Originally Posted by JUREK

Yes the writting is on the wall. What an insult to give $250 to the seniors and hope they are happy.

Actually he should be honest and tell seniors that because the cost of living hasn't gone up this year so under the law there will be no cost of living adjustment.

End of story...but instead he offers $250.00.

And you all are p***ed about it. Would you prefer nothing? That's what I got this year for a raise.

Originally Posted by cabo35

cologal, this will be the third time I've posted this Bloomberg link. You really need to read it and tell us how you interpret the context. Perhaps you agree and that at least is an opinion.

I respect your opinion even if it diverges significantly from mine on this issue.

Cabo....you ask for my opinion and as I respect you I will answer. My answer will be seen for what is it...not a political statement. I really wish we could meet over coffee to have a heart to heart about this...but failing that here it is. I have spent all of my adult life in working in hospital throughout this country and the world. (Jersey Shore Medical Center is the latest.) During my lifetime I have lost 4 brothers, 1 sister, both my parents and numerous other relatives. My family is very Catholic and very medical...whenever a family member was in danger we always had member of the religious and a medical type in attendance to make decisions. In my fathers case when the doctors explained his condition there was no treatment which would do no harm...so the family decided to do nothing but make my father comfortable. A few years later it was my turn to make the decision about treatment for my mother. The doctors told my sister the only choice was to put my mother on a vent...I knew that should they do that my mother would not survive being taken off the vent. I called my Aunt the nun and my nephew the doctor and after that consult I told the doctors NO. 48 hours later my mother recovered and was released from ICU. Several months later her condition again was grave and the nursing home asked if we wanted her transferred to the hospital this time we said NO. Give her the antibiotics and make her comfortable. Within a few days she was at peace. At this point you might be asking what does this have to do with anything. It is a fact that in a patients final days is when the most money is spent. Doctors are trained to treat conditions but not patients. Quality of life is important and sometimes they should remember to do no harm. The best thing seniors can do is to make clear to the family, in writing what they want. I am only 59 but I have already done that. And that was the purpose of the funding for senior counseling on end of life issues. Unfortunately, the person that who first distorted this clause into the death panel charge was Betsy McCaughey. She has fought against healthcare reform for years. Here is a link for you:

http://news.muckety.com/2009/08/17/b...e-reform/19161

the Federal Coordinating Council for Comparative Effectiveness Research, is not in the enforcement business. The legislation specifically states it cannot mandate coverage or create clinical guidelines. There treatment guidelines out there but they are a good thing. Like the clot busting guideline for stoke victims....if you give it to late...not a good thing. How about the treatment guidelines for HIV...it works.

There was a speaker at a Anti-Healthcare Reform rally here in Pueblo, CO who compared ObamaCare to Hitler final solution. I really hate when any political party uses fear as a weapon. Do I like the healthcare bill...not sure. I think it should include negotiated pricing for drugs. I think the public option is the only way to insure competition but would be ok with a trigger. I would favor tort reform as a part of the bill and the illegals issue has to be solved.

Hopefully, I have answered your question...

We already have "death panels" in this country.

We call them Health Maintenance Organizations (HMO)

You can't convince me of the Government Death Panel rhetoric after what I had to experience with my grandmother. We were all in the damn room saying our goodbyes to a woman who was in the middle of a practically day-long heart attack. She signed and we all witnessed her signing the DNR orders with the doctors.

To make a very long and painful story short so that I don't get too worked up over this...

They ignored the orders and forced more treatment on her, literally in the middle of the night when we were sleeping - defying the orders. They scheduled her for QUINTUPLE bypass surgery after they told us (myself, my adoptive mother along with several aunts, uncles and cousins) she was too weak to take the surgery (and the DNR orders would prevent it anyway).

They put her through that and then five years of debilitating "recovery" where she lost her mobility, had a series of strokes and made her life - if you can call it that - a LIVING HELL for FIVE YEARS. And DON'T get me STARTED on what this did to the family!

Who was at fault? The bloodsucking doctors and hospital who were looking to suck on the Medicare teat some more and needed more "DRG" days to bill for. My adoptive mother scorched their ceilings screaming at them that if they were only interested in MONEY that there were DOZENS of other diagnosed conditions she had that she could be billed for - and that was just off the top of her head! But, no, they picked the MOST intrusive, the MOST debilitating, the MOST expensive, the BIGGEST physical insult to the body - on a 75 year old woman who had already made her peace with the world.

And this was in Boston. The supposed center of medical care in this country.

I spent 7 years working at Boston's Beth Israel Hospital. The things I learned there gave me quite an education in how health care "works" in this country.

Originally Posted by djplong

.

I spent 7 years working at Boston's Beth Israel Hospital. The things I learned there gave me quite an education in how health care "works" in this country.

....and how do the things you learned temper the prospect of 15 million to 45 million new patients who will be entering the system under Obamacare? Sorry about the numbers...they've been at best elusive and I believe...understated.

What I learned, first and foremost, is that it took us over 50 years to get into this mess and we're not getting out of it all at once. There are a large number of things that have to be attacked ALL AT ONCE in order to *really* solve the problems - and those are only the problems as I saw them (and see them now). I am, by trade, someone who looks for answers and solves problems (I do it with computers, I design, write and implement software, databases, etc).

Malpractice. This got so bad in the late 1980s and early 1990s that, if you lived on Cape Cod and got pregnant and didn't already have an OB/GYN, you could not get one. There were NONE accepting new patients. That's just the bad example we had locally. Out in the midwest I heard of worse horror stories. One thing that a "public option" would do is cut the cost of malpractice awards since, in a sense, the victim would no longer need a huge award to cover the cost of care for the rest of their lives.

Supply/Demand. I hear this a lot. It's one of the contributing factors to high medical costs. Did you know that the government regulates the supply of doctors? Probably the most shocking thing I learned at Beth Israel was how the teaching hospitals get the grant money that, quite frankly, is their bread and butter. The government basically says "you will graduate this many GPs, this many heart surgeons, this many neurosurgeons, etc, or you won't get the grant and research money". For the record, and those who don't know, Beth Israel Hospital is now Beth Israel/Deaconess and, as far as I know, is still affiliated and part of Harvard Medical School.

Payment. Insurance companies pay a set price per day per patient. It doesn't matter if you're in for an aspirin or bypass surgery. If you're in overnight, the insurance companies pay $X/night for you. And the hospitals are at their mercy if they want to be on the insurer's "approved" list. Now, these number are quite old, but we were going through budget cuts at BI trying to figure out how we could continue to provide our level of care at the $1600/nt rate that we had negotiated with several companies. The next year they started coming in at $1200 and we were in meetings lamenting about how we would LOVE to have the old "hardship" prices.

You read that right. At a time when premiums were going up 10-20% per year, the insurance companies were cutting what they were paying to hospitals. I have no doubt this is continuing. Where is that money going? Look at the balance sheets.

Class Envy. If you're going to have a "public option", then you're going about it all wrong in how to pay for it. Sure, you're going to get savings from cutting fraud and I'm all for that. (Someone elsewhere said to trash Medicare because of all the fraud - that's throwing out the baby with the bathwater) But one is naive to think that'll pay the whole way. I'll get back to this part in a bit.

I hear people screaming that they don't want to ruin the best health care system in the nation. Problem is, they're defending a ghost. Depending on who you talk to we're ranked around 37th in the world. Not that the UK NHS (National Health System) or the Canadian single-payer system is the best (though they're ranked around 17th and 7th, respectively). But actually *France* seems to be top-rated and they have a combination public and private system setup.

We *do* however, pay more than anyone else does. Part of that is due to the fact that we are the R&D center for the world Drugs cost more here (to recoup the R&D costs) than they do in other countries and, to be honest, I'm getting tired of that. It's time for other developed nations to foot the bill we've been covering.

Which brings me back to paying for whatever system comes up. In Canada they have what is basically a sales tax. Pure and simple. No pitting the middle class against the rich or the poor - everyone pays. Period. If you have to have "progressivity" in the system, you can make an allowance in the income tax structure for the poor. If you're unemployed, well, then, there's an incentive to get employed again - but at least you still have access to health care. Of all the pungent methods of paying for health care, this seems to be the least painful. Cry me no croccodile tears for this being on the backs of the poor with sales taxes being regressive because, as I said, you can rectify that in the income tax code and, let's face it, the poor also make poor decisions (smoking, drinking, poor health choices). Quite frankly, if the poor had access to proper care and didn't have to use the ER as their primary care physician, those that are NOT making bad choices but ARE victims of circumstance would probably be in better shape to improve their lot.

Everyone talks about the cost involved. But, I'm sorry, that can't be taken seriously when we have a situation where we have spent over $36,000 for every man woman and child in Iraq (over a trillion dollars before this year is out, depending on which accounting you pay attention to) destroying and rebuilding that country.

If we got our spending priorities realigned, cost would be a non-issue. We operate 160 bases overseas and I think it's time that the countries who's bacon we've saved start paying the freight.

It's not just a "Can Medicaid handle the influx" question. We already ARE handling it. These people, no matter what the number, are in our Emergency Rooms. They're staying sick when they could be getting better and (presumably) being more productive. They're spreading illnesses instead of getting innoculated. Their lives are being shortened because they can't afford preventative care.

We are the country that put a man on the moon. Why are we now the country that CAN'T do anything? Why can't we look at what France, Canada and the UK have done and say "we can do that better"? Why do we have people saying "keep government out of Medicare" (showing their ignorance)? Why are people saying medical decisions should stay between a doctor and patient when that DOES NOT EXIST NOW? (Those decisions are between your doctor and an insurance clerk) Why are we protecting a system that encourages hospitals to torture the sick just to help their bottom line (ok, that was my personal experience, I grant you)?

Do I have all the answers? Certainly not. But I *do* know that jingoism and sloganeering isn't going to solve the problem. It'll only make it worse.

Originally Posted by djplong

What I learned, first and foremost, is that it took us over 50 years to get into this mess and we're not getting out of it all at once. There are a large number of things that have to be attacked ALL AT ONCE in order to *really* solve the problems - and those are only the problems as I saw them (and see them now). I am, by trade, someone who looks for answers and solves problems (I do it with computers, I design, write and implement software, databases, etc).

Malpractice. This got so bad in the late 1980s and early 1990s that, if you lived on Cape Cod and got pregnant and didn't already have an OB/GYN, you could not get one. There were NONE accepting new patients. That's just the bad example we had locally. Out in the midwest I heard of worse horror stories. One thing that a "public option" would do is cut the cost of malpractice awards since, in a sense, the victim would no longer need a huge award to cover the cost of care for the rest of their lives.

Supply/Demand. I hear this a lot. It's one of the contributing factors to high medical costs. Did you know that the government regulates the supply of doctors? Probably the most shocking thing I learned at Beth Israel was how the teaching hospitals get the grant money that, quite frankly, is their bread and butter. The government basically says "you will graduate this many GPs, this many heart surgeons, this many neurosurgeons, etc, or you won't get the grant and research money". For the record, and those who don't know, Beth Israel Hospital is now Beth Israel/Deaconess and, as far as I know, is still affiliated and part of Harvard Medical School.

Payment. Insurance companies pay a set price per day per patient. It doesn't matter if you're in for an aspirin or bypass surgery. If you're in overnight, the insurance companies pay $X/night for you. And the hospitals are at their mercy if they want to be on the insurer's "approved" list. Now, these number are quite old, but we were going through budget cuts at BI trying to figure out how we could continue to provide our level of care at the $1600/nt rate that we had negotiated with several companies. The next year they started coming in at $1200 and we were in meetings lamenting about how we would LOVE to have the old "hardship" prices.

You read that right. At a time when premiums were going up 10-20% per year, the insurance companies were cutting what they were paying to hospitals. I have no doubt this is continuing. Where is that money going? Look at the balance sheets.

Class Envy. If you're going to have a "public option", then you're going about it all wrong in how to pay for it. Sure, you're going to get savings from cutting fraud and I'm all for that. (Someone elsewhere said to trash Medicare because of all the fraud - that's throwing out the baby with the bathwater) But one is naive to think that'll pay the whole way. I'll get back to this part in a bit.

I hear people screaming that they don't want to ruin the best health care system in the nation. Problem is, they're defending a ghost. Depending on who you talk to we're ranked around 37th in the world. Not that the UK NHS (National Health System) or the Canadian single-payer system is the best (though they're ranked around 17th and 7th, respectively). But actually *France* seems to be top-rated and they have a combination public and private system setup.

We *do* however, pay more than anyone else does. Part of that is due to the fact that we are the R&D center for the world Drugs cost more here (to recoup the R&D costs) than they do in other countries and, to be honest, I'm getting tired of that. It's time for other developed nations to foot the bill we've been covering.

Which brings me back to paying for whatever system comes up. In Canada they have what is basically a sales tax. Pure and simple. No pitting the middle class against the rich or the poor - everyone pays. Period. If you have to have "progressivity" in the system, you can make an allowance in the income tax structure for the poor. If you're unemployed, well, then, there's an incentive to get employed again - but at least you still have access to health care. Of all the pungent methods of paying for health care, this seems to be the least painful. Cry me no croccodile tears for this being on the backs of the poor with sales taxes being regressive because, as I said, you can rectify that in the income tax code and, let's face it, the poor also make poor decisions (smoking, drinking, poor health choices). Quite frankly, if the poor had access to proper care and didn't have to use the ER as their primary care physician, those that are NOT making bad choices but ARE victims of circumstance would probably be in better shape to improve their lot.

Everyone talks about the cost involved. But, I'm sorry, that can't be taken seriously when we have a situation where we have spent over $36,000 for every man woman and child in Iraq (over a trillion dollars before this year is out, depending on which accounting you pay attention to) destroying and rebuilding that country.

If we got our spending priorities realigned, cost would be a non-issue. We operate 160 bases overseas and I think it's time that the countries who's bacon we've saved start paying the freight.

It's not just a "Can Medicaid handle the influx" question. We already ARE handling it. These people, no matter what the number, are in our Emergency Rooms. They're staying sick when they could be getting better and (presumably) being more productive. They're spreading illnesses instead of getting innoculated. Their lives are being shortened because they can't afford preventative care.

We are the country that put a man on the moon. Why are we now the country that CAN'T do anything? Why can't we look at what France, Canada and the UK have done and say "we can do that better"? Why do we have people saying "keep government out of Medicare" (showing their ignorance)? Why are people saying medical decisions should stay between a doctor and patient when that DOES NOT EXIST NOW? (Those decisions are between your doctor and an insurance clerk) Why are we protecting a system that encourages hospitals to torture the sick just to help their bottom line (ok, that was my personal experience, I grant you)?

Do I have all the answers? Certainly not. But I *do* know that jingoism and sloganeering isn't going to solve the problem. It'll only make it worse.

I waded through your prolific response for an answer to a simple question. You talk around it with canned talking points we are all familiar with. You dismiss the question with a "we are already handling it", regarding the "influx" as you put it. However, that is not honest because it does not address the antiicpated new influx of full coverage patients, not just emergency room treatment cases.

I will try to simplify the question for you although I believe you understood it the first time around.

How will America handle the influx and addition of up to 15 million to 45 million individuals( fickle but often repeated numbers) with full coverage to a medical system already threatened by bankruptcy and insufficient human resources like...you know....doctors, nurses ?