Doctors not accepting Medicaid patients

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Medicaid is the government insurance program for low-income citizens. Many on Medicaid are permanently disabled. Some are low-wage workers. Because the payment rates to doctors is so low, many, especially high-priced specialists, are not accepting any new Medicaid patients. In some cases, there are doctors who spend a day or two a week working in non-profit clinics, and they refer Medicaid patients away from their private practice to these clinics. General practioners sometimes are able to convince a specialist who they personally know to take a Medicaid patient who the specialist usually would not take. Sometimes, a doctor has to plead with a specialist to see a patient.

Many Medicaid plans are now run by HMOs who have lists of doctors who accept Medicaid. These lists are sometimes inaccurate and out-of-date. The patients are advised to call the HMO if they can't find a doctor. The insurance companies who run the plans say that having to wait to see a doctor for months on end is unacceptable. In Michigan, a non-profit community mental health center stopped seeing Medicaid HMO patients because it didn't pay them enough to be able to afford to continue seeing them, even though community mental health centers were orignally created largely to serve people who may not be able to afford mental health services from a private practitioner and who,in many cases, who have a chronic mental health condition. In MIchigan, something like 88% of all physicians once took Medicaid; now the number has dwindled to something like 61% or so, and may be continuing to drop. State and federal public officials had better find a way to raise the reimbursement rate for doctors and hospitals for Medicaid, which is part of the health care reform program that was enacted.

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Robindell
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Comments

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.
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J.J
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From J.J.'s post:

It (the Mayo Clinic) lost $840 million last year on Medicare...

Lost $840 million compared to what? The year before? What they charged? What they wanted to charge? What their expenses really were?

If it was according to what they charged, that's a bogus statement. Medicare has been paying prorated fees compared to the diagnoses given regardless of what is billed ever since DRG's ('Diagnosis-Related Groups') were put into effect almost 30 years ago--during, believe it or not, Reagan's administration--so, these assessments on what will get paid and how is nothing new. How they lost $840 million last year--but, what?, were able to 'get everything covered' for the past 30 years--is a little bit of a pickle....

Watch out how this gets framed. As I've been saying every since I've been on this forum (over 3 years now), what's really the problem with medicine is that some get it paid as a right while others (most likely the ones paying for the ones who get it as a right) could go bankrupt for the same services. And, as Barack Obama's book, The Audacity of Hope, points out (in a way that I have never heard Barack Obama explain in any public address on this), 20% of the population takes up 80% of the medical budget and, of that 20%, I am sure the government is paying the greatest percentage of those people--leaving the other 80% that take up 20% of the medical budget as profits for insurance companies. It's the same ol' 'privatize profits and socialize costs' that the financial industry is doing with government....

From Robindell's post:

Because the payment rates to doctors is so low, many, especially high-priced specialists, are not accepting any new Medicaid patients.

Again, this is a little skewed on the perspective of what constitutes the medical-legal environment of American medicine today. While it may be right that practitioners that can get their clinic patients from better paying sources will do so, that does not mean that Medicaid patients aren't seen. They can (and many do) always go to the ER. Also, as a part of the laws and regulations on hospitals (including EMTALA laws), no hospital can refuse a patient because of low or no pay--and those hospitals have to have the specialties that they offer in that hospital on call for that ER regardless of whether they pay or not (it is specified in the law). So, that still means they get seen (even by the specialists--and the specialists I know would rather have a Medicaid patient than a non-paying patient--but, if that hospital has the space available and they offer that specialty, it matters not, that specialist has to see that patient as a back-up call physician for the ER)--and, in a penny-wise-but-pound-foolish manner, ER and hospital care used for primary care purposes are, of course, the most expensive for anyone to pay (even the government).

And, NONE OF THIS is really addressing the most pressing point. Legally, Americans have the right to seek medical care whether they can pay or not--if no where else, at least the ER. It's how that is fairly 'divided' financially that has become the biggest problem in the United States where some do get it at little to no cost to themselves at the time (as if a right) and others have to risk bankruptcy for the same services (in the same hospitals--with the same specialists). What the United States really needs to do is decide it once and for all--is medicine a right and, if so, make it a right for everyone--or, is medicine a privilege that only gets distributed to those who directly pay for it and, if so, decide what to do with those who show up in ER's expecting treatment but not having (or being willing) to pay for it, themselves. This 'split decision' is just a manner in which corporations can play off government for their profits and benefits--at the expense of the taxpaying consumer that is paying for all of it....

Think through this and I think you can see the problem....

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Kerry
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Quote Kerry:

From J.J.'s post:

It (the Mayo Clinic) lost $840 million last year on Medicare...

Lost $840 million compared to what? The year before? What they charged? What they wanted to charge? What their expenses really were

looks like it was taken from this orginal article.
Last year, Mayo lost $840 million on $1.7 billion in Medicare work. It compensated by charging private insurers a premium for the Mayo name, but they're starting to balk.

Whether you feel it bogus or otherwise... The Mayo Clinic is testing the NO GOV CARE busniess model.

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J.J
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Aug. 3, 2010 1:31 pm

So the medical industry in America puts profit before human life.

Is that something to be proud of?

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meljomur
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Quote J.J.:

looks like it was taken from this orginal article.
Last year, Mayo lost $840 million on $1.7 billion in Medicare work. It compensated by charging private insurers a premium for the Mayo name, but they're starting to balk.

Whether you feel it bogus or otherwise... The Mayo Clinic is testing the NO GOV CARE busniess model.

I looked over your article, J.J. What seems to be bogus is that the article spends much of its time touting how that clinic in Rochester, Minn., has saved so much money--and, then, adds that it needs more money (which got me to asking 'based on what?'--what their real expenses were or what they wanted to charge?--your article doesn't address that nor answer that question--and DRG's have prorated Medicare payments with regards to diagnoses in hospitalized patients for the past thirty years--now, there are ways to tweak out more money through doing more procedures--but, that's going to have to be done above and beyond specifically hospitalized patients to do so--probably one of the reasons why 'all the work-up be done before they get hospitalized' in many cases--even ER).

And, while everyone wants 'evidence-based medicine', the problem with that concept, itself, is 'Based on whose (or what) evidence?' Statistics that have no factual basis (and medicine has a lot of elements that lack complete factual content, anyway) can always be skewed--and are.

If you want to talk about epidemiological evidence, it's was shown years ago in such studies that by-pass cardiac surgery doesn't prolong life (even as it can improve the quality of life left), by-pass extremity surgery doesn't reduce the incidence of amputations, antibiotic use in children with earaches don't reduce the incidence of meningitis and hearing loss, and C-sections in pregnant women don't always end up with better babies--but, that hasn't stopped any of these interventions from being 'standard of care'.

The question is which person not to do the by-pass procedures, antibiotic use in children's earaches, or C-sections in pregnant women--and I'm afraid that 'evidence-based studies' aren't really going to solve that--and will look just exactly like that article expresses--the imposition of some government (or even insurance) agency is restricting access to care--and that's 'rationing'.

To top it off, as far as malpractice cases go, you are sued much more often for 'doing too little' than you ever are for 'doing too much' (which is one of the main impetuses for C-sections to be done in pregnant women in the United States--and I am sure that the United States does more C-sections per capita than any other country in the world) . As a case in point, I personally have a problem with the use of thrombolytics in stroke patients (that I have discussed in thomland elsewhere--but suffice it to say that, despite what the advertisements on TV say, thrombolytic use in strokes is not the same thing as thrombolytic use in heart attacks). However, as a required 'teaching course' from one of the ER companies that I work with, it reported that, while there, indeed, were more severe complications with the use of thrombolytics in stroke patients vs. heart attack patients and that its use in strokes was questioned by even some experts in the field, more malpractice lawsuits were coming from not using the thrombolytics than from using them. And, in any given case, how are you to know when to 'go all out' and when to 'ration for effectiveness'? It's hard enough for the practitioner that is having to handle that case--I'm not sure how any committee or 'expert' not involved in the situation can do it. And, in malpractice cases, a lawyer can always find an 'expert' that favors his position.....

And, if you are going to keep money-making and profits as part-and-parcel to American medicine in any way (vs., like the Mayo Clinic does, just salary all physicians and get the 'money-making incentive' out of it altogether--an option that I am not totally against depending upon how its implemented), you are going to have ways in which the system will be skewed 'to make money' no matter what 'evidence' you base it on. My own mother was free of cancer when she died--but she died of the complications of the treatment. After having gone through what appeared to be a successful chemotherapy regimen, she was convinced by the radiation therapist to have radiation with the statement 'you could not do it and see if it kills you'--in which case, that treatment fried her back and her lungs, gave her tremendous pain, pneumonia and a new cancer in line with the radiation in which subsequent chemotherapy 'controlled the cancer'--but, then, had her have a brainstem stroke that debilitated her and eventually ended up killing her--with, once I expressed my anger to those physicians on how this was managed, they responded with 'we did the standard of care'--and you get sued more often in this business for doing too little than doing too much. So, when it comes to any treatment entity, how do you ever know when the physician is doing it as a 'best possible treatment protocol' and when it is being done 'for profit'. If the profit incentive still exists in medicine, you won't know....and, adjusting that to 'best evidence protocols' won't really change that...as my mother's issue showed to me, 'standard of care' implementations can still kill....

Medicine is not an exact science--and, with that limitation, many things can be skewed. I doubt that all the studies in the world are going to make it 'more exact'. What perhaps the Mayo Clinic was doing (and what was being done at my own training center--Scott & White in Temple, Texas) was more emphasis was being placed on patient education and patient self-management. You aren't really going to get control of any chronic illness, otherwise.

But, your article was right in one respect, 'treatment interventions' are where the money is. Hell, I found that out by one of my patients when I was in solo private practice in a small Texas town about 25 years ago. I charged $15 a patient visit--regardless of the case (but got paid only $7.50 by Medicaid). To make that cost-effective for me, I had to get the money up front from the patient (however, by law, you can't do that for Medicaid patients--you can for Medicare patients) and, then, we gave them the paperwork to file for Medicare (or their insurance companies--however, not a common finding in a rural practice to have an 'insurance patient') for their reimbursement. One patient that I had spent maybe 10 or 15 minutes on scraping off an old-age spot on his face came back to me quite angry over what he was reimbursed by Medicare for that procedure. When I started to explain to him that that is why I have him pay up front, he interrupted me and said that the Medicare spokesperson told him that if I had just billed it under a different code, he would have received an $80 reimbursement (meaning he would have made money off of my procedure on him). So, after that, I 'adjusted' my practice a little and when an old person with an old-age spot came to me, I would just ask them 'You want me to take that spot off your face for you? I can do that in just a few minutes and I'll even bill Medicare for that instead of you.'----Get the idea?

From your article:

The ultimate success of Obamacare might depend on a cultural change among doctors and patients, a national realization that more care isn't better care. "We've got this ethos that the best doctors do everything under the sun and rule out every zebra," Emanuel says. "And hey, they get paid more to do it. But we've got to change all that."

But, if you 'miss a zebra' and someone has a bad consequence from that, you're likely going to be sued. So, how are we to 'restrict that'?

Since some have argued that malpractice lawsuits have 'improved medical care' and since I am sure that the United States has the most medical malpractice cases brought out in the world, by such presumptions, we should have the best care in the world--and we don't. That's why I don't believe that medical malpractice has improved American health care....not to say that there shouldn't be malpractice cases (I have even served as an 'expert witness' in one), but it is to say that, maybe, we should quit looking at malpractice lawsuits as, somehow, 'correcting' American medicine or being used as an alternative income source in these bad economic times....but, that may just be me.....

But, still, many people (including doctors) believe that the most expensive treatment is the best treatment--every time. And, if one person is offered it, why aren't they? sort of thing. And, while I believe education is the key, you get paid a lot more doing something to the patient than you ever do for speaking to that patient. As one (non-interventionalist) cardiologist said in my medical school, 'If you can poke them, stab them, or cut them, you can charge them and it won't matter to most people. However, if you just spend an hour talking to them and they get that bill, they are likely going to protest.' I've even had patients ask me, "Are you a real doctor like Dr. So-and-so (the surgeon)--or are you just an M.D.?'

How are we going to change that?

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Kerry
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I looked over your article, J.J. What seems to be bogus is that the article spends much of its time touting how that clinic in Rochester, Minn., has saved so much money--and, then, adds that it needs more money (which got me to asking 'based on what?'--what their real expenses were or what they wanted to charge?--your article doesn't address that nor answer that question-

I suggest you request all of Mayo Clinic records hire yourself a team of accountants and really get to the bottom of this.

Beyond that... everything else is irrelevant other than Mayo claimed to have lost a lot money on Gov care, Mayo is experimenting with the NO Gov care model and this attempts to explain the thread premise of "Doctors not accepting Medicaid patients". Which is, They lose too much money.

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J.J
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I see that you have no interest in really discussing this issue, J.J. As I said in my first post here, patients that seek medical care in the United States get it--if no where else, the ER. And, as required by law, no hospital that gets any government subsidies from anywhere can refuse to see that patient--and the specialist that serves in that hospital is required by law to cover the ER for any cases that may need his or her specialty. Think about that for a second and, then, explain how the Mayo Clinic is going to go without government care. Is it going to turn back patients that present to the ER's it is associated with? Are its specialists that depend upon hospitalized patients to make their living going to quit covering that ER?

So, the point of the matter still stands. If it's 'not treating the patients that they don't get paid what they want' on, how is that going to be done when, by law, no person can be turned down in an ER and every hospital specialty that practices in that hospital has to cover the ER for any patients that require their care (whether they get paid or not)? Sure, they can extract them from their clinic (so far, that's not covered 'by law'), but, then, when that patient's diabetes or heart disease worsens and they have to go to the ER, what then? Actually more and expensive treatment will be needed at that point making the 'cost of the care' more and expensive--and, unless you are ready to turn them all away at the door to the ER, that will still be factored into the overall cost of American medicine--and, you are right, someone is going to have to pay. Now what?

Do you see the penny-wise-but-pound-foolish point here--or are you just going to spout off something that you, apparently, don't even want to look into--or consider? Or even try to know anything about....

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Kerry
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in wa maYBE 10% ACCAEPT MEDICAID

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FoxMulder
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Man, this is a hard crowd. Let me say it again--IT DOESN'T MATTER WHAT THE PAY SOURCE IS OR HOW IT GETS PAID (IF BEING PAID AT ALL), PATIENTS THAT SEEK MEDICAL CARE CAN GET IT, IF NO WHERE ELSE, IN THE EMERGENCY ROOM. And, as a part of that ER's service AS REQUIRED BY LAW, specialists that work in that hospital have to take turns covering that ER for whenever their care may be needed WHETHER THAT PERSON PAYS OR NOT. That's been the way that American medicine has been implemented ever since I've been in medicine for over 30 years. Any claim (especially by any corporation) on 'not being paid enough' will have to acknowledge AND ADDRESS that point before I will think that anything they say is anything more THAN BOGUS BULLSHIT meant to divert rather than solve....and I think these claims on 'how much money has been lost' is more a diversion than a solution. Until and unless you turn away the low or non-paying patients at the ER, they are going to get medical care--and, of course, someone is going to pay.....NOW WHAT?

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Kerry
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Quote Kerry:

I see that you have no interest in really discussing this issue, .


No I don't.
Just felt compelled to supplement the premise of the thread.

Think about that for a second and, then, explain how the Mayo Clinic is going to go without government care.

They are the Mayo clinic and are internationally renowned company. If they are doing enough to offset the losses incurred by treating gov patients then I sure they will do wonderfully by eliminating that loss. Let alone all the time/staff needed to process Gov care.

Seems to me that the law you’re referring to, especially in a down economy will ultimately bankrupt hospitals. Then nobody will get care. Anybody know what the hospital failure rate is?

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J.J
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Quote J.J.:

Seems to me that the law you’re referring to, especially in a down economy will ultimately bankrupt hospitals. Then nobody will get care.

And, what are you OR THE MAYO CLINIC offering instead, J.J.? Are you saying that patients that cannot or will not pay should get turned away in the ER? I've tried to get anyone that doesn't address this issue squarely as either 'being a right for all' or 'being a privilege for all' to address that question--and most ignore it. It 'does not compute'. But, let me reiterate it, again, everyone has the right to go to the ER for care--and, if a specialist is needed at the time, that hospital has the obligation to offer that care. That has been 'the law' for at least 30 years--and it's been the moral of medicine since any physician that I know can remember. In a malpractice lawsuit, a non-paying patient can sue for just as much as any patient that personally paid the entire bill. With regards to the law, any hospital or responsible physician does not follow the regulation that all patients who presents to the ER gets that care, they both can be sanctioned (ie. 'their license to practice removed') and/or fined up to $50,000 per occurence. IT'S THE LAW!

It was just a little different before Medicare and Medicaid along with the 'corporate insurance policies' took over at the end of the 1960's. Physicians that were around before that said that the physician groups in the community shared in their application of medical care. In other words, they split the non-paying patients among themselves. But, after listening to the older physicians, a couple of points vs. the present set-up were brought up. If a physician came along that didn't want any non-paying patients in his practice, the other physicians in that group would eventually squeeze him out by not referring patients to him, not offering to cover for him when he was gone, etc. And, if a patient came along that was just a deadbeat that didn't want to do anything that the physician suggested but still 'demanded treatment', they were, also, squeezed out when every physician dropped that patient from their practice and, after a while, every physician had dropped that patient. Point is that there is NOTHING in the present 'medical system' that addresses such greedy doctors or deadbeat patients--in fact, in today's third party 'reviews' and medical malpractice set-ups, the greedy doctors (and their 'administrators' by proxy) and deadbeat patients (and their 'malpractice lawyers' by proxy) are the ones controlling it.....

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Kerry
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Jul. 31, 2007 4:01 pm
And, what are you OR THE MAYO CLINIC offering instead, J.J.?

I don't have to offer anything to merely state a reality.

I've tried to get anyone that doesn't address this issue squarely as either 'being a right for all' or 'being a privilege for all' to address that question--and most ignore it.

It's a false dichotomy and I also will ignore it.

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J.J
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Aug. 3, 2010 1:31 pm

Yeah, out you come with another spurious remark of 'false dichotomy'--but, I'll note that you actually didn't answer the question. In any other application of any service that I know government to be involved in, if one group was granted such services without another group getting it, claims of discrimination would be forthcoming--and, rightfully so as far as I'm concerned. Government shouldn't be in the business of offering services to some but not others--any taxpayer that gets excluded has the right to object and see to it that the government does something to correct it. But, not medical care. Why? There is no rational reason for that to be the case except for the 'rationale' that government 'covers the costs' while corporations 'reep the profits' off of the 'general application of medical care in the United States'.

So, J.J., you're right in line with the sheeple accepting that set-up. Don't mind if I object to it, do you? And, do you really mind if I ask you, personally, whether you think everyone that needs medical care should receive it--or not? It's not a 'false dichotomy'--I see it as instrumental in both exposing the fallacies of how we 'think of medicine as a business and a service' and how we should approach solving this issue--all the present fallacies do is have the present corporate-government collusion capitalize on it where 'the costliest' get 'the right' and 'the most profit-making' have to approach it as 'a privilege'.....ignorance like yours is what makes that collusion work....

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Kerry
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Jul. 31, 2007 4:01 pm

Probably time for a "barefoot doctors" program like China set up a few decades back.

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captbebops
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Quote Kerry:

I'll note that you actually didn't answer the question


That is pretty good considering I said I wouldn't

So, J.J., you're right in line with the sheeple accepting that set-up. Don't mind if I object to it, do you?

Are you assuming or projecting, Because I have gone out of my way to not to get bogged down discussing anything with you regarding your health care dichotomy. So how am I "right in Line" with anything... and an Insult to boot.. So go ahead and object to my posting that Mayo claimed to have lost $840 million in 1 year due to Gov care. Knock yourself out.

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J.J
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Quote captbebops:

Probably time for a "barefoot doctors" program like China set up a few decades back.

I'll note that, once again, that didn't answer the question as to whether people that show up to the ER should get medical care or not regardless of whether they pay or not. It really must be such a simple question that the hypocrites are having a hard time thinking around it to cover it up, aren't they?...I know it distracts from their fanfare but I believe that even they understand what 'this reality' is just as much as I do......but, addressing that question squarely isn't 'politically correct' to the con-jobs.....is it?

No, there's no solution to it that doesn't have 'government' in it...unless, of course, they are willing to say that people that need help shouldn't get it (even through the ER) unless they pay for it. But, they don't want that stark a truth to their (hypocritical) 'position' be exposed....

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Kerry
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Jul. 31, 2007 4:01 pm
Quote J.J.:

So go ahead and object to my posting that Mayo claimed to have lost $840 million in 1 year due to Gov care. Knock yourself out.

Well, with regards to thomland, I guess you can post anything that the monitors don't object to--so, be my guest. What I AM objecting to is your rather consistent ignorance on what that statement really means in the context of a system that, by law for at least the past 30 years, 'guarantees access' to medical care if, from no where else, the ER--inclusive of the specialists that, by law, have to cover that ER. Either say that you are against that law and against people having access to medical care unless they pay for it directly--or, if you agree with that law, come up with a better, more equitable, manner in which to fund it. That, I believe, are the rational choices we have before us.

Otherwise, we can continue to 'split the decision' where government still pays for what gets paid for out of the costliest patients--and corporations get to profitably capitalize on the others--exactly like what the financial industries have done in 'privatizing profits but socializing costs'--and, then, somehow, 'blame government' for all of that collusion like the con-job hypocrites that you are....

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Kerry
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Quote Kerry: What I AM objecting to is your rather consistent ignorance on what that statement really means in the context of a system that, by law for at least the past 30 years, 'guarantees access' to medical care if, from no where else, the ER--inclusive of the specialists that, by law, have to cover that ER. Either say that you are against that law and against people having access to medical care unless they pay for it directly--or, if you agree with that law, come up with a better, more equitable, manner in which to fund it. That, I believe, are the rational choices we have before


My "consistent ignorance on what that statement really means". Odd, Could have sworn the statement meant that the Mayo Clinic has lost $840 million on satisfying Gov Care requirement. That In order to save their hospital, their employees and the People that they care for, they have to sever their ties with Gov care. Your EMTALA law is pointless if there are no hospitals around because they all went bankrupt. Medicare/Medicaid is equally pointless if nobody accepts them as patients.

say that you are against that law and against people having access to medical care unless they pay for it directly--or, if you agree with that law, come up with a better, more equitable, manner in which to fund it.

You do know that false dichotomy is also known as the Either/Or fallacy. I am niether for or against either of your false chioces.

Have you ever heard the saying "The road to Hell is paved in Good intentions" that is what I think of EMTALA.

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J.J
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Aug. 3, 2010 1:31 pm
Quote J.J.:

Odd, Could have sworn the statement meant that the Mayo Clinic has lost $840 million on satisfying Gov Care requirement. That In order to save their hospital, their employees and the People that they care for, they have to sever their ties with Gov care.

First off, I'm not sure how THE MAYO CLINIC translates into 'their hospital' (as I've said all along, 'the law' doesn't reach CLINICS, yet). Secondlly, the interpretation of that 'loss statement' that you continue to quote still doesn't take into account that, whether THAT HOSPITAL wants it or not, BY LAW (as has been the case for least the past 30 years), that hospital has to see any patient that comes to the ER for medical care--and offer the level of care needed to solve the problem as it exists at the time of presentation. Now, hospitals can get around at least the spirit of 'the law' if it can be seen that the patient, at the time of presentation, doesn't have an 'emergency case'--but, they still have to accurately evaluate that status at the time of presentation. If an 'emergency case' does exist, they have to treat it to the ability of that institution. That's been the case for at least 30 years. If, somehow, and 'suddenly', that institition no longer can do that because it's 'lost so much money', I suspect something's awry with the manner in which they apply that assessment at this time since that's been what has been going on for the last 30 years. Why now? Why not 30 years ago? Or even 20? Or 10. Why now? I strongly suspect that 'information' is there to be used just as much to distract from as much as resolve to...and, unless more specifics concerning that statement come forth, I see no other way to see it...

Quote J.J.:

Your EMTALA law is pointless if there are no hospitals around because they all went bankrupt. Medicare/Medicaid is equally pointless if nobody accepts them as patients.

You act like something has 'suddenly changed' to change the Mayo Clinic's 'solvency' in seeing all these patients--and, as I've been trying to tell you all along, THAT'S JUST NOT THE CASE. If the Mayo Clinic has within it a 'hospital facility', like everywhere else in the United States, that facility has had to operate under the EMTALA and COBRA laws just everyone else. And, Medicaid patients, every since Medicaid was conceived now over 40 years ago, has always paid less compared to other paying sources (as I related to you, when I was in a private solo practice around 25 years ago, Medicaid paid me half of what I charged--and even stated to me at the time that, were I to want $15/visit for a Medicaid patient, I had to charge everyone else $30/visit--and make them pay that--if I were to get caught acting like I charged them more in the interest of getting $15/visit out of Medicaid, that would have been considered Medicaid fraud). In short, this is nothing new. How this, alone, is blamed for 'all the hospitals closing today', I have no earthly idea why today's medical-financial environment has changed to make that happen now....I suspect 'insider manipulation'....like so many other things that are done by the corporate-government collusion.....

Quote J.J.:

say that you are against that law and against people having access to medical care unless they pay for it directly--or, if you agree with that law, come up with a better, more equitable, manner in which to fund it.

You do know that false dichotomy is also known as the Either/Or fallacy. I am niether for or against either of your false chioces.

The choices aren't false. As I see it, they are fundamental to the manner in which we are to approach changing American medicine since what we have now is not sustainable--the 'privatizing profits as we socialize costs' that has imbedded the taxpaying consumer into an untenable debt crisis just like in the financial markets. The only way out is to decide whether medicine is a 'right-based service' (just like education)--or whether it is a privilege that only goes to those that pay for it. Keeping the way it is is what makes American medicine cost more per capita than any other country in the world--and, most other first world countries have decided it as a right to their citizens and have paid for it, accordingly. However, if you and the Mayo Clinic are 'so much against government payments', then, perhaps you should be more honest about it and state that government is to get out of it and people are to get medical care only if they pay for it at the time. Then, you and the Mayo Clinic need to come up with a solution as to how to turn away patients that actually need medical care that come to the ER--and, of course, that would include trauma patients, kidney failure patients, people who present with life-threatening illnesses, and a whole array of conditions that will have their life or well-being compromised by not addressing it at the time. The idea that 'some' get paid for by government while others may go bankrupt for the same conditions is really NOT a choice--but, so far, that's what the sheeple have been lead to believe is 'the choice' for American medicine--'this reality'....

Quote J.J.:

Have you ever heard the saying "The road to Hell is paved in Good intentions" that is what I think of EMTALA.

So, let me get this clear, does that translate into you believing that people that show up for medical care in the ER shouldn't get it unless they pay for it directly? I'm having a hard time understanding your 'neither for nor against it' position.....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm

I'll answer the question. I think people have a right to medical attention regardless of their ability to pay. A few years back, I saw a flier in a local store with a picture of a 10 yr. old girl on it. Her family was trying to raise $80,000 dollars for a dialysis machine for her. In my mind, I pictured a warehouse with 100 dialysis machines waiting for sale. It was a disgusting thought that the businessmen would sooner see the little girl die than give up the ability to profit off her ailment. I believe the Hippocratic(?) Oath demands that doctors give care to anyone in need, rich or poor. This reflects that throughout history, contributions have been made by many minds to the body of knowledge that doctors have access to. These contributions were made for the purpose of ending human suffering--a historical humanitarian effort. It is deplorable to profiteer off of this knowledge. This is exactly what insurance companies are doing (and, I'm sure, some doctors as well). I also think it is foolish for any government to put decisions regarding life and death of its citizens, and the power that that includes, in the hands of any entity. Any government that doesn't retain that power isn't a government at all. This is exactly what they have given insurance companies, which have become our new, non-democratic government on many levels.

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MarkRoger
Joined:
Jul. 20, 2010 1:50 pm
Quote MarkRoger:

I'll answer the question. I think people have a right to medical attention regardless of their ability to pay


Your pro-slavery?

J.J's picture
J.J
Joined:
Aug. 3, 2010 1:31 pm
Quote Kerry:
Quote captbebops:

Probably time for a "barefoot doctors" program like China set up a few decades back.

I'll note that, once again, that didn't answer the question as to whether people that show up to the ER should get medical care or not regardless of whether they pay or not. It really must be such a simple question that the hypocrites are having a hard time thinking around it to cover it up, aren't they?...I know it distracts from their fanfare but I believe that even they understand what 'this reality' is just as much as I do......but, addressing that question squarely isn't 'politically correct' to the con-jobs.....is it?

No, there's no solution to it that doesn't have 'government' in it...unless, of course, they are willing to say that people that need help shouldn't get it (even through the ER) unless they pay for it. But, they don't want that stark a truth to their (hypocritical) 'position' be exposed....

No, because I was responding to the theme of the topic not to your post. But it abstractly addresses it because IT IS a way to address the problem of accessibility to medical care that one country implemented but Americans are so socialist phobic it would never happen and they also see medicine as such a "high art" they would be afraid of it.

Another way to solve is open the doors of medical colleges much wider. No reason for it to be an exclusive practice. Let's flood the market with doctors.

Not everyone needs to be going to the ER either. A couple years ago I went to the ER to ask where the damn Urgent Care clinic was (tucked away somewhere in the hospital and not properly indicated). Urgent care is not emergency care but what a lot of people should be using unless it truly is an emergency.

And yes people who are in an emergency situation should be treated whether they pay or not. Maybe the answer is you never pay. IOW be like the health programs in other countries. In a different time and economy it might not matter so much. And it will require some major changes in US government and maybe even a new one.

captbebops's picture
captbebops
Joined:
Jul. 31, 2007 4:01 pm
Quote Kerry:

First off, I'm not sure how THE MAYO CLINIC translates into 'their hospital' (as I've said all along, 'the law' doesn't reach CLINICS, yet).


The Mayo Clinic "hospital" was built in 1998, where you ask... Arizona... I was looking at that when I wrote that.. Don't worry, I will not insult you or read too much into your ignorance.

I didn't say they were bound by EMTALA. I said they lost money on satisfying government Medicare/Medicaid requirements. As it states in the article you claimed to have read.

You might also want to bone up on your EMTALA. The law only covers participating Hospitals. If your not covering Medicaid or Medicare patients, you’re not obligated under EMTALA.

I have no earthly idea why today's medical-financial environment has changed to make that happen now....I suspect 'insider manipulation'....like so many other things that are done by the corporate-government collusion.....

You have no earthly idea.. None.. You couldn't even come up with some wild ass theory. Like maybe
“Fifty-five percent of emergency care goes uncompensated, according to the Centers for Medicare & Medicaid Services The amount of uncompensated care delivered by nonfederal community hospitals grew from 6.1 billion in 1983 to 40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured.”

Maybe you’re not trying real hard.

The choices aren't false. As I see it, they are fundamental to the manner in which we are to approach changing American medicine since what we have now is not sustainable

Full blown Communism or Full blown Anarchy. There is a reason it a fallacy argument

However, if you and the Mayo Clinic are 'so much against government payments', then, perhaps you should be more honest about it and state that government is to get out of it and people are to get medical care only if they pay for it at the time.

You are like a Bull in a china shop. Never said I was against Gov payments. If I was against anything, it would be the insufficient payments they make for the care they demand. They force people to cost shift hurting everyone.
So, let me get this clear, does that translate into you believing that people that show up for medical care in the ER shouldn't get it unless they pay for it directly? I'm having a hard time understanding your 'neither for nor against it' position.....

Maybe you should meditate on the quote and ponder its significance and maybe you will understand my position a bit better.

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J.J
Joined:
Aug. 3, 2010 1:31 pm
Quote J.J.:

MarkRoger wrote:

I'll answer the question. I think people have a right to medical attention regardless of their ability to pay


Your pro-slavery?

No. I'm not sure if I want you to explain the need to ask that, but it's an easy answer.

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MarkRoger
Joined:
Jul. 20, 2010 1:50 pm

LOL...
Well, you did say "I think people have a right to medical attention regardless of their ability to pay."

A doctor is a private citizen that has paid for his education, his business, his tools and equipment and in essence you want to force a private citizen to provide a good and service to another without compensation under threat of law.

Sounds like slavery to me. "the state of being under the control of another person"

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J.J
Joined:
Aug. 3, 2010 1:31 pm

We both know that it is possible for a nation to foster a healthcare system in which noone is denied care, and also no doctor is left high and dry for his services. It's being done.

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MarkRoger
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Jul. 20, 2010 1:50 pm
Quote captbebops:

Another way to solve is open the doors of medical colleges much wider. No reason for it to be an exclusive practice. Let's flood the market with doctors.

Sorry if I mistooken your comment as a snide remark. However, if the way in which medicine is financed is not changed, I believe making more doctors will just cost more money--not less.

The two rural hospitals in Texas that I worked in closed--Medicare intended on most small hospitals closing with the mistaken idea that conglomerating physicians into larger institutions was going to somehow save Medicare money. However, what actually happened was that when more doctors were conglomerated into an area, that just meant that more things were done to each patient. As one physician I know once said when his own father-in-law had to be sent to a larger hospital in San Antonio, 'Before the sun sat on that first day, he had ten doctors working on him. Hell, if his big toe was hurting, he had a big toe specialist to tend to it...' (or something like that).

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Kerry
Joined:
Jul. 31, 2007 4:01 pm
Quote J.J.:

I didn't say they were bound by EMTALA. I said they lost money on satisfying government Medicare/Medicaid requirements. As it states in the article you claimed to have read.

You might also want to bone up on your EMTALA. The law only covers participating Hospitals. If your not covering Medicaid or Medicare patients, you’re not obligated under EMTALA.

While you are technically correct in EMTALA only involving hospitals that accept Medicare or Medicaid, I don't know of any hospital in my area that doesn't accept Medicare or Medicaid. And, as far as hospitals go, they cannot pick and choose. If they accept one patient with Medicare or Medicaid, they are under EMTALA laws. And, as everyone knows, most of the elderly are covered by Medicare--if there exists a hospital that doesn't take Medicare, there are very few (if any). In your computer searches, did you read that the Mayo Clinic was going to abandon all Medicare and Medicaid patients in 'solving' their problem?

Scott & White tried to do that 25 years ago--but, it didn't work well for them at all (even though they would, then, be able to charge Medicare patients whatever they wanted--but, you still can't charge a Medicaid patient). Government pays for half of all medical bills now in the United States--and, as I said, that half involves the most costly 20% of the patients, anyway. That leaves the half that insurance companies (and even a few private payers) pay for coming from payments of the other 80% of the population that need it less and, therefore, can be counted on for more profit. Did any of your computer searches disprove that point, J.J.?

Quote J.J.:

“Fifty-five percent of emergency care goes uncompensated, according to the Centers for Medicare & Medicaid Services The amount of uncompensated care delivered by nonfederal community hospitals grew from 6.1 billion in 1983 to 40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured.”

That span of twenty years doesn't take into account that the cost of medical care has exceeded the average inflation rate for every year you are talking about--so, how much of it that depends upon real expenses is hard to calculate--what percentage of uncompensated care was happening in 1983? Your source doesn't say....

And, which would a hospital (and their specialists) rather have--uncompensated patients or Medicaid patients? You do have a rather skewed way of seeing this.

Speaking of which:

Quote J.J.:

The choices aren't false. As I see it, they are fundamental to the manner in which we are to approach changing American medicine since what we have now is not sustainable

Full blown Communism or Full blown Anarchy. There is a reason it a fallacy argument

Is that what you think of public education--that's it's a 'communist manuever'? Are teachers slaves if every child doesn't pay them outright? What bullshit you spout....

Quote J.J.:

They (the government) force people to cost shift hurting everyone.

What does non-paying patients force? So, the question still stands: Are you for patients getting only what they personally pay for? Your replies on this don't really clarify this problem. Do you think an insurance company would 'cover us all' better? I doubt that. I know how a lot of people claim that 'government intervention is rationing'--but, then, if it were up to private industry that only covered the patients that paid, would that, also, not be 'rationing'? I know how that's not asked in the corporate media that covers this--but, then, like you, they're really just there to distract rather than resolve....

Quote J.J.:

Maybe you should meditate on the quote and ponder its significance and maybe you will understand my position a bit better.

No, I haven't figured out what you are going to do with the patients that present to the ER that don't (or won't) pay, yet....can you clarify that position?

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Kerry
Joined:
Jul. 31, 2007 4:01 pm

http://takingnote.tcf.org/2010/04/myths-facts-about-health-care-reform-doctors-who-take-medicare-.html

A lot of myths, some from doctors who have read the reports or plan.

MYTH #1: Reform legislation calls for a 21% cut in Medicare payments to physicians.

FACT: First, the 21% cut has nothing to do with reform legislation. Secondly, it is never going to happen.

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douglaslee
Joined:
Jul. 31, 2007 4:01 pm

MYTH #2: Healthcare reform means that doctors will stop taking Medicare patients.

FACT: This assertion is usually linked to the assumption that Medicare is going to slash all doctors’ fees by more than 20 percent. (See MYTH # 1). Instead, under the reform legislation Medicare will hike payments to many doctors. The AMA lists the increases:

  • 10 percent incentive payments for primary care physicians. All physicians in family medicine, general internal medicine, geriatrics and pediatrics whose Medicare charges for office, nursing facility and home visits comprise at least 60 percent of their total Medicare charges will be eligible for a 10 percent bonus payment for these services from 2011–16.
  • 10 percent incentive payments for general surgeons performing major surgery in areas where more health professionals are needed. All general surgeons who perform major procedures (with a 10- or 90-day global service period) in a health professional shortage area will be eligible for a 10 percent bonus payment for these services from 2011–16.
  • 5 percent incentive payment for mental health services. In 2010, Medicare is boosting payment for psychotherapy services by 5 percent.
  • Geographic payment differentials. In 2010 and 2011, Medicare will make a separate adjustment for the practice expense portion of physician payments that will benefit physicians in rural and low cost areas.
  • In 2013 and 2014 Medicaid payments to primary care physicians will be lifted to match Medicare rates. Today, Medicaid typically pays doctors 30% less than Medicare for the same service. The federal government is providing 100% of the funding needed for states to meet this requirement.

Why don’t we ever hear about the good news for doctors on Fox? Because Fox News is bent on spreading the canard that, thanks to reform, seniors will lose their doctors. The truth is that many physicians will see their incomes rise, beginning next year. Why would they possibly choose to stop taking Medicare patients just when Medicare fees are climbing?

Not only will many physicians profit from increases in Medicare and Medicaid payments, they also will benefit from an influx of formerly uninsured patients who, thanks to government subsidies and new regulations will be able to seek care. Many of these patients will suffer from pre-existing conditions; others will be low-income Americans who may not have seen a doctor for some time.

In Part 3 of Myths & Facts, I’ll discuss how reform will affect Medicare benefits as well as the premiums and co-pays that Medicare patients pay. I’ll also talk about what is likely to happen to patients who are now on Medicare Advantage. In Part 4, I’ll take a close look at the impact that reform will have on hospitals

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douglaslee
Joined:
Jul. 31, 2007 4:01 pm

If you want to talk about 'slavery', take a look at the 'new leader' in 'managed health care'--the Press Ganey scores:

http://ceoblog.pressganey.com/

The key word in that article is the patient's perception of care. And make no mistake about it, that perception of care is now going to be used as the prime way in which hospitals and physicians are reimbursed. This is up against our knowledge as physicians that some of the best physicians with respect to their knowledge and care are the crustiest--sometimes the most abrasive. And, that's not necessarily a bad thing--when it comes to patient compliance, sometimes you have to confront the patient to get them to understand what they are doing wrong. Wonder what kind of 'Press Ganey score' House would get?

My wife (a nursing supervisor) says that these scores are already being used on her workers to gauge their pay scales. Problem with it is that not everything that happens in a hospital is 'fun'--her IV starters received a 3% approval rating on the 'Press Ganey scores'--which, as the new corporate controller, will translate into less pay for them.

And, speaking of Medicaid and Medicare patients, their score counts just as much. Now think about this. Most of the hospital workers are taxpaying citizens. Some of their taxes go to pay for Medicaid and Medicare patients. Now, thanks to the 'new ruler', the Press Ganey scores, those Medicaid and Medicare patients getting that tax money from those hospital workers get to judge how those hospital workers are 'treating them' (not in really performing any real medical treatment but in how they perceive that treatment )--and the hospital workers have no recourse against it. As taxpayers, they are paying for those patients to be able to criticize them--but, they have no way to respond to it--or even, when the real treatment calls for it, criticize the patient.

Only thing hospital workers and doctors will have left to say to the patient is 'Do you want fries with that order, master?' After all, as most hospital administrators have been saying for quite a while now, they are more 'customers' than 'patients'....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm
Quote Kerry:
Quote captbebops:

Another way to solve is open the doors of medical colleges much wider. No reason for it to be an exclusive practice. Let's flood the market with doctors.

Sorry if I mistooken your comment as a snide remark. However, if the way in which medicine is financed is not changed, I believe making more doctors will just cost more money--not less.

Cuba seems to be able to graduate a lot of doctors and supposedly very good ones. If we'd stop wasting our money on foreign wars we'd probably have plenty of money to train more doctors. Though not a doctor I know enough about medicine to think we can probably revise the way it is trained and operated. Again it is a case where capitalism is a poor system to develop such schemes though.

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captbebops
Joined:
Jul. 31, 2007 4:01 pm

white south africans are now denied medical aid in south africa

FoxMulder's picture
FoxMulder
Joined:
Apr. 22, 2010 11:15 am

Foster children are also on Medicaid. It's really a shame that doctors are accepting both Medicaid and Medicare at lower and lower rates. Caring for patients should always be a top priority. I don't expect doctors to work for free, especially with their astronomical student loan debt, but they still need to put patients first. This is the line of work they chose.

FunnyFeminist
Joined:
Aug. 15, 2010 1:12 pm

The Mayo Clinic, I heard, computerized their records to cut down on costs. Computerizing medical records was supposed to have been a part of the Democrat's health care reform.

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Robindell
Joined:
Jul. 31, 2007 4:01 pm
Quote douglaslee:

Secondly, it is never going to happen


Funny... it did happen for 2 weeks. Between July 15th and July 30th whille the House of Reps was on break. worst is. They only funded it through December.

Your right, it was purposely left out of the reform legislation

J.J's picture
J.J
Joined:
Aug. 3, 2010 1:31 pm
Quote Kerry:

; In your computer searches, did you read that the Mayo Clinic was going to abandon all Medicare and Medicaid patients in 'solving' their problem?


You mean other than the story that was posted that said they were making Arizona branch a test case.. NO

That span of twenty years doesn't take into account that the cost of medical care has exceeded the average inflation rate for every year you are talking about--so, how much of it that depends upon real expenses is hard to calculate--what percentage of uncompensated care was happening in 1983? Your source doesn't say....

If your that interested.. Go look "from the Kaiser Commission on Medicaid and the Uninsured"

And, which would a hospital (and their specialists) rather have--uncompensated patients or Medicaid patients? You do have a rather skewed way of seeing this.

Neither, both are losing options. Both are considered "uncompensated patients” only getting paid for half the bill, leaves the other half uncompensated.

Is that what you think of public education--that's it's a 'communist maneuver'? Are teachers slaves if every child doesn't pay them outright? What bullshit you spout

Since when is Education a federal endeavor. I do love when people can't keep state and federal separated when attempting to make a point. Anyway... to finish your point Are doctors State employee's?
So, the question still stands: Are you for patients getting only what they personally pay for? Your replies on this don't really clarify this problem.

And will remain standing.. It’s overly simplistic and ignores certain realities.
No, I haven't figured out what you are going to do with the patients that present to the ER that don't (or won't) pay, yet....can you clarify that position?

I could, but there is no need to. Solve the “Doctors not accepting Medicaid patients” and the Rest is inconsequential

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J.J
Joined:
Aug. 3, 2010 1:31 pm

If the insurance companies can raise their costs at will every year with no State regulators over looking them because the legislators are lobbied heavily, as is California, then the question of keeping costs in line become mute. When your Congress and state legislators have become corporate shills then the democracy has been corrupted by the corporations who can now basically write the legislation and disrupt any change. In California, since term limits took hold, 40% of the legislation comes from private interests, taking president over public interest. Public financed campaigns and doing away with lobbyists by making them illegal would stop most of this.

Dan4liberty's picture
Dan4liberty
Joined:
Jul. 31, 2007 4:01 pm
Quote J.J.:
Quote Kerry:

No, I haven't figured out what you are going to do with the patients that present to the ER that don't (or won't) pay, yet....can you clarify that position?


I could, but there is no need to. Solve the “Doctors not accepting Medicaid patients” and the Rest is inconsequential

Why so evasive, J.J.? I was wanting to see where you stood on the issue to make sure that I'm not being treated as a slave. You did say having to treat non-paying patients was 'slavery', didn't you? So, why not clarify your position here?

The questions are quite simple. The first just needs a 'yes-no' answer. And, then, depending upon that answer, a little explaining by you would be in order so that I can be sure that I'm not being treated like a slave.

1) Should every person coming to the ER be evaluated and seen and, then, treated in the level of care that the emergency assessment requires? Yes or no.

2) If you say 'yes', how should that be paid for?

3) If you say 'no', how do you propose we handle those cases that show up without funds or a funding source?

I know how you appear to like to talk in platitudes but some of us have to deal with reality. You have said that taking care of patients without being paid is 'slavery' and I can tell you that I goddamn sure don't want to be a slave to anyone--or anything. So, in further delineating how this is to be done, I think it pertinent for you to start in the ER because that is where patients that feel they have an emergency go. Saying 'it depends' doesn't answer it--unless you better qualify what you mean by 'it depends'.....Now, can you address my questions squarely or will you continue to evade the issue?

The 'doctors not accepting Medicaid' issue is actually secondary to this point because, as I've said, whether doctors take those cases in their clinic or not does NOT address how they are to be handled when those patients present to the ER--and, as I've said, any access to this medical system gives that patient access to those services (not 'just the ER'--and, also as I've said, even those same doctors if they practice in a hospital at all). So, you really need to start with any access to the medical system--and, for now, that is the ER....but, should it be? After all, I don't want to be considered a 'slave'......

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Kerry
Joined:
Jul. 31, 2007 4:01 pm

webster tarpley 2 years ago said omabama sucks and is a wall st goon and he will flay us alive

south african whites stravtving

i hope you democrats are prude of yourselves -

fys

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FoxMulder
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Apr. 22, 2010 11:15 am

http://www.facebook.com/pages/Webster-Griffin-Tarpley/233477792342?v=info&ref=search#!/pages/Webster-Griffin-Tarpley/233477792342?v=wall&ref=search

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FoxMulder
Joined:
Apr. 22, 2010 11:15 am

It would be helpful to the general puiblic to see an item that details what Medicaid is and isn't.

Doctors who sign up to accept Medicaid patients (and it is entirely voluntary) are only required to meet a certain quota of patients. Doctors are NOT required to treat Medicaid recipients. Period. If you are in need of a doctor, it can be necessary to call around to find one; when youcall, simply ask the answerting desk if that doctor is accepting any more Medicaid patients that month. If not, either keep checking, or try to scedule and appointment for the following month.

Note, too, that doctors are not actually required to provide medical care/prescriptions. It isn't unusual for a doctor to accept a patient visit (for which they are reimbursed), but "conclude" that no treatment/medication is needed, even if it is (since they are often poorly compensated for actual treatment/meds).

If you are new to Medicaid, and surprised by any of this -- well, welcome to the new Third World USA. That's just the way it is. This is necessary to keep Medicaid spending within a certain parameter to prevent to complete "reform" (i.e., elimination) of Medicaid itself.

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SHFabian
Joined:
Jun. 1, 2010 6:42 pm

And no comments about the typos in my post. I have a good excuse (or will, as soon as I think of one.)

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SHFabian
Joined:
Jun. 1, 2010 6:42 pm

it should be understood that a hospital emergency room is not a cost-effective way of providing health care. Some time ago, there were reports about hospitals in L.A. that dumped indigent, homeless patients at homeless shelters or even out in the street.

I am not sure that all hospitals automatically take Medicaid patients, and if they do, if they would provide adequate or ongoing treatment for more serious or complex cases.

There is also the question as to what happens to patients who do not even qualify for Medicaid but currently have little or no health insurance coverage.

If the staff of ERs are tied down with patients who could have been seen in an office setting if only doctors would take them, that could lessen the effectiveness of the ERs in treating actual emergencies.

Former New Jersey Senator Bill Bradley had a proposal which would have supposedly replaced Medicaid with a new program which I assumed would have been more encumpassing in who it included. At the time, I was against Bradley's idea of replacing Medicaid, but today, I think both Medicaid and Medicare are inadequate and should be both replaced with something that is better and more inclusive and with more comprehensive coverage, but the piecemeal approach relying on insurance companies that passed in the name of health care reform is all the politicans could muster support for.

Several years ago, I wrote to the dean of the one medical school of a state university which exists in my state. The dean who, of course, is a physician, wrote back saying that he is doing all he knew how to do, that some doctors who serve lower-income people have to give up income in the process of doing so, and that the country would be worse off if government officials didn't do something to improve health coverage. I was not entirely convinced with his answer as I think the medical profession could work on the high cost of care and do more to control it and make it more affordable.

Washington, D.C. for many years had a public hospital which was an older facility in an older part of town, but the city closed the hospital, despite the miraculous work that was done there and the large number of shootings that take place in the nation's capital requiring emergency care. Howard University Hospital was supposed to be involved with some sort of arrangement to pick up some of the slack from the closed DC public hospital, but I don't know what if anything ever came of that.

Some large cities have excellent public county hospitals with strained budgets. Chicago replaced the historic Cook County Hospital with the John Stroger Hospital several years ago. Voters in Indianapolis voted to replace the outdated county hospital, Wishard Memorial, with a brand new facility. In addition to serving low-income citizens, WIshard Memorial is also a teaching hospital for Indiana University.

Non-profit clinics that provide low-income people with health care are useful and important, but they may not have access to needed specialists. If the current system is not sustainable, the policians, sooner or later, may be back at it. The American educational system does a poor job of teaching people about medical developments, about biology, and about health, and ignorance has made people frightened about improving the financial arrangements of our health care system.

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Robindell
Joined:
Jul. 31, 2007 4:01 pm

i see rich hippies and yuppies instores buying expensive stuff and i cant find dentists

and doctors treat me like shit!!i blame the democrats!! tooth was broken off and i think bacteria built up in thraot f--ing up my general health and no one gives adamn!! luckily its fixed now for a while paid for by money i saved

wait till november!! i dont sense democrats help me and they hate who i voted for and judge me maybe im paranoid and maybe its also true dems are bigots -i think so

i feel im barely alive because of you dems

and dont even get me srtaed about my mental health!!

no one gives a rats ass!!

FoxMulder's picture
FoxMulder
Joined:
Apr. 22, 2010 11:15 am

"No one gives a rat's a--" is correct. The Corporate Party and its two wings, Dems and Repugnants, don't give a rat's a--. Top corporate donors like the Koch Bros. finance the Tea Party smokescreen. They don't give a rat's a-- either. This isn't Scandinavia.

ObamaCare should more aptly be called Care for Health Ins. Co.'s. They are healthier than ever.

The Father of Fascism, Mussolini, called fascism a marriage between corporations and the state. My Congressman negleted to mail me an invitation to their U.S. wedding. Perhaps you received one.

Retired Monk - "Ideology is a disease"

polycarp2
Joined:
Jul. 31, 2007 4:01 pm

Perhaps bills should be read before they are passed?

Dexterous's picture
Dexterous
Joined:
Apr. 9, 2013 9:35 am

Perhaps if Congress had written the 2,000+ page bill, they'd have known what was in it. Health Ins. firms wrote it and presented it to Congress for their rubber stamp. The "real legislature" isn't on Captol Hill.

The Canadian health care bill was 12 pages. It didn't need 2,000 pages of legaleese to insure profitability and loopholes for private insurers. I suspect Candian lawgivers wrote it and thus knew what was in it.

Currently I'm visiting in Colorado. My health ins. plan is only valid in the state of Missouri...in one county. They do things a bit wacky in that conservative state. Even the DMV is privatized. Being extra rude seems to be a part of their min. wage employee training program.

Retired Monk - "Ideology is a disease"

polycarp2
Joined:
Jul. 31, 2007 4:01 pm

Perhaps the American public should vote them out of office for NOT writing the law they passed without even reading, and then exempting THEMSELVES from the plan they just passed and forced onto the public.

Help me again, how many Republicans voted yea for this bill?

Dexterous's picture
Dexterous
Joined:
Apr. 9, 2013 9:35 am

What your GOPimps have been "for" is much worse than the "moderate Republican" wave at health insurance from Heritage, so that these hypocritical ankle-biting cynicis for corporate did not vote for the bill they helped misdesign and load up with corporate pork is not to the point. They prevented anything better from being passed, and that was enough to get them back-slaps from the Privateer Sector as well as some Tea Party juice.

Truly brilliant in the pathological sense of preventing even our shadow of democracy from casting its electoral consequences. So Dex, we believe that Medicaid should be brought up to equality of healthcare and doctors not have to do public service to serve the poor. That they will do lots of this beyond what we establish as the equality bottom line is not to be missed. Doctors go to school to become healers, not money makers, so we just need to treat the bottom end decently to keep healthcare in that basic family value of equality of access and quality.

It is a lot more efficient to cover everybody fully so we don't have to figure out who needs help paying the bills and who is just whining. The equality comes in a progressive tax system where those who can afford more pay more taxes and get equal access to the Commons. Those who cannot afford a dime have equal access to the Commons. Cuts down on administration like nobody's business.

drc2
Joined:
Apr. 26, 2012 12:15 pm

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