<p>“More than 90 million Americans live with at least one chronic illness, and seven out of ten Americans die from chronic disease. Among the Medicare population, the toll is even greater: about nine out of ten deaths are associated with just nine chronic illnesses, including congestive heart failure, chronic lung disease, cancer, coronary artery disease, renal failure, peripheral vascular disease, diabetes, chronic liver disease, and dementia. As chronic disease progresses, the amount of care delivered and the costs associated with this care increase dramatically. Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, with much of it going toward physician and hospital fees (Medicare Part A and Part B) associated with repeated hospitalizations.”</p>
<p>" Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, with much of it going toward physician and hospital fees (Medicare Part A and Part B) associated with repeated hospitalizations."</p>
<p>It is easy to make mistakes. There is a lot of information out there. We all make mistakes. It is hard to keep track. </p>
<p>But, you have to understand there is a reason we get all the information INCLUDING medicare. </p>
<p>Either way, it doesn’t matter to me. I’m in favor of everyone getting care. I just don’t think this particular law is doing anything but help the insurance companies and the costs can only be kept down if you leave out the 30 million or so minimum wage workers it was supposed to cover.</p>
<p>The law doesn’t go far enough. And the reason it doesn’t go far enough is because they are lying about the whole thing and pretending it will make costs cheaper.</p>
<p>As long as you have to be cheaper, then the 30 million still uninsured will be left uninsured. That means the law didn’t even insure half of those it set out to help.</p>
<p>We’re bundling costs in this talk- “care for the elderly, Alzheimers, EOL, chronic,” etc. I’d be curious how those parse out. Some is maintenance, pain management and oversight. Others may be more expensive and, in terms of life expectancy, futile.</p>
<p>I also think we’re not distinguishing between quality of life decisions and reactive procedures. Does grandma really need knee replacement, if she has other viable, humane options and is sedentary? Or is her ongoing contribution such that, yes, it makes sense? </p>
<p>From the Dartmouth: “Most patients defer to their physicians when it comes to deciding what care they receive. When it comes to elective surgery, physician opinion can vary widely as to when the treatment is necessary, and which patients are appropriate.”</p>
<p>Deferring shouldn’t mean abrogation of the need to more rationally participate in decisions. Have the family conversations, have a DNR, make it clear to docs where patient and family draw the line.</p>
<p>Well poetgrl…we are just going to get zapped…</p>
<p>I wrote earlier I dont like the hype. </p>
<p>I dont think we could have gotten where you want to go…</p>
<p>I may want to go to the same place as you but I dont think it is ever going to happen. That is my opinion…</p>
<p>So… I look at what is possible in my opinion…
We have ACA…
I think it is better than what we have now…Not for every single person. Better overall.</p>
<p>I do believe that “Perfect is the enemy of the Good”.</p>
<p>I agree with tom1944. We all have different experiences and that creates or impacts our judgments…</p>
<p>I know many disagree with ACA. I actually dont think that is fine but it is what it is and people have the right to dislike ACA.</p>
<p>"Zoosermom: clinics for those with non-emergencies. Ages ago, young, I had a trip to the hospital and from the ER front desk, they diverted me to a doc in offices attached. The only hook is building them adjacent, in areas where a segment too routinely relies on ER, for things like the flu or a minor wound. Hospitals in my area are highly concerned about the costs they absorb. "</p>
<p>In this area, clinic appointments can take a while to get. The population I work with is a group of adults who are not yet fully literate (which is where I come in). They don’t have the resources and sophistication to make more informed choices (although I am working on it!), so they go where they are familiar, where their needs can be met relatively immediately, and where other resources are available. It is often problematic that private doctors and non-emergency clinics have limited hours of operation because people in lower level jobs have zero flexibility. I am not trying to be combative or political, but I respectfully submit that the people who are most likely to utilize emergency rooms for non-emergencies need more than insurance coverage in order to change long-term behavior. And frankly, from their perspective, the behavior is rational, sensible and works. Why should they change it just to save other people money? New York is very generous in terms of coverage, but many eligible people don’t even sign up when offered assistance to do so. I know that because I often do the reading for paperwork, and my sister in law is the night social worker in our local hospital. Some things are much more complicated than they might seem on the surface, and the resolution isn’t always the most obvious one.</p>
<p>Only 17,000 people in New York have individual health insurance. .</p>
<p>Millions dont.</p>
<p>I find that amazing…</p>
<p>Edit…ok I have to be accurate too… Only 17,000 people in NY buy insurance on their own. </p>
<p>"The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State.</p>
<p>State officials estimate as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals. "</p>
<p>Ideally, we expand the number of clinics. One can wait 3 hours in ER, depending. So, I’m a tad less concerned about time spent in the clinic waiting room. I envision appropriate staffing and committed on-calls. And a low visit charge. What this offloads from ER, which is trying to balance services against the cost of their operation, seems to make this viable. </p>
<p>Your clients go to the familiar; my clinics would be adjacent, same footprint or across the street. </p>
<p>But, yes, it’s problematic, today. Our best known Free Clinic has an application process.</p>
<ul>
<li>I think that 17,000 is only among those not covered by employer plans-?</li>
</ul>
<p>For the population I am talking about, it is not wait time that is the problem. It is having clinics open only during business hours. Generally speaking, if they don’t work they don’t get paid.</p>
<p>In New York, children are covered well up to pretty high income levels, and the parents of those kids often choose to remain uninsured in the event they don’t qualify for subsidized coverage. For many of them it really is a rational and thoughtful decision.</p>
<p>It is a rational decision not to buy health insurance in NY. It is a terrible system. There was mandated coverage and people dont have to buy insurance so you end up with the unhealthy buying coverage and the healthy betting they dont get ill. And the costs of health insurance becomes astronomical under that system.</p>
<p>I think we all know we can argue “rational” and don’t want that segue. But, sure, why buy insurance if you can go to ER and, for a segment, not pay a dime. Then the system absorbs it and, ultimately, we are the system. Each bail out eventually costs us. I’d like to stem the bleeding at the sources. Let’s make first level care available through less costly alternatives. 24 hour, if that’s what’s needed. </p>
<p>I can even imagine some of us using clinics- when I lived in CA, many women of all income levels used women’s health centers for gyn, various services.</p>
<p>I think this data is a bit misleading, because everyone must ultimately die of something. Going back to my father as an example, his cause of death at 89 was “renal failure,” which I guess is considered a “chronic” disease. But his renal failure did not occur until the last few months of his life, so was it really “chronic?” The doctors did actually offer him dialysis treatment for it, but fortunately for us he declined, as it is expensive, wasteful and futile at age 89.</p>
<p>“Looking forward, I agree with you, but what I am saying is that providing insurance alone won’t solve the problem.”</p>
<p>Without having everyone covered (whether by insurance or in some other manner), there are virtually no major problems that can be solved. It is necessary; just not sufficient.</p>
<p>I asked this a while back, but I think it got lost in the quick moving nature of this thread. Am I correct that the subsidies are in the form of a tax credit? Many many many low income people do not pay any tax. So would the tax credit for those people be in the form of a payout, like the EIC?</p>
<p>Z, I know. We need a sea change- not just in what’s available and how it’s delivered, but also the very education you are trying to offer. </p>
<p>What bothers me is this miracle plan is going to cost some folks a chunk of change. It looks like, with calmom’s link, a 28k individual may pay $34/month. At 29k, the subsidies disappear and it’s $4xx/month. Where do they get that? What are their real life options?</p>
<p>axw, not only a tax credit, I think a possible up front reduction. I saw it and I believe calmom mentioned that, in noting her own choices.</p>