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Old 07-01-2012, 06:37 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 8,286,691 times
Reputation: 3873

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Quote:
Originally Posted by d4g4m View Post
Now that Obamacare has been ruled 'constitutional' and it contains a provision to reduce Medicare by half a trillion dollars, I'm wondering what services, procedures will be reduced, eliminated. How will it affect doctors/hospitals who currently accept medicare. Will we be competing with medicaid patients to see a doctor. How nasty will the 'death panels' be [and yes, there is a death panel in the law] when it comes to their judgment whether you do or don't get treatment.
Things not looking good for seniors.
Perhaps the services that will be reduced or eliminated (in terms of reimbursements) are those that don't make any medical sense. My father (93) is a big user of health care services. For some things that are stupid. Like he has had 4 MRIs for rotator cuff problems after he was 80+ - when no sane doctor would do a rotator cuff operation on a person who is 80+. Why do any tests - especially expensive ones - if no sane doctor would do anything based on the results? That is always the approach my husband and I take - he post-Medicare - I pre-Medicare. We always ask doctors what they would do on the basis of test results. Just thnk about what we could get in terms of dental if could rid of all the useless imaging.

He also had colonoscopy every year for 20+ years. Because he had a couple of polyps in his 50's. A waste of money (every 5 years would have been plenty). My late mother - who never had colonoscopy (she thought it was yucky) died of colon cancer about 5 years ago.

Medicare - indeed all health insurance - has to have standards. In terms of testing for people who are at high/low/medium risk for various things. Today - it seems that people on Medicare (people with regular health insurance as well) either tend to use too much in the way of useless stuff - or not do things that are recommended.

I think that imaging procedures can be very useful - although many are quite expensive. I had my first MRI about 3 years ago because I was having GYN problems. It was a very very expensive yucky MRI. But it enabled my surgeon to complete her operation in about 30 minutes (she knew exactly what the problems were - and where they were). But many are a total waste of money. That is perhaps one area where big savings can be achieved.

Also - I think the "death panel" thing is kind of dubious. Having watched parents die - well to everything there is a season - and a time. I don't think it makes any sense to all to spend hundreds of thousands of dollars to keep anyone - seniors - preemies - whatever - alive for another 8-12 weeks. Just like any sane person wouldn't spent thousands of dollars repairing a broken down car to get another 8 weeks from it. If you want to spend your own money fighting a short war that you will most certainly lose - at great expense - well I don't have a problem with that. Our late parents knew when it was their time (although Medicare spent a lot of money during their end of life care - it could have spent a whole lot more),

Of course - there is the possibility that Medicare reimbursements will become so little that good providers won't accept Medicare patients at all. Since we have a branch of the Mayo Clinic here - I tend to follow it. As the canary in the coal mine. If our Mayo Clinic stops accepting all Medicare patients - that will set off a lot of alarm bells for me. Robyn
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Old 07-01-2012, 08:17 PM
 
4,931 posts, read 8,809,802 times
Reputation: 6271
Quote:
Originally Posted by d4g4m View Post
Now that Obamacare has been ruled 'constitutional' and it contains a provision to reduce Medicare by half a trillion dollars, I'm wondering what services, procedures will be reduced, eliminated. How will it affect doctors/hospitals who currently accept medicare. Will we be competing with medicaid patients to see a doctor. How nasty will the 'death panels' be [and yes, there is a death panel in the law] when it comes to their judgment whether you do or don't get treatment.
Things not looking good for seniors.
There is no "Death Panel" in the Law. I do not believe you know what you are talking about.

If you think you are so right then SHOW US! Since you allege to know so much about "Obamacare", tell us and give us a citation to the Act.

While you are at that simple response, you can also discover the changes to Medicare and so inform us all.

I will be waiting and we will see. Be precise and be well prepared for my response.

OK, it is your show, support your statement!



Livecontent
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Old 07-02-2012, 06:34 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 8,286,691 times
Reputation: 3873
I think that when many people talk about "death panels" - they are talking about the allegedly unfettered "right" of people on Medicare to demand tens and hundreds of thousands of dollars in care to keep them alive for days or weeks or perhaps a couple of months when they're very close to the end of their lives. I reckon some people grasp at these expensive straws. No one in my family or my husband's family ever has. OTOH - I think people should be allowed to die with dignity (no dirty diapers) and without pain.

FWIW - I have seen some friends go through all the hideously expensive (and often just plain hideous) end of life care. Mostly people who are younger - with young children. Mostly with cancer. If you're 40 - and your kids are 8 and 10 - you want to be around for them as long as possible. So they'll at least remember you when they're grown up. Totally different dynamic IMO. Also totally different expense profile. I had one friend with a 10% co-pay who paid over $100k in co-pays in the last year of her very short life. She couldn't bear to leave her young children. In the end - she accepted the inevitable - and died with dignity (although she had endured a lot of pain to stay alive that extra year). Robyn
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Old 07-02-2012, 07:20 PM
 
4,931 posts, read 8,809,802 times
Reputation: 6271
No, Medicare does not want more money with keeping you alive and you will suffer. That is completely opposite of what actually is the policy and the new Act was to codify a way of dealing with these sad issues. That publicity pandering Palin slithered out and made comments. She was laughed at with her ignorance. However, the codified funding proposal was removed from the and have the Act supported for its more essential objective of affordable health care.

Essentially it was to help people deal with end of life decisions to allow Medicare to fund counselors and the time of physicians and to codify procedures under Medicare to help the families understand the options when we are dealing with terminal illness.

I am going to give you a real situation in my own life about 3 years ago. My mother had a stroke. She was in her 80s. The stroke was so severe and with her ongoing health problems, there was issues of keeping her alive. She would have to have permanent tube inserted to keep her body functioning. There was no quality of life. She was send to the hospital from the nursing home and decisions had to be made, of what to do. I was the one who had to make those decisions.

The hospital brought me and my younger siblings together and we met with a Counselor, a Minister and a Doctor and we all together went over the issues in a meeting. It was a Catholic Hospital and the Physician had a specific specialty of counseling families and helping them to understand the Medical issues. The medical procedures that my mother was enduring was making her suffer and giving her more pain. There was no hope for recovery. There was not pressure to end my mother life or pressure to extend treatment. I made the decision, I am crying as I type this, to pull all the tubes and let my mother die naturally.

We moved my mother to a hospice where she was given medication to relieve pain and she died about 3 weeks latter. A hospice is fully funded by Medicare to allow patients to die with dignity. It cost nothing as Medicare picks up the full cost, including all transfers from the hospital. Medicare made that funding decision years ago to remove patients from life extending medicine that only would only cause suffering with no improvement expected. The hospice was made part of Medicare and it has specific rules that require that no life extending procedures be taken. So, you are wrong if you think Medicare wants to prolong life to get more money--that is not the case. Why then would the government fund hospice and make it part of Medicare.

My terrible decision was made much easier with the help and counseling that was providing at the hospital. In addition, the hospice had extensive programs for support and counseling that even extending one year after my mother's death. The hospice part was all funded by Medicare but we got no bills from the hospital for the hour meeting with all the professional staff. The Act was to make that more a necessary mandated function of Medicare, so that ALL, over the country would get equivalent help. The Act was an initial step to extend the help that is part of the hospice programs.

To say that the new law wanted to make to make these end of life decisions easier for families and call it a "Death Panel" is a crime of misinformation from ignorant selfish loud mouths like Palin and others.

I cannot write anymore. It is too much pain for me now!

Livecontent

Last edited by livecontent; 07-02-2012 at 07:39 PM..
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Old 07-03-2012, 01:17 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 8,286,691 times
Reputation: 3873
The panel is actually called the Independent Payment Advisory Panel. It *will* decide whether or not Medicare will pay for certain things:

http://www.nytimes.com/2011/04/20/us.../20health.html

If course - if Medicare won't pay for something you want - you will be free to pay for it yourself.

I am reserving judgment in terms of whether or not it is appropriate to call it a "Death Panel" depending on what it winds up doing. Robyn
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Old 07-03-2012, 02:04 PM
 
4,931 posts, read 8,809,802 times
Reputation: 6271
Quote:
Originally Posted by Robyn55 View Post
The panel is actually called the Independent Payment Advisory Panel. It *will* decide whether or not Medicare will pay for certain things:

http://www.nytimes.com/2011/04/20/us.../20health.html

If course - if Medicare won't pay for something you want - you will be free to pay for it yourself.

I am reserving judgment in terms of whether or not it is appropriate to call it a "Death Panel" depending on what it winds up doing. Robyn

You are wrong and have no knowledge of what you are saying. This is NOT the issue about the "death panel." Why do you not learn to research and find information that would support your contention? You continue to blabber nonsense.

The issue of the "death panel" is exactly what I specifically posted. Learn to read and understand.

Read the wordings in the wilkpedia:

""Death panel" is a political term that originated during a 2009 debate about federal health care legislation to cover the uninsured in the United States. The term was first used in August 2009 by former Republican Governor of Alaska, Sarah Palin when she charged that the proposed legislation would create a "death panel" of bureaucrats who would decide whether Americans—such as her elderly parents or child with Down syndrome—were worthy of medical care. Palin's claim, however, was debunked, and it has been referred to as the "death panel" myth;[1] nothing in any proposed legislation would have allowed individuals to be judged to see if they were "worthy" of health care.[2] Palin specified that she was referring to Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options..."

The issue you are referencing is about controls of Medicare cost as per procedures, durable medical equipment and medications. This reviews have always been done, that is why there are list of approved medicare reimbursement. It is setting up another system to do these review.

I again challenge readers to look at the Act,yourself, and what it puts into effect http://www.healthcare.gov/index.html and do not rely on people who post wrong information and especially question Sara Palin. People with more education and intelligent are laughing at her outburst and ignore her rants--perhaps you should do the same. "...PolitiFact gave Palin's claim its lowest rating—"Pants on Fire!"—on August 10[2] and on December 19 it was named "Lie of the Year" for 2009... "Death panel" was named the most outrageous term of 2009 by the American Dialect Society..." from the Wikipedia article.

Livecontent

Last edited by livecontent; 07-03-2012 at 02:29 PM..
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Old 07-03-2012, 03:11 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 8,286,691 times
Reputation: 3873
I am well aware of what's in the act (I've read the parts that do or might affect me).

And this panel will just be on top of other parts of the current Medicare bureaucracy that already determine what things Medicare will pay for. For example - I take a drug that has been approved by the FDA to treat a condition I have. It is not on the Medicare formulary - so when I go on Medicare in a couple of months - I will have to pay for it out of pocket.

FWIW - here is what Wikipedia has to say about the "Independent Payment Advisory Board":

Independent Payment Advisory Board - Wikipedia, the free encyclopedia

Note that I ain't got no dog in this fight.* Except as a person who would like to see the return of some form of fiscal sanity both in our health care system and in our government spending. I dislike both the current President and the former President and Congress for getting us into the pickle we are in today. And allowing people to get a "free ride" in the health care system by paying a $95 tax (or penalty or whatever you want to call it) is certainly not a step on the road to sanity. If you're going to have a mandate - you need a "stick" much larger than $95 to enforce the mandate. Nor is it particularly sane to subsidize my Medicare Part B coverage to the tune of 75%. But I guess I get that subsidy because lots and lots of seniors vote. Robyn

*I - like most people on traditional Medicare with excellent Medigap coverage and a Part D plan - actually stand to save some money if the money I spend on drugs gets me into the "donut hole".

P.S. You have no monopoly in terms of having to deal with parents' difficult end of life issues. My husband and I have been through it 3 times.
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Old 07-03-2012, 03:20 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 8,286,691 times
Reputation: 3873
P.S. Here is the Act itself. Note that it is 906 pages long:

http://www.gpo.gov/fdsys/pkg/PLAW-11...111publ148.pdf
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Old 07-03-2012, 05:36 PM
 
20,797 posts, read 32,833,203 times
Reputation: 9904
Quote:
Originally Posted by Robyn55 View Post
I am well aware of what's in the act (I've read the parts that do or might affect me).

And this panel will just be on top of other parts of the current Medicare bureaucracy that already determine what things Medicare will pay for. For example - I take a drug that has been approved by the FDA to treat a condition I have. It is not on the Medicare formulary - so when I go on Medicare in a couple of months - I will have to pay for it out of pocket.

FWIW - here is what Wikipedia has to say about the "Independent Payment Advisory Board":

Independent Payment Advisory Board - Wikipedia, the free encyclopedia

Note that I ain't got no dog in this fight.* Except as a person who would like to see the return of some form of fiscal sanity both in our health care system and in our government spending. I dislike both the current President and the former President and Congress for getting us into the pickle we are in today. And allowing people to get a "free ride" in the health care system by paying a $95 tax (or penalty or whatever you want to call it) is certainly not a step on the road to sanity. If you're going to have a mandate - you need a "stick" much larger than $95 to enforce the mandate. Nor is it particularly sane to subsidize my Medicare Part B coverage to the tune of 75%. But I guess I get that subsidy because lots and lots of seniors vote. Robyn

*I - like most people on traditional Medicare with excellent Medigap coverage and a Part D plan - actually stand to save some money if the money I spend on drugs gets me into the "donut hole".

P.S. You have no monopoly in terms of having to deal with parents' difficult end of life issues. My husband and I have been through it 3 times.
First, Wiki is NOT a reliable source of information-any Tom, Dick or George and post information on that site and they are not responsible for the content....

Second, EVERY insurance company has a review panel or system in place to review treatment outside of the plan documents. This is not new and in most cases is to the benefit of the insured as they can often receive treatment that would not otherwise be covered.

Third, EVERY insurance company has a formulary. My son's allergy medicine is not on our formulary. It's a common one, nothing experimental, etc. just not covered. We can chose to find another one that works for him or pay out of pocket. It's not new and it's not exclusive to Medicare. You have the same options OR you can take it to the review panel and ask for special consideration. We have done this in the past with for a couple different issues and they have been covered, even though they were not in our plan.
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Old 07-03-2012, 05:54 PM
 
4,931 posts, read 8,809,802 times
Reputation: 6271
Quote:
Originally Posted by golfgal View Post
First, Wiki is NOT a reliable source of information-any Tom, Dick or George and post information on that site and they are not responsible for the content....

Second, EVERY insurance company has a review panel or system in place to review treatment outside of the plan documents. This is not new and in most cases is to the benefit of the insured as they can often receive treatment that would not otherwise be covered.

Third, EVERY insurance company has a formulary. My son's allergy medicine is not on our formulary. It's a common one, nothing experimental, etc. just not covered. We can chose to find another one that works for him or pay out of pocket. It's not new and it's not exclusive to Medicare. You have the same options OR you can take it to the review panel and ask for special consideration. We have done this in the past with for a couple different issues and they have been covered, even though they were not in our plan.
You are very correct in the what the wiki is and what is it not. I have used it to make a simple explanation of what Sara Palin has said but I am very aware the information on this Wiki entry is the facts. However, I do not rely on it unless I check all the information for myself.

You have made a correct issue in pointing out that medical care is always reviewed by some entity and must be reviewed to follow standards of care. All insurance carriers, as you said, have defined formularies for medications that they cover. Some also have defined protocols of care. Medicare has to have defined statutory list of what they will pay for and what they will not. That is fiscal responsibility as it controls costs and also gives all patience equitable treatment.

Livecontent
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