<p>No question. But people are understandably uncomfortable with being stats.</p>
<p>BB, I see rationing as a term that’s weighed down by emotions- the fear someone will deny you something. In reality, they’ve been doing the effectiveness considerations for some time. You don’t always realize it. </p>
<p>Same goes for hinting at “death panels.” Conjures up more than it actually is.</p>
<p>"In reality, they’ve been doing the effectiveness considerations for some time. You don’t always realize it. "
-Not comparable. You are trying to compare very informative risk/benefit analysis with something based strictly on cost effectiveness (desire to cut cost will prevail, desire for more elderly die a bit earlier will prevail, it is an ugly truth, but you do not have to believe in it, your right. I do not have to believe, I have lived it and have lost my own mother to this type of “unofficial” policies, I know first hand where health care will be in a very close future - no care for those who needs it crticallty). Make sure to stay healty as long as you possibly could, devote whole ton of effort / money / time into your own health and your family health. It should be a priority under any system. But with the new system, this is much more critical.</p>
<p>Earlier, I mentioned a test that can detect a life-threatening heart condition. It does, in 4% of those tested, and the tests run about 20k. </p>
<p>More important, having the condition does not predict the crisis will come. There is no treatment to prevent that condition reaching a crisis. So, GP said she’d want that test. Does it make sense? She’d learn she has it, take BP meds. And wait.</p>
<p>But, there are other patterns docs look for, to avoid this sort of crisis, in the first place. Since high BP is the distinct #1 contributing condition, our docs treat high BP. </p>
<p>If you have high BP, you (should) take the meds. You should be aware of a whole host of bad things that can come from high BP. Do you need that test? Does your insurer have to pay for it, considering it only detects in a small % and there is no cure? Do the rest of the folks in the pool have to pay for it, so all can be tested? That’s what I mean about research and stats. No one is saying they won’t treat you in ER or that your doc won’t give you BP meds.</p>
<p>Miami, it is not solely about cost slashing.</p>
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<p>Hey, you are just the poster of No.</p>
<p>I think it would be nice if that could be a conversation you have with your doctor and then you decide if you want to spring for payment. I do not think everyone should share the cost of every random test for every unlikely disease for everyone. A lot of that does go on in this plan. It’s the stats problem, again.
But, it is what it is at this point.</p>
<p>"I mentioned a test that can detect a life-threatening heart condition. It does, in 4% of those tested, and the tests run about 20k. "
-I was not talking about these type at all…not even close, I was talking about being neglected with the very common (this days) condition - type 2 diabetise. This one can kill quickly and effectively, in many cases, it is imfection from the simple scratch …or not very clean niddle…
The fact is that the goal is NOT to serve but to be served. With this goal in mind, control is the best weapon. Control over your money (exercised freely against those who fall out of favor) is one level, but control over your health (that will be exercised by exactly the same govenment entity that currently controls your money) is giving much higher degree of control, much, much higher than contorl over money. We have created this system, we cannot change it, now we have to adjust to it. Psychological adjustment is a first step…</p>
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<p>We can change it… All that is required is a little bit of courage and introspection. And maybe a history lesson.</p>
<p>More likely that one of my mother’s specialists can’t ask her to repeat x-rays for an appointment, when she just had them done two months earlier, for another specialist. </p>
<p>“desire for more elderly die a bit earlier” and the suggestion diabetes will be off the approved list-- same issue with phrases that conjure and arouse our fears.</p>
<p>Again, we’re supposed to stay away from comments based on political sentiments.</p>
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<p>Actually, I do.</p>
<p>Many moons ago, I attended a conference on cost-effectiveness, and one of the presenters from a top east coast med school was a GYN expert. Among his slides, were clear and convincing “stats” that if women had more frequent pap smears – they’d catch xx more potential problems before they became medical issues. But as he showed the cost-benefit curve, he suggested that the total (societal) cost would be exorbitant to find those few additional individual marginal cases of cervical cancer. Voila: annual recommendation.</p>
<p>Of course, that annual was recently changed to a three-year rec. No doubt it will result a few more cervical cancers in women who otherwise might have been diagnosed earlier under the annual.</p>
<p>Cost effective for society as a whole, but not so good an idea if it is your wife, daughter, mother who gets cervical ca.</p>
<p>I don’t disagree, in principal. But again, if we allow others to make this personal (that my mother’s diabetes will be off the table, she will suffer and “die early,”) it can mislead. </p>
<p>Remember this thread and its parent fussed a lot over unnecessary tests, the flat out statement docs were out to run up charges, treat you more than you needed, for their benefit. Insist grandma have some unnecessary procedure, so they could rake in the bucks.</p>
<p>Now we get an agency charged with oversight- and some flip.</p>
<p>If cervical cancer runs in a family (or other risk factors apply,) your doc can recommend more frequent testing. Other than that:</p>
<p>" pap smear can cost you anywhere between $50 to $200 without insurance. This all depends on your location and what doctor’s office you go to. You should be able to find an inexpensive doctor to perform a pap smear at your local clinic offices and planned parenthood locations. You can find more information here: <a href=“http://www.womenshealth.gov.”>www.womenshealth.gov.</a>"</p>
<p>“Cost effective for society as a whole, but not so good an idea if it is your wife, daughter, mother who gets cervical ca.”</p>
<p>So the solution is, the government pays for/subsidizes/requires coverage of a test frequency that is best for society given our finite resources. People who want a higher level of investigation than is cost-effective pay for it themselves (out of pocket or through an unsubsidized luxury plan). No one has proposed making it against the law for you to have daily full-body MRIs if you and your physician think it’s a good idea. Obamacare (like Medicare/Medicaid) just sets a minimum standard based on the evidence, improves access to care at that standard, and allows the individual to do whatever they like above it. There will be no shortage of doctors willing to do fee-for-service Pap smears for cash at whatever frequency you like.</p>
<p>“The board does not have the power to enact anything… Does it?” </p>
<p>“Ipab makes proposals if medicare spending increases at a certain rate? Correct? The proposals can be overruled…”</p>
<p>Actually, when you read the law, it is evident the board has incredible powers to reduce Medicare spending and indirectly other health spending if insurance companies adopts its guidelines. When it makes a recommendation, Congress needs a super majority to reduce the recommended spending cut or it can adopt its own spending cut as long as it is not less than what was recommended by IPAB. This for all intents and purposes allows the board to operate almost independently from Congress and even future Presidents. The board is also not subject to the Congressional appropriation process. It receives its funding from the Medicare trust fund. </p>
<p>The board can only recommend spending cuts (which will be very difficult to overturn) if Medicare exceeds a growth rate to be determined by the Medicare actuary, but it is undeniable that Congress gave it extraordinary powers to insulate it from future Congresses and the political process.</p>
<p>It is also interesting to note that with the recent action taken by the Senate to end filibusters for Presidential appts, President Obama will have the opportunity to select the majority of the board for the rest of the decade because the terms are staggered.</p>
<p>People our age need to save our money and be prepared to pay for a lot of our medical treatment in cash.</p>
<p>[Online</a> SHOP enrollment delayed by one year - Jason Millman - POLITICO.com](<a href=“http://www.politico.com/story/2013/11/online-shop-enrollment-delayed-by-one-year-100438.html]Online”>Small businesses hit with ACA delay - POLITICO)</p>
<p>“The Obama administration today announced a year-long delay of online enrollment for small businesses looking to purchase health coverage through federal-run exchanges, another setback for HealthCare.gov.”</p>
<p>Anyone here impacted by this positively or negatively?</p>
<p>EDIT - It sounds like the plan and tax credits are still available through brokers, just not through the website.</p>
<p>This ^ must be considered bad news by the WH or it wouldn’t have been released the afternoon before Thanksgiving when most people are busy traveling or baking and not paying attention to the news.</p>
<p>We just got our small group (DH and myself) rates from Anthem. I am pleasantly surprised. Our monthly premium will go up from $1468/month to $1533, a 4.4% increase. That includes required dental coverage for two of our kids, since they’re under 19. Our OOP maximum is also lower, from $10,000/person to $6,350. It also includes the 2.59% ACA Insurer Fee and the $5.25/month/participant ACA Reinsurance Fee. Huh, interesting - if you take those fees out, the monthly premium is almost EXACTLY what we paid per month in 2013. So there’s a zero percent increase, except for the government-mandated fees.</p>
<p>Other good news - the premium for our 21-year-old son is $228/month (his younger siblings are only $144/month), but he is covered by MaineCare due to his mental illness. So I think I can jettison him from our policy (I was hesitating because it means he’ll have to go to a clinic in a different town to see his psychiatrist every other week, but it’s worth it for 228 bucks a month). Then our monthly premium would be only $1,240/month.</p>
<p>Of course, we won’t get a subsidy if we go this route. I don’t know if it’s worth taking a chance on the exchange or not. If business improves in 2014, we would be in a pickle. We need a crystal ball.</p>
<p>So, with SHOP delayed another year, and small business owners left hanging…this about where it stands…</p>
<ol>
<li>Government workers (Federal, State, Local) all continue on the taxpayers dime.</li>
<li>Medicare (mushroomed by Baby Boomers) continues.</li>
<li>Those not working (by choice or otherwise) will get full subsidies.</li>
<li>Congress keeps their plans with subsidies.</li>
<li>Unions keep their Cadillac Plans at little or no cost.</li>
<li>Undocumented continue to use the emergency room.</li>
<li>Even potential insurance cheats have a field day with no verification.</li>
<li>Young and healthy will continue on their parents’ plan or opt out for a very unlikely $95 fine.</li>
<li> A considerable number previously paying for their policies will now receive subsidies.<br></li>
</ol>
<p>And that leaves exactly WHO to pay for all of this…???</p>
<p>ML - Are you giving trying to enroll through the website then? Sounds like you are probably going with the agent.</p>
<p>Is SHOP applicable to your business?</p>