurt anyone!
I do like some of the "best practices" that the UK system incorporates for disease management. My problem w/ the UK system is that sometimes Dx are put off a long time when they should be ordered immediately. There really is a fine line b/n over-using Dx testing and under-using it.
People here in the USA don't have a clue how the UK system really works. They don't realize UK citizens usually pay taxes for healthcare (like we pay for social security and medicare). That is why I just shake my head when people call it "free."
I know we have discussed this before and I am of the same opinion as you-that a system somewhere in the middle is required ie disease specific best practice evidence based guidelines, that are produced in a timely fashion (not after the good specialists in hospitals have been doing it for 8 years) and use of cost effective timely investigations based on those guidelines.
I do believe that no health care system can be all things to all people and there does have to be some method of deciding who gets what. There is never going to be a bottomless pit of money available.Looking at health economics it is generally accepted that QUALYS are used to look at cost effectiveness. Someone of 75 would not get a heart transplant here, but if you look at the bucket of drugs they have to take and potential side effects (especially in someone who may already have chronic health problems) it's also an ethical decision, not just a matter of cost.
One of my biggest problems is that often people have so little control over dying, and we should encourage people to think about what they would want if they become ill.
I know we have discussed this before and I am of the same opinion as you-that a system somewhere in the middle is required ie disease specific best practice evidence based guidelines, that are produced in a timely fashion (not after the good specialists in hospitals have been doing it for 8 years) and use of cost effective timely investigations based on those guidelines.
I do believe that no health care system can be all things to all people and there does have to be some method of deciding who gets what. There is never going to be a bottomless pit of money available.Looking at health economics it is generally accepted that QUALYS are used to look at cost effectiveness. Someone of 75 would not get a heart transplant here, but if you look at the bucket of drugs they have to take and potential side effects (especially in someone who may already have chronic health problems) it's also an ethical decision, not just a matter of cost.
One of my biggest problems is that often people have so little control over dying, and we should encourage people to think about what they would want if they become ill.
Your philosophy and mine are on the same page. Quality of life issues along with ethics and disease management . . . it takes someone w/ a broad perspective to be able to incorporate all, and often, I think when folks are in one field (i.e, healthcare management, finance, or clinical) it is hard for them to cross over and incorporate a balanced approach that includes considerations f/ every aspect of the issue.
We have a problem w/ death and dying in our society . . . people are too often inclined to put off making those hard decisions (about their treatment options) rather than deal with it ahead of time - and discuss decisions with family members and friends who they want involved with their care.
I encourage people to use ADs, including filling out a Power of Attorney for healthcare decisions, and discussing their desires w/ the person/s they choose to represent them.
In addition, we need to be more proactive about discussing palliative care options and at what point we go to that stage of care.
I want to die at home. Sadly, many people do not relay this to their family members. Plus, they are rushed to ER when they take a turn for the worse, instead of allowing family members to die at home as part of the natural stage of either disease or age. Hospice caretakers do a wonderful service w/ helping family members know how to handle their loved one's wishes and can provide medications to keep patients comfortable at home.
We need more discussion about quality of life, aging and end of life decisions. I feel we don't prepare ourselves and our families and friends for handling what is often the inevitability of death.
Add Alzheimer's patients to this mix ("the long goodbye") and the cost of care gets quite expensive, and quality of life issues become even more important as families typically have a terrible time coping with what it means to have a parent who may be physically capable but mentally impaired.
I am appalled by how so many of our elderly end up warehoused, even tho both the government and geriatrics professionals are loathe to see such situations. Yet, it does happen. We often emotionally abandon our elderly once they are "tucked away" in a facility somewhere.
Discussions about filial responsibility are going to become more in the public arena in coming years, I feel sure, as costs sky-rocket and our aging population becomes a bigger % of society.
Just let us not forget that a big mid term election is coming.Lets throw them all out on their honorable asses.And start fresh,if the next bunch don't work out we can do the same to them.Lets get the message across to these selfish elitist,do the will of the people or your time in office will be short lived.Remember black,hispanic,white ,etc. we are all exspenable in the eyes of these leeches.Just imagine if we all as Americans not different ethnicties got together and became one powerful force what we can do.The leaders of this country and so called leaders of certain ethic communities aren't doing it for the good of the people they are doing it for there own good.The racial bickering keeps us so busy worrying about each other we never realize how bad they are sticking it to all of us. Unite
Funny how none of you neocons were complaining when they were spending trillions on wars to make us "safer". Yeah, that's it. We are SOOOOOOOO much safer now because of Iraq and Afghanistan. You guys care about spending when caring fits your agenda, and pretend that GWB didn't wreck this country. Keep on keeping on. I'm not defending Obama or wealth redistribution. I think that the government should basically stay out of people's personal lives, but at the same time when corporations' ONLY motive is return for their shareholder/increase in stock price, you get where we're at now, so I'm all for tighter regulation so this mess doesn't happen again.
You want to decrease taxes while running record deficits...IT CAN'T HAPPEN. Finance 101 people. You don't run up credit cards and then get a lesser paying job. This country has been bankrupt for years, and EVERY politician simply kicks the can down the road. THAT is the real problem - left or right, blue or red, you DON'T have someone in DC that truly represents your interests, even if you think you do.
I'm not minimizing the health care thing, but why do we need to spend close to a trillion dollars on defense this year? Anyone?
Funny how none of you neocons were complaining when they were spending trillions on wars to make us "safer". Yeah, that's it. We are SOOOOOOOO much safer now because of Iraq and Afghanistan. You guys care about spending when caring fits your agenda, and pretend that GWB didn't wreck this country. Keep on keeping on. I'm not defending Obama or wealth redistribution. I think that the government should basically stay out of people's personal lives, but at the same time when corporations' ONLY motive is return for their shareholder/increase in stock price, you get where we're at now, so I'm all for tighter regulation so this mess doesn't happen again.
You want to decrease taxes while running record deficits...IT CAN'T HAPPEN. Finance 101 people. You don't run up credit cards and then get a lesser paying job. This country has been bankrupt for years, and EVERY politician simply kicks the can down the road. THAT is the real problem - left or right, blue or red, you DON'T have someone in DC that truly represents your interests, even if you think you do.
I'm not minimizing the health care thing, but why do we need to spend close to a trillion dollars on defense this year? Anyone?
It appears you have not read the thread, so since I am the OP, let's start at the beginning to keep things on track.
Here is what I posted:
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2% surcharge on your income tax.
Geeezzz.
And more taxes on cigs, alcohol . . . SIGH.
Locally, we will be having taxes go up, too. We have to do something.
More federal taxes, more state taxes and more local taxes . . . all these gubment programs are draining the heck outta our coffers. Time to start cutting some of this stuff out.
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I believe it was made very clear from my initial post how I feel about federal government spending on entitlements, especially.
And I am certainly no neo-con. I am very hands off when it comes to federal spending and the states. This is a Republic composed of 50 different states, and I feel the federal government has issued way too many mandates to the states, all of which cost big bucks. And although I am a fiscal conservative, I am a liberal on social policies. In the end, we are all Americans and even if we may differ on the way we want money spent, I believe we all agree that we are spending too much at the federal level. So the labels are not helpful to the discussion and are divisive, when this country needs uniting, not dividing.
Nothing in the OP was mentioned about spending on the war effort . . . but since you want to take it there, I will do a momentary detour from the original post and speak for those folks around the country who feel we should bring our troops home and let the middle east deal with its own problems. However, as long as we have troops there, I believe most Americans want them to have all the resources they need, including health resources after they leave military service.
It is not as though one can chop that budget while we have troops in Afghanistan and Iraq. And as far as references to GWB, he is not in office so trying to bait some sort of retort about his policies is senseless. Congress and Pres Obama could have made different decisions about budgetary spending regardless of what ANY previous President has done in the past.
Having said that, we need to keep the thread on track. Talking about federal spending and mandates, entitlements, etc. as long as it is in reference to how such things are affecting us at the local level is fine. This thread has remained in the Charlotte forum b/c we have kept it focused on how the federal budget is affecting us locally.
Part of the problem with raising taxes locally in a town close to a state line is that the local government can potentially be shooting themselves in the foot - the more taxes go up here on certain goods and services, the more likely people will be to find that it is worth the short drive into SC to purchase those same goods and services at a lower price. Which will decrease the revenue brought in to the local government.
Good example: a few years ago when I was still in MD, the state raised the tax on cigarettes roughly $1.00 per pack (on January 1, 2008) and expected to see a huge increase in tax revenue from tobacco sales (I do not recall what the projected numbers were). One year later, it was reported that tax revenue generated from tobacco sales in MD actually went down, and went up in VA and DE (both of which had much lower cig taxes). Last I recall, there was discussion about other taxes to make up for that unexpected shortfall.
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