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promoguy
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July 31, 2009 7:12 pm  

All great government programs you have there in Canada. Americans on a whole tend to have as little intrusion in our lives as possible.


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promoguy
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July 31, 2009 7:13 pm  

Now that is truly a silly comment.. Let's not change anything in health care and guess what.? those folks you're worried about will still have the same programs.


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dougtamjj
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August 1, 2009 2:48 am  

I did my high school term paper on the cause and effects of "The great depression". Same thing going on now times ten.


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islandtyme
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August 1, 2009 1:24 pm  

The big drug companies are a serious problem.....................
I am currently in the states and I can fill my hubby's prescriptions at Walmart or Kroger's and they are just $4.00 each.
We attempted to fill the same prescriptions at a CVS (it's closer) .............TOTAL STICKER SHOCK! the same meds were going to cost over $50!
His meds in STX would have cost me over $60, even Kmart West my lowest price for them was over $50.
I know Kroger's and Walmart are the largest chain stores in the US.......but CVS is on darn near every street intersection of almost every state, so why are their meds so much more???

Another problem is the cost of going to the doctor........just the office visit w/insurance $25, w/out insurance & pay cash $65.......no insurance & pay with check or plastic......rape me for $85.........WTF??

If the gov wants to help me, then regulate prices & stop accepting BRIBES in the form of campaign contributions, then maybe the cost of things will even out & I can afford to get sick w/out socialism.


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East Ender
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August 1, 2009 1:45 pm  

And if you all regulate the drug companies, who are taking all the risk in the market, where do you think the next generation of antibiotics or the first anti-beta-amyloid drug are going to come from?

islandtyme: Do you think it is a good thing to have knowledge of the cost of the services you are receiving?


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Jules
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August 1, 2009 2:07 pm  

$85 to see a professional who spent a quarter of a century in school and training while delaying his/her income a decade beyond his/her peers, forgoing compounded interest on savings, racking up interest on student loans, missing out on normal human activities due to the insane work hours, (as a profession) suffering from a high rate of depression, suicide, divorce, etc, being subjected to unilateral price fixing without being able to collectively bargain on his/her behalf, being told how to practice medicine by administrators and insurance companies, being forced by insurers to provide (sometimes) inappropriate or inadequate care and yet being the person left holding the malpractice bag (when the insurers should be the ones sued), etc...

Sounds to me like the doc should raise his price.

I don't know if islandtyme's post was a complaint against doctors per se or if it was a complaint that the doctor had to charge that much to pay his overhead, but I am tired of seeing doctors demonized as the cause of the high cost of health care. They are not the cause.


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islandtyme
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August 1, 2009 2:29 pm  

The big drug companies get govt & private grants for research and development............not to mention the extra racked in for the over pricing of medicine.....so I think they should have plenty of money for new improved meds.

I know that you can NOT regulate all.......how ever you can regulate the basic services.

When I get my statement from the dr VS insurance & see what is charged to me, what the insurance will pay, what the dr/hospital will accept is insane......many times what the insurance pays is considered paid in full & I do not have to pay the difference.
So if a procedure costs $1000 and insurance pays $300 and that sum is accepted as payment in full............why would I be charged $1000 with out insurance? If $300 covers the bill, then why try to milk me for more than the service is worth.....


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Linda from Michigan
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August 1, 2009 2:30 pm  

And you really think the high price of meds goes ONLY to research for the next gen drugs?!!! Come on! How bout that big dollar advertising they do - open any magazine, turn on the tv. THAT"S where a huge amount of money goes. My best friend worked at UPJOHN's for over 15 years in the R&D library. Oh, the things that never make it to the public about what issues the drugs have!!!!

And if they have all this money coming in for R&D tell me why there is no CURE for anything??? It's because they can't perpetuate thier buisiness venture and make money on a cure - only on keeping illness and disease AT BAY. If they cured a freekin disease who would pay $200/month for 1 prescription - Or like my parents who only pay $5/rx due to decent (expensive) insurance - and between the 2 of them (in their mid-70's on a limited income) still pay over $300 month in prescription costs!!!! And THAT just feeds into the high cost of insurance coverage - along with misused/overly-ordered medical tests and visits. My parents (dad is a long time cardiac patient) go to the doctor every month - because the doctor schedules them that often - no need for it - he's very stable now.

And here's a thought - when the government passes this insurance thing for all - who is going to administer it? And what of all the employees at the current insurance agencies now? Will they continue on? Will they be used for his plan? I admit I haven't looked too deeply into it to get the answers to these questions - but I'm sure one of you have and will enlighten me. Or tell me to google it myself.


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islandtyme
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August 1, 2009 2:39 pm  

Blame is not placed on the dr........just the price structure


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Jules
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August 1, 2009 2:43 pm  

Islandtyme, in your $1000/300 example, the hospital or doctor who was forced to accept the $300 as payment in full may have lost money on that particular service; may have to make it up by hoping that some other insurance or person pays more.

That's how Medicare/Medicaid have worked for doctors. Most doctors I know say that they lose money on Medicare patients (certainly on Medicaid, which pays even less). The only way they can see those patients is to make a profit elsewhere.

With ever-increasing overhead and ever-decreasing reimbursement, I know a lot of docs who can no longer afford to see Medicare and Medicaid patients.

Cost shifting. That's how the system has worked in the last few decades ("worked" is a relative term of course-- I agree that the current "system" is badly flawed and broken). People with insurance provided enough profit for doctors/hospitals to provide care for people without insurance or with inadequate insurance.

There is no longer enough profit to shift-- at least not at the doctor/hospital level.


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Lizard
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August 1, 2009 2:53 pm  

East Ender/Jules/Islandtyme/Linda from Michigan, not one of you are wrong! Paradox to say the least!


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Ms Information
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August 1, 2009 3:04 pm  

Right now there are so many LIES, THREATS and IGNORANT statements flying around, that many good intentioned people are not fully supporting health care reform. The fact is, that our health delivery system is totally out of control and if it isn't changed will eventually make our current economic problems seem like nothing.

People will never totally agree on how to fix it. There are too many special interests at work. I am on Medicare, I love it, I don't want it changed (really good government health plan (tu)). Health insurers want their gravy train to continue to grow(td), Doctors want to protect their income. on and on and on...

But the fact is that we all pay way to much for our medical care and too many people DO NOT HAVE medical coverage at all. Yes, they can get emergency care, but at a cost 10 times what a sensible plan would cost.

All of the scare talk from Fox News and the political bashing from the president's enemies is just that, mostly lies and mostly counter productive to a healthy future for Americans.

It is time for all of us to get behind a plan who's time is NOW.


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dougtamjj
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August 1, 2009 3:09 pm  

I agree we need some change but not unless we are fully informed. Everyone should read this health care proposal. We did not get in this situation overnight and we should not make hasty decisions without knowing all the facts. We need to educate ourselves not depend on government to make all of our decisions or to take care of us.


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Linda from Michigan
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August 1, 2009 3:17 pm  

I agree. We need to avoid the "a bad boyfriend is better than no boyfriend" mentality. If we put a poor plan in place now just to get one in, it has the potential to do harm for decades. Look how long the system we have has been in place - and how degraded it has become.


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Jules
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August 1, 2009 3:56 pm  

Lizard, I agree with your last statement. It's such a complex problem and there are few clearly right/clearly wrong views.

I couldn't resist going to to the Health and Human Services website to search for Medicare reimbursement rates for physicians. Thought I'd share an example:

You have vague stomach pain. It gets worse. You think it will get better. But it gets worse. Eventually at 1 am you realize that you had better see someone and you go to the ER. The ER doc sees you, gets some tests, and suspects appendicitis. The on-call general surgeon is paged.

Surgeon wakes up, gets dressed, drives in. Reviews chart and tests. Talks to you, examines you. Perhaps observes for a while or gets more tests. Decides that you have appendicitis and that you need emergency surgery. Makes a bunch of calls to get the OR crew in place. Waits for crew to arrive. Takes you to the OR, performs laparoscopic appendectomy. Oversees your care while hospitalized. Does tons of paperwork, dictations, discharge, etc.

What does your surgeon make for this work? First, let's review the work: many hours on the day of the problem and in the OR, time seeing you each day that you're in the hospital, and your follow-up office visits to see him are not billable for 90 days (ie, the payment he receives for doing the surgery include 90 days of after care)

Charge for the ER visit/hospital admission: $122.07 (could be as high as $179.51). This is Medicare's VI rate; they pay more in some locations, less in others. It is not negotiable. The doctor's usual and customary fee may be three or four times that amount, but he cannot bill the patient for the balance. He just has to accept the meager rate from Medicare.

Charge for the surgery and 90 days of "free" care afterwards: $529.32

Grand total: $651.39 (or perhaps $708.83 if the admission was complicated).

This is Medicare. Medicaid pays much less.

This is why doctors are afraid of a new system that might pay as little (or less) than Medicare.

And office visits? Here's the VI Medicare reimbursement for a follow-up office visit of low complexity: $36.72 (again, the amount varies per Medicare district. For instance, in Miami that same visit would be reimbursed $40.86)

You might think "well, the doctor only spent 5 minutes with me". Yeah? And then he had to spend 20 minutes or more doing paperwork, filling out forms, etc. And pay his staff. And rent. And bills. And malpractice. And personal taxes. Etc.

The data in this post was taken from http://www.cms.hhs.gov/PFSlookup/

You have to do some research to find the right "codes" for the procedures.

I don't see how these figures can be viewed as reasonable or fair remuneration for such a highly trained professional. Who on earth still wants to be a doctor?

Even if you think that as a patient, those numbers are too high-- do you really feel that the doctor should be paid that little, or do you just want someone else (government/taxpayers) to foot part of the bill?

Again, I'm not saying that health care reform is unnecessary-- I'm just concerned about a government-run system since Medicare and Medicaid are such disasters. If health care reform ends up looking like Medicare, will doctors bail out in droves? Can medicine continue to attract the "best and brightest"?

Howard Dean recently asserted that all physicians should be salaried. Hmmm. Just think about that-- if there was no incentive to doing more work, is the doctor going to add you on to his schedule when it's already full? Probably not. There may be some instances in which salaried positions work well, but as a one-size-fits-all solution I think there would be mass rebellion (mass exiting of doctors).

I'll end this post now but will probably add more as this thread develops. Health care reform is a HOT topic right now so I'm reading all I can about it...

Addendum: one more thought. In this post I focused on the economic reality of Medicare from a physician standpoint. Perhaps the bigger concern is that of non-physicians dictating how to treat patients and what treatments to provide. Whole 'nother topic.


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Bombi
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August 1, 2009 3:57 pm  

An example of unevenly applied healthcare. I had an MRI last year, they always charged @ $800 but last year the cost rose to over $1000.
I enquired why the increase. The response was that the machine was only getting 50% usage so the price was adjusted. I asked for some information to support this and was given the run around for 6 months. Finally after contacting state health officials and my insurance carrier I didn't get answers but did get the bill reduced to the old charge. I recieved a letter from state of maine health officials aking me decribe my experience and copies of my correspondence.

There are all sorts of quirky situations that affect costs


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Bombi
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Lizard
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August 1, 2009 5:03 pm  

Before any decisions are made on Health care. I want my Beer Break with Obama in the backyard of My White House. I would also like to bring my own bartender and server from Hotel on the Cay. They make the Best Frozen strawberry Daq, that could satisfy some of the fresh fruit requirements.


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A Davis
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August 1, 2009 5:19 pm  

bombi:

wow. never mind the article.

check the comments. none of the people riled up enough to comment are for health care reform. a few seem to not have read the actual article, the bill, nor are inclined to listen to anything any government official has to say at all.

medicare and medicaid are socialized medicine and they don't work because they are not worked correctly. is it possible to work them correctly? of course it is. but apparently no one believes it.

can we have the equivalent of an "assigned risk pool" with subsidies for those who cannot afford health care or shall we continue to wait for people with minor illnesses that become catastrophic going to the emergency room and perhaps being admitted to the hospital for surgery or treatment - which we all currently pay for, insured or not?

we have to do something. right now we are doing nothing. i want washington to sit down and work this out. u.s. health care is very sick and in need of reform.


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Ms Information
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August 1, 2009 5:23 pm  

I agree we need some change but not unless we are fully informed. Everyone should read this health care proposal. We did not get in this situation overnight and we should not make hasty decisions without knowing all the facts. We need to educate ourselves not depend on government to make all of our decisions or to take care of us.

That's what special interests have been saying since Harry Truman was president. It is just another way of protecting their money pot.

Yes, I agree educate yourself, the facts have been out there for over 20 years. It is time for us to take charge and run out the boo birds...


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Linda from Michigan
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August 1, 2009 5:49 pm  

Someone just emailed me this - haven't checked it out yet - but yes - if they are gonna force something upon us - they should be willing (and obligated) to fall under the same provisions we have.

[Congressman John Fleming ( Louisiana physician) has proposed an amendment that would require congressmen and senators to take the same healthcare plan they force on us (under proposed legislation they are curiously exempt).
Congressman Fleming is encouraging people to go on his Website and sign his petition (very simple - just first, last and email).

I have immediately done just that at: http://fleming.house.gov/ . Please urge as many people as you can to do the same!

If Congress forces this on the American people, the Congressmen should have to accept the same level of health care for themselves and their families.]


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promoguy
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Posts: 436
August 1, 2009 5:59 pm  

Cure..........not sure about that.

Ask someone with HIV whether they'd be dead today without the drugs they take. You seem to have a short memory and forget that HIV at one time was almost a death sentence.


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promoguy
(@promoguy)
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August 1, 2009 6:03 pm  

Office visit for $85.00 isn't so bad. Do you have car insurance? Do they pay for your lube and oil? No I don't think so. Look at health insurance as a true benefit when you have major health catastrophe. Before I got on Medicare this past June I had a 2500.00 deductible. I was protecting myself against major health issues.


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promoguy
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August 1, 2009 6:06 pm  

If medicare and medicaid are as screwed up as you think they are, and I agree, why would you think this would all get better with the government taking over health insurance.

And how about some other options to lower cost. How about tort reform? Hard to happen when the trial lawyers are one of the biggest donors to the Dems. How about insurance companies having to compete across state lines? Those are starters and don't involve the government being the provider.


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Linda from Michigan
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August 1, 2009 6:23 pm  

No short memory on my part. I have no problem with palliative treatment. I have 2 friends who died from complications from AIDS. I agree it is necessary, but do you really believe "they" don't have a cure or potenial cure cooked up somewhere but don't make it known for financial reasons?

The ones that get me are the "newer and better" drugs they come out with for Fibromyalgia, diabetes, cholesterol, asthma, etc. Ones that you are convinced you need to be on forever - month after month after $$$ after $$$$. There are proven ways to non-pharm alleviate these conditions down to a normal or near normal level without paying out all that dough. But do doctors talk about them regularly with patients? No - because they are following big pharm.

I spent 40 days one year as an in-patient at University of Michigan Hospital for my asthma. I was on 4 inhales and 2 meds. They came in one day and said, here - take this. This is the newest inhaler that will alleviate your symptoms. I said - ok - what are we taking me off of? The reply was - Nothing. You use this along with the others. I was like - WHAT???!!!! If it is the latest, greatest - why do I have to add it to what I'm taking now. I was told that's how it is prescribed. I ended up within 3 months weaning myself off everything and using a rescue inhaler only occassionally. I haven't used that even in 4 years at least. So - how was it I needed to be on all that stuff - and to whose benefit? The meds made me have diabetes problems, heart palpatations, and immune suppressive issues.

Think about how little time most doctors allow for each patient when scheduling. At quite a few doctors I've been to if you need as little as 15 minutes with the doctor you have to schedule a special appointment time - and they charge extra for that. There are people (my parents) that won't take even a vitamin unless the dr tells them. They truly (blindly) believe that the doctor has their best interest at heart (which most do ideally) but don't realize that the dr is rushed and human and may not be understanding the situation or concern. They aren't the know all, be all they were once upon a time when I was a kid. And don't think I am anti-physician - I was pre-med in college but was turned away as I saw back then the tides turning where Physicians were owned either by the Hospital or the Insurance company.

[Source is quoted below:
What is the average amount of time a patient is allowed to speak
before their physician interrupts them?

?? Physicians typically wait only 23 seconds after a patient begins
describing his chief complain before interrupting and redirecting the
discussion. Such premature redirection can lead to late-arising
concerns and missed opportunities to gather important data?

Source:
JAOA ? Vol 105 ? No 1 ? January 2005 ? 13-18
CLINICAL PRACTICE
Patient-Physician Communication: Why and How
http://www.jaoa.org/cgi/content/full/105/1/13 ]


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