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Old 11-25-2016, 11:46 AM
Location: Living rent free in your head
31,085 posts, read 13,614,329 times
Reputation: 22147


Originally Posted by pilotpair View Post
2sleepy - I agree and disagree with your comments.
Section 3403 authorizes the board to target the administrative costs and profits under Medicare Advantage Part C plans and Part D (prescription drug plans). You're on target but it wasn't specific to costs of any one item. There's nothing in the law (I found) that says insurance companies have to pay for x items from their profit. Is that wishful thinking?
I can't find the link where I read that but your questioning it caused me to do more research and it looks like what I read was wrong, this is how it works: "Each year Medicare Advantage plans place bids based on estimated enrollee costs for Medicare Part A and Part B services and accepted bids are compared to the benchmarks in their county or region.1 Plans that bid higher than their benchmark are paid the benchmark amount and the planís enrollees pay the difference between the bid and the benchmark in premiums, while plans that bid lower than their benchmark are paid the bid plus a rebate that is equal to 75% of the difference between the benchmark and the bid.2 The rebate is required to go to enrollees through extra benefits such as reduced premiums for part B and part D, reduced cost sharing, or coverage of services not included in original Medicare." As far as "wishful thinking", no actually I wish that all medicare recipients received vision, dental, and hearing benefits.
Originally Posted by pilotpair View Post
Section 3403 also authorizes the board to target reimbursement rates to physicians as well as costs of items such as walkers under Part B which is original Medicare. Interestingly, the board has no authority over hospital reimbursements (someone has a good lobby). So it is broader than you stated although the law doesn't 100% take effect until 2020.
fair enough!

Old 11-26-2016, 12:42 AM
6,684 posts, read 3,172,693 times
Reputation: 8464
Originally Posted by Larry Caldwell View Post
Is the fact that Americans are getting skinned morally wrong, in your opinion?
Children get skinned when they run and fall on the sidewalk. Make concrete illegal. It's one of our most violent enemies. Compared to losing your skin, losing your money is nothing. As proof that it's nothing, lots of people lose their money, and they have nothing.
Old 11-26-2016, 04:08 AM
Location: R.I.
979 posts, read 606,557 times
Reputation: 4248
Originally Posted by golfingduo View Post

Oh by the way. It is not the doctors nor the nurses at the VA that are the problem. Most likely it isn't anyone person in the VA. I suspect it is just the system. If I had the ear of the head of the VA I would suggest they look at the Reliant Healthcare system I am in. Although I think it would need something a bit more because Reliant is IT heavy. I email doctors and nurse practitioners with questions and concerns. I get responses back quite quickly. The VA could not depend on that with how many homeless veterans there are.
The VA does have an IT program which is called My Healthy Vet where some patients do communicate with physicians via e-mail as well as can get med refills and look up test results. The program has been pretty successful, but with the turn around being 48 hours and I and the techs have to be the first screen of these e-mails because although the Vets are instructed that this is not a communication methods to relay urgent health issues, we do get a few e-mails relaying those type of issues which require intervention ASAP.

I too would like to have the ear of the future secretary of the VA!! Where I have seen the biggest burden of the system is what we call dual or co managed care. There is an ever growing number of Vets that receive care from multiple providers in the community, and basically want to utilize the VA for the medication benefit. Unlike military retirees that can and do see community providers, if they receive a prescription from those providers they can go with their prescriptions to an active duty military base pharmacy and get those prescriptions filled. This ability does not exist at the VA, so for a Vet to get a prescription written by a community provider filled at the VA that prescription has to be rewritten by a VA provider. And additionally, these Vets have to have minimally an annual exam with a VA PCP to make this happen. This has created a terrible burden on the system because those physicians that are rewriting those prescriptions have to review volumes of supportive documentation which identifies the need for the medication and once they rewrite the prescription they become responsible for the medications actions and reactions. Daily it is a non stop stream of Vets presenting to the PC Reception Desk with prescriptions written by community providers, and more often than not without supportive documentation. Knowing these Vets do not have the funds to purchase these meds at CVS and need to begin these meds now, staff and VA physicians have to pretty much stop what their are doing to do what needs to be done so that Vets gets the medications they need. The powers that be have done zilch to control this problem because the VA gets lots of $$$ for that one annual PCP appointment and could care less about the work load that falls on physicians and staff the rest of the year which is the primary reason why the two physicians I work with work 60 hours a week instead of 40. And I the R.N. spend very little of my day actually practicing nursing, but instead spend a good part of my day taking calls from patients and community providers to check to see if faxed prescriptions were received and then go sifting through hundreds of faxes to try to locate them.

But as discouraging as this crazy system I work in can be, it is that one or two Vets that cross my path daily that sometimes all I can offer them is a compassionate ear or a kind encouraging word is what keeps me doing what I am doing because ALL VET'S LIVES MATTER, and it is because of these heroes including the ones that post on this forum are the reason I enjoy the freedoms I do living in this still great country.
Old 11-26-2016, 07:04 AM
Location: Eugene, Oregon
219 posts, read 131,968 times
Reputation: 381
When you hear about the high cost of healthcare more often than not it is exobanant costs for medications under guise of paying for R&D and FDA approval. This justification sort of beaks down 10 years on and the actual production cost is pennies and the price to patient is unafordable without insurance.

The high cost of non-drug medical devices. Many times simple band-aid type devices that are marked up 1000%. This and low cost simple procedures are jacked in price to, "make up deficits where insurance under allocates dollars". This further convolutes the true cost of healthcare.

The cost of just staying in the hospital is outrageous in 'for-profit' facilities.

My mother died last year but before she did, she was paying $7000+ per month for non-government supported assisted living.

As Michael Moore pointed out 50K Americans die every year for lack of insurance. If we had implemented single payer when Hillary tried to 20 years ago that would have saved 1 million people's lives. Those people died so a few investors could make money on their stocks.

These are the things I think need to be controlled by the government, along with reducing costs for doctors to do their jobs.

More and more insurance companies are dictating healthcare decisions. Thank god, with our type of insurance, we can afford to ignore the price conscience recommendations of our GP and independently seek a specialists opinion. It is funny to me that opponents of single payer system say they don't want the government all up in their business but, it seems to me, we already have that with the insurance companies closely controlling medical decisions.

Somehow the very rich don't think they will be able to buy what ever advanced and truly costly procedures their little hearts (literally) desire. Or do they not care if 50K people die each year for lack of insurance because they would have to find other investments outside of healthcare industry and maybe pay higher taxes.

My 2Ęs worth.

Last edited by Djkingman; 11-26-2016 at 07:12 AM..
Old 11-26-2016, 08:11 AM
7,982 posts, read 11,667,446 times
Reputation: 10473
I'm worried about TSP. I can't see Trump not raiding it.
Old 11-26-2016, 03:50 PM
Location: SW US
2,220 posts, read 2,036,902 times
Reputation: 3824
Originally Posted by Djkingman View Post

It is funny to me that opponents of single payer system say they don't want the government all up in their business but, it seems to me, we already have that with the insurance companies closely controlling medical decisions.
I've never understood either why some people think corporations seeking to maximize profits can make better, more trustworthy decisions about their health, than government people with no profit motivation.
Old 11-27-2016, 02:15 AM
Location: R.I.
979 posts, read 606,557 times
Reputation: 4248
Originally Posted by Giesela View Post
I'm worried about TSP. I can't see Trump not raiding it.
Stop listening to all these talking heads on both sides of the fence because everything that comes out of their mouths you have to divide by 10 and maybe believe the rest!!! Fix yourself a nice cup of hot chocolate, turn on the Hallmark channel and enjoy the holiday season. If that does not quell your TSP fears, if you are 59.5 you have the opportunity to pull out all your money minus taxes and stuff it in your mattress if that makes you feel better.
Old 11-27-2016, 06:07 AM
7,982 posts, read 11,667,446 times
Reputation: 10473
I haven't really listened to anyone. Its pretty obvious.
Old 11-27-2016, 06:17 AM
2,443 posts, read 2,073,079 times
Reputation: 5690
I will be very upset if they try and raid my social security, 401K and IRA's to pay for deadbeats and wars.
Old 11-27-2016, 03:27 PM
Location: Central Massachusetts
4,800 posts, read 4,850,322 times
Reputation: 6379
Originally Posted by Giesela View Post
I haven't really listened to anyone. Its pretty obvious.
its not obvious. Where do you get the idea when he hasn't even taken office yet. Gee whiz give the guy a break before you just trash him. I am part of the TSP system too. If you have money in the G Fund that is the only money the feds have access to and that is because it is treasury securities. Otherwise the money is in the market.
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