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Old 03-14-2017, 10:58 AM
 
1,187 posts, read 664,268 times
Reputation: 4119

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The time has come for a compromise on health care in Congress as I agree that the system is not sustainable but I doubt it will ever happen. Throwing millions off healthcare is not going to solve the problem.

I live in a state that did not expand Medicaid and the devastation to rural hospitals has been major - they are shutting down completely and now it can take several hours for many to get to hospitals with any level of trauma care unless patients are airlifted. Jobs were lost that were badly needed in impoverished areas. Our urban hospitals are still overwhelmed with the uninsured.

I agree costs need to come down, more choice in plans needed (including catastrophic at all ages not just under 30), and subsidies/tax credits need to be expanded to those above the current levels and got walloped by huge increases in premiums and deductibles. All this should be accomplished by compromise.

As far as Medicaid paying for the elderly, you can't get blood from a stone in many cases. I do feel there is way too much "estate planning" in the vein of spend down your money and deed over all your property so the government will pick up skilled care costs. Sure it is legal, but I think the time has come that the look back period needs to be expanded. Paying for your own LTC , instead of taxpayers, should trump (no pun intended) deeding over your home to your heirs. Not sure how that would be accomplished but Medicaid as it stands is not sustainable.
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Old 03-14-2017, 11:26 AM
 
Location: next up where ever I go
588 posts, read 344,756 times
Reputation: 2087
Quote:
Originally Posted by SportyandMisty View Post
Thanks for the explanation.

I've worked in several Fortune 50 corporations. Whenever it was time to significantly reduce expenses via a layoff, our HR department and our Legal department, including labor attorneys, went through an extensive statistical analysis to look for any evidence of disparate impact prior to actually implementing the layoff. The corporation's objective was to stay on the right side of the law -- and not even come close to the line.

When any such evidence was discovered, there was substantial discussion on what to do about it so as to stay legal. Sometimes this included changing the layoff criteria prior to implementation, and then re-running the analysis.

This doesn't mean that no individuals in protected classes were laid off. But it does mean that no rogue middle-manager could get away with doing something wrong such as targeting the older or women or protected racial minorities or veterans or LGBTQ or other individuals for layoff while attempting to retain younger white men.
Misty,

Interesting that your Fortune 50 corps did their due diligence. I suspect that was because of the whole sale slaughter of the Reduction in Force made by the Fortune 1000 corp I worked for where you got a pick slip on Friday, given to you as you left the compound by security, never allowed to return for their belongings, through a plate glass window. Workers were going home and committing suicide over the weekend so they started handing out the slips on Monday.

This, mind you, was 20 years ago. I would think companies learned how to cover their asses a lot better since then. One can only hope.
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Old 03-14-2017, 11:40 AM
 
29,782 posts, read 34,871,258 times
Reputation: 11705
A few thoughts as others have noted. Concurrent with this thread we have another on leaving for heirs or spending it away. Some have suggested a third option which is to save for long term health needs. WTF? How can we still be having that conversation about spending it away instead of paying for your health down the road? Conversations like that can create indifference to the plight of 80 year olds needing help when others bothered to save and NOT spend. Lost in the discussion often becomes the plight of those who never earned enough to be able to save.

It is like discussions about saving for retirement and having some be of the spend and worry later school and others of the save and be prepared school. The savers at 65 say the heck with those who didn't save. Lost in the discussion is often those who never earned enough to be able to save.

Then we have the discussions about Long Term Care insurance to buy or not to buy that is the question. If current proposed legislation passes what happens to those who said they will take their chances? Again will there be sympathy and a willingness to pay by those who did buy. I wonder how that thread discussion will go in the future if the forces at work have their way? Hmmm. Again there are those who had no choice.

What comes to mind to me at this point is a recent article I read about a Assisted Living Facility being raided and having 17 clients being served. The facility was licensed for 4 people. Yes 4 and they had 17. Physical exams showed them to be in good shape but 12 or so were locked in one room. They said they were happy and it is all under investigation. I contrast that to the upper CCRC's we have looked at and the contrast is staggering in quality of life and service. What is to be the expected level of care for Assisted Living and Nursing Care and are big inequities ok. Society can't afford what it is trying to do now and certainly can't up the standard for all.

Which brings me to my main point and probably the crux of the issue and that involves how the machine is changing our lives and world and how we either adapt or ok we don't. Thomas L. Friedman noted Pulitizer Prize winner and author of the World is Flat and Thank You for Being Late defines The Machine as the nexus of technology and wall street. It is the financing of wall street that is driving rapid acceleration in technology and as a result life and the world. It is the machine that has created the oh so hated by some globalization as communication across the miles is normal etc etc.

The machine has created the rapid advances in medical services that keeps driving the costs up. like all newer technology it is not affordable by all. Unfortunately when that new technology saves and enhances lives not being able to afford it takes on another life. Thus we are at that point. What is a basic level of medical service that is affordable for society to support and up to the individual to go above on their own?

Consider 2007 the year that Friedman refers to as the inflection point and the release of the device that changed the world.
The IPhone. Followed by smaller and faster micro chips that year. That rate of acceleration if not already growing at a exponential rate was now doing so. The phone at first was only for the wealthy or those diverting resources from other spending to the purchase of a IPhone. With time, technology and subsidies smart phones became cheaper and more accessible to most if not close to all. Smart technology has for many become essential to surviving and prospering in todays accelerated world.

Medicine is like that also. What was new and innovative a decade ago is dated now. New medicines come on line. new surgical techniques, new equipment etc. However they come at a cost not all can afford. Should there be a level of care based on affordable technology, pharma and doctor resources or should there be access to the top standard for all?

So perhaps the question is not just what is affordable health care for seniors but what is the minimum society can afford and above that it becomes personal.

Food for thought!
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Old 03-14-2017, 11:46 AM
 
30,108 posts, read 47,344,680 times
Reputation: 16045
Quote:
Originally Posted by shamrock4 View Post
The time has come for a compromise on health care in Congress as I agree that the system is not sustainable but I doubt it will ever happen. Throwing millions off healthcare is not going to solve the problem.

I live in a state that did not expand Medicaid and the devastation to rural hospitals has been major - they are shutting down completely and now it can take several hours for many to get to hospitals with any level of trauma care unless patients are airlifted. Jobs were lost that were badly needed in impoverished areas. Our urban hospitals are still overwhelmed with the uninsured.

I agree costs need to come down, more choice in plans needed (including catastrophic at all ages not just under 30), and subsidies/tax credits need to be expanded to those above the current levels and got walloped by huge increases in premiums and deductibles. All this should be accomplished by compromise.

As far as Medicaid paying for the elderly, you can't get blood from a stone in many cases. I do feel there is way too much "estate planning" in the vein of spend down your money and deed over all your property so the government will pick up skilled care costs. Sure it is legal, but I think the time has come that the look back period needs to be expanded. Paying for your own LTC , instead of taxpayers, should trump (no pun intended) deeding over your home to your heirs. Not sure how that would be accomplished but Medicaid as it stands is not sustainable.
I too live in state (TX) that did not expand Medicaid--
In fact our state attorney general spent millions of $$ to sue the Fed and oppose the original ACA--
I think some people forget that happened before the ACA was actually implemented--
And the ACA we have now had for the past 7 yrs is NOT the original version of the ACA that was passed by Congress and signed into law---

The fact that states -- Republican states--were given the OK from the Supreme Court to set up their own exchanges vs using the Federal system originally conceived is basically why we have the issues we do...
States that did not expand Medicaid (like mine) got crap, expensive policies from the insurance companies and our state did nothing to tryi to reduce the costs or improve the coverage--
They would not go against the "free market" system for insurance...
And the penalty for NOT taking insurance is less severe than originally designed and as such is not a real deterrent to keeping everyone insured...risk pools are smaller than anticipated and really needed to lower costs....

Most people in states that used the original system are fairly happy with their coverage...
MOST doctors in states that expanded Medicaid stayed on the system---
MOST states that went on their own exchange saw doctors and some private hospitals refuse to work with the new ACA plans because they didn't know what would happen---because there was the lawsuit delay and lot of states were hoping the law would be declared unconstitutional by Supreme Court and did not design any system if it wasn't killed...

This new proposed system wants to have it both ways--
Wants to wait until after the 18 elections to mitigate damage to GOP candidates...
My husband heard Tom Cotton this weekend---
His BIG complaint against this current bill is taht if the GOP does get it passed that it will
HURT CHANCES FOR REELECTION OF GOP CANDIDATES in 2018.
HOW IS THAT FOR CARING ABOUT THE NEEDS OF THE AMERICAN PUBLIC!!!
PASSING THIS BILL IS DANGEROUS TO CONGRESSMEN!!!
Not to hospitals, not to other medical providers, not to the end users who actually pay for their policies...
BUT IT WILL HURT GOP CANDIDATES RUNNING FOR OFFICE....

That is the real problem with this bill---self-serving, political hacks who only worry about being REelected!!!
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Old 03-14-2017, 12:00 PM
 
Location: next up where ever I go
588 posts, read 344,756 times
Reputation: 2087
Dear Love,

I am afraid that the Government has forgotten that they work for us. We the People. What happened to the People?
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Old 03-14-2017, 12:01 PM
 
15,258 posts, read 4,033,310 times
Reputation: 11028
Quote:
Originally Posted by dothetwist View Post
Congrats! And I agree with your outlook....life is so much shorter once we get to the high side of 50.
I retired from having to sit in the store by the phone at 45 years old - since then I have done what I wanted to do work-wise (mostly web publishing and writing).

I pay my health care premiums as always - the wife and I have seen our go up very little (all in all) over the last 15+ years. Better yet, we live in MA - #1 in health care in the USA and all the preventative stuff is covered (physicals, etc.)...

Now we are only two years away from Medicare which we have paid into for about 35 years.

I wouldn't want to go without health insurance - but we can afford the premiums so we won't have to. Sure, it's our largest payment each month - but so be it.
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Old 03-14-2017, 12:14 PM
 
1,187 posts, read 664,268 times
Reputation: 4119
Quote:
Originally Posted by loves2read View Post
I too live in state (TX) that did not expand Medicaid--
In fact our state attorney general spent millions of $$ to sue the Fed and oppose the original ACA--
I think some people forget that happened before the ACA was actually implemented--
And the ACA we have now had for the past 7 yrs is NOT the original version of the ACA that was passed by Congress and signed into law---

The fact that states -- Republican states--were given the OK from the Supreme Court to set up their own exchanges vs using the Federal system originally conceived is basically why we have the issues we do...
States that did not expand Medicaid (like mine) got crap, expensive policies from the insurance companies and our state did nothing to tryi to reduce the costs or improve the coverage--
They would not go against the "free market" system for insurance...
And the penalty for NOT taking insurance is less severe than originally designed and as such is not a real deterrent to keeping everyone insured...risk pools are smaller than anticipated and really needed to lower costs....

Most people in states that used the original system are fairly happy with their coverage...
MOST doctors in states that expanded Medicaid stayed on the system---
MOST states that went on their own exchange saw doctors and some private hospitals refuse to work with the new ACA plans because they didn't know what would happen---because there was the lawsuit delay and lot of states were hoping the law would be declared unconstitutional by Supreme Court and did not design any system if it wasn't killed...

This new proposed system wants to have it both ways--
Wants to wait until after the 18 elections to mitigate damage to GOP candidates...
My husband heard Tom Cotton this weekend---
His BIG complaint against this current bill is taht if the GOP does get it passed that it will
HURT CHANCES FOR REELECTION OF GOP CANDIDATES in 2018.
HOW IS THAT FOR CARING ABOUT THE NEEDS OF THE AMERICAN PUBLIC!!!
PASSING THIS BILL IS DANGEROUS TO CONGRESSMEN!!!
Not to hospitals, not to other medical providers, not to the end users who actually pay for their policies...
BUT IT WILL HURT GOP CANDIDATES RUNNING FOR OFFICE....

That is the real problem with this bill---self-serving, political hacks who only worry about being REelected!!!
Exactly right! People in states where there was not expanded Medicaid do not realize the damage done to folks needing care plus everyone else paying for far more expensive insurance. Medical and hospital costs keep going up with no end in sight. People want to stay alive and will continue to show up in the ERs at extreme cost to all of society.
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Old 03-14-2017, 12:14 PM
 
15,258 posts, read 4,033,310 times
Reputation: 11028
Quote:
Originally Posted by TuborgP View Post

Medicine is like that also. What was new and innovative a decade ago is dated now. New medicines come on line. new surgical techniques, new equipment etc. However they come at a cost not all can afford. Should there be a level of care based on affordable technology, pharma and doctor resources or should there be access to the top standard for all?

So perhaps the question is not just what is affordable health care for seniors but what is the minimum society can afford and above that it becomes personal.

Food for thought!
If you replaced "society" with "for profit shareholder corporations" you'd have a more clear picture of costs.

For example, a recent anecdote from a Swede currently living in China tells of the difference between the two countries health care. As you may know, the Swedes are usually in the top 5 worldwide - yet this guy vastly preferred the Chinese medical system.

Here is his example experience:

"This is what I do in China:
I go directly to the hospital and tell the nurse at the entrance what kind of problem I have. She tell me which specialization I need to see. I go to a counter, pay about 1 USD for a ticket (with number) with the specialized doctor, then go directly to that department and queue. I usually get to see the specialized doctor within 3060 minutes. The doctor will always let me do X-ray, CT scan, or whatever, if they think it will help to diagnose. I pay for that myself, ~70 USD, and I can go queue for that scan directly the very same day. After the scan, I go back to the specialized doctor again (no need to re-queue, just go directly). Doctor will look at the result and give a well informed diagnosis.

So with Swedish healthcare, it takes months to achieve what I can achieve in one day with Chinese healthcare.

And yes, not everyone can afford good healthcare in China, but there are very reasonable health insurance packages to buy there that the vast majority can afford."

So think about it. For $70 in China you get an MRI. Same machine here - probably billed at over $5K and 1-2K paid.

The real culprit here are the corporations which we have prayed at the altar of. You can't have guys like Romney, Frist, Rick Scott and others making BILLIONS and still have reasonable health care. We in the USA have chosen the former.
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Old 03-14-2017, 12:17 PM
 
15,258 posts, read 4,033,310 times
Reputation: 11028
Quote:
Originally Posted by shamrock4 View Post
Exactly right! People in states where there was not expanded Medicaid do not realize the damage done to folks needing care plus everyone else paying for far more expensive insurance. Medical and hospital costs keep going up with no end in sight. People want to stay alive and will continue to show up in the ERs at extreme cost to all of society.
When the GOP crowd shouted "let em die" to a question at the primary debate they were dead serious. They want people to suffer and die and want corporations to make obscene profits. When one studies the GOP, this makes perfect sense.

What doesn't make sense is how they convince so many of lesser means that suffering and dying is good for the soul.
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Old 03-14-2017, 02:28 PM
 
Location: next up where ever I go
588 posts, read 344,756 times
Reputation: 2087
Quote:
Originally Posted by craigiri View Post
When the GOP crowd shouted "let em die" to a question at the primary debate they were dead serious. They want people to suffer and die and want corporations to make obscene profits. When one studies the GOP, this makes perfect sense.

What doesn't make sense is how they convince so many of lesser means that suffering and dying is good for the soul.
That was not the ticket the GOP and Trump sold. They sold no one dying in the streets, granny is not going to be pushed off the cliff

AFFORDABLE HEALTHCARE FOR ALL

And as an added bonus...we are going to make the Mexicans pay for it...OOPS! Sorry that was to keep our jobs for all of our out of work people.

The healthcare issue will bring down the deficit so that the government can ramp up our military. So need a job? Sign up!

Be very careful what you wish for.

Wonder what the rust belt is thinking now that their healthcare is about to be ripped from them along with any hope of them getting a decent paying job.

Welcome To America

The land of the I GOT MINE so F YOU
Oh, and I am one of the statistics. I will lose any chance of getting insurance within my ability to pay and I have money socked away for my retirement at the expense of a lux life. But it will be gone or deeply dismembered by the time I hit 54. But then again, the GOP wants to move Medicare to 70.

Do you think they will take a 61 year old with a chronic inherited illness for the army?
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