Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Of course OK, Tincup.
I just wanted to make sure people understand the reason the legislation talks about guidelines and that it doesn't come from a desire to control nor a desire to impact Lyme treatment.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
Those are government employees whose sole purpose in life is to regulate insurance companies.
You have no understanding of just how regulated the insurance industry already is. If it isn't fair, change the laws. That simple.
If insurance lobbyists are preventing the rules from changing then we have a corrupt government.
Nomoremuscles,
If you go after the real villan, the cost of medical care (that is not ins premiums my friend) then you will eliminate the need for insurance except when catastrophic illness occurs to the extent you can't work and must have help paying all your bills including your medical bills.
That is the purpose of insurance, but greedy America wants insurance to pay for everything and greedy America doesn't care that the drug cartel is charging extortionists rates.
You don't care because you don't pay. Your insurance company pays, so you get mad at them for not covering everything.
Go after the real villans and wake up to how corrupt our government is.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
posted
PS: Quality medical care is not determined by how much you pay for it. In other words, more expensive does not equate to better care.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Luvs,
I do know how under-regulated the poor insurance companies are.
I know that link you provided is to state level commissioners. I know a federal law, ERISA, exempts most employer provided coverage from all state regulations.
I know that ERISA exemption means a laws passed in a state like Rhode Island that requires insurance companies to pay for Chronic Lyme treatment is exempted by ERISA which means it does not apply to any employer self-funded plan so many people don't have that protection.
I know that even if we reduced the cost of medical care, we couldn't reduce it to the point that many Americans could afford access to regular care necessary to treat chronic illnesses because prescription drugs are only 8% of the cost of medical care and it costs a whole heck of a lot to run a doctor's office.
I know those "extortionist rates" you reference amount to only 8% of medical costs in the U.S. so even eliminating all drug costs would still keep health insurance unaffordable.
I know that health care costs would decrease if everybody had insurance that paid for preventive care and chronic disease care because fewer people would end up in the hospital. Fewer people would also end up on social security which would save tax dollars.
Don't tell me what I don't know. I know a heck of a lot about how our health insurance system works and how it is regulated.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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posted
Problems with guidelines are just that, they are guidelines only, not supposed to be followed as gospel. But they are, why would you think this only happens with LYME?
Every person is unique with different genetics, different response to medications, different metabolism. A tumor causing my hypertension was missed BECAUSE the docs were following guidelines instead of "THINKING" for themselves.
Meds didn't work for me so we just kept adding more meds "according to guidelines".
No one treatment works for everyone, what you say about asthma and diabetic guidelines isn't true. Docs follow them but the guidelines themselves can be outdated. They don't keep up with current research. Often don't stress things that might be causing the asthma, like allergy, but promote use of medication, medication and more medication.
Sometimes, really most times, the older medications would work just fine but newer meds are pushed as more effective. Just why is that? Newer meds have patents which make generics unavailable. Drug companies make more that way.
Big Pharm is involved in making many of these "guidelines" and in sponsoring "studies" which "prove" their treatments the most effective.
Also they sponsor studies showing natural hormone replacement is dangerous, vitamins and other supplements do not work...
Then guidelines are made from these studies
Preventative care was stressed by the HMOs. I had the best preventative care available but still am sick.
I had 52 doctor appointments in 2005 and was headed in the same direction in 2006 because no one found a tumor on my adrenal because they were following guidelines not looking at and listening to me...called me non-compliant because I refused to take any more meds and wanted testing done.
Docs love to follow guidelines, it takes thinking out of the process and gives them cover when the patient doesn't improve or worse yet, dies. Hey the guidelines were followed, don't look at me!
I worked with these "guidelines" every day of my nursing career. I saw patients dismissed because nothing was working for them while following these guidelines
I also saw the other side, with some people you can give them info on diet, exercise, use of meds, send them to nutritional counseling etc and they will still not do a thing to help themselves, not take their meds as ordered, not keep their blood sugar in a good range, eat the way they want no matter what.
No amount of "preventative" care or long term care for chronic illness will help them
I saw parents constantly refuse to follow the sick and well asthma plans I wrote for them to use with their children, how the dog or cat had to stay, the windows had to be open and no air conditioning used so the kids would still end up very ill from their asthma year after year.
How do you fix that? More money won't help it.
Posts: 130 | From Central NY | Registered: Jul 2009
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seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
Luvs, What do you do for a living?
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
Toots (or anyone else, for that matter)
why do you think private insurance companies could not compete with a Public Option insurance plan administered by our government?
Aniek- i had completely forgotten that nasty part of ERISA- that it exempts employers from having to pay health insurance....
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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posted
The government would offer lower rates on the public plans because they have unlimited monetary resources.
The employer would decide it was cheaper to pay the penalty imposed on them by the government for not offering insurance and stop offering it to their employees who then would be forced from the private plans into the public.
The private plans would have fewer participants thus have to increase the cost of premiums....they cannot get money from the air like the government does
Posts: 130 | From Central NY | Registered: Jul 2009
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quote:Originally posted by Need Lots of Help: As a child my father said I would argue with a stop sign,
Now, that's funny!
Thanks.
Posts: 845 | From Eastern USA | Registered: Jul 2006
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sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
renee-
nothing is finalized about the plan, but right now there is a provision that would exempt over 80 percent of small business employers from any penalties.
in theory, the point of a public option plan is to provide competition to private insurers, now essentially a multi-headed monopoly.
isn't competition a good thing?
also--leaving aside how much money our government does or does have.... only the x amount of funds that are budgeted for a purpose can be spent-- the faucet doesn't stay on.
IF a reform plan passes, and IF it doesn't do what must be done- including reining in overall health care COSTS (editing typo) there won't be a politician in DC who will climb back on that sinking ship. much less ask for additional funds for it.
[ 08-03-2009, 11:19 AM: Message edited by: sometimesdilly ]
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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posted
I have never for the life of me heard that by introducing an additional plan from which to choose would actually create less choice.
That is what this country is all about. Having choices. Right now, there are no choices for many, many people.
Bottom line is competition is competition and will only help to reduce cost so long as there is a market for the product. The product here is healthcare and there is a growing market day by day. Our country is growing in number and more and more need care.
If everyone agrees that we want everyone to have coverage than that is a step in the right direction, however the private sector has never cared about that in the past and did not come down on their prices.
I am including in this statement not only Insurance agency's, but also Big Pharm and the medical business to. They have had years to offer a viable plan and affordable prices and have done nothing but sucked everyone dry.
I do think view points are changing daily. Just the other day a friend of mine who was very against the government getting involved two months ago lost her job and is now concerned that when her cobra runs out what will she do????
She did a complete 360 because she does not have much savings(she has a little bit, but not much if something major was to strike) due to working a job that doesn't pay tons of money.
She researched what private insurance costs and is in total shock .
Now, she sees how scary it's for a woman who has worked in a respectable job all her life(but isn't wealthy) to be faced with this horrible situation.
Funny how when she walked in the shoes of someone else for a moment how quickly her direction changed. This is not some free loading bum, but rather a hard working wonderful community member who is devastated by her world being turned upside down.
I also agree with dilly's above post. If it passes and does not help overall health care, you can bet your bottom dollar that there will be no one signing on next round.
I am sure the plan won't be perfect, but something must be done. Staying idle certainly has not worked and there have been many years where other offers could have been put on the table and there was not one.
I respect this president and administration for at least trying.
-------------------- aka: Lyme Warrior
In order to do "real" science, you have to have a "real" conversation with nature.
Well Behaved Women Rarely Make History!
"Just Demand your Rights" Posts: 869 | From nor - cal | Registered: Apr 2008
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luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
posted
Of course you guys just keep talking about reducing the cost of health insurance.
What about the cost of medical care?????????????
Holy cow. I wish they would just remove the insurance option from everyone so everyone would focus on the medical cartel.
And the thought that a failed government program will be abandoned has me rolling on the floor laughing.
Look how many programs are in the red right now.
Government is not a for profit business, therefore, they have never had to be profitable. They just force us to pay more taxes.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Dilly - it's not that ERISA exempts employers from having to pay health insurance. There is nothing at all that requires employers to pay health insurance. But ERISA exempts most employer plans from state regulation. Everybody thought the federal government would come in and regulate those plans, but they pretty much haven't except for very few issues, like when Clinton passed the bill requiring hospitals not to kick women out of the hospital right after giving birth.
Renee - If you don't have employer insurance, you can still buy private insurance. It's not going to be employer insurance or the public plan.
And I don't understand what you mean by saying the government has unlimited resources. Do you really think the government is going to price the public plan less than it actually costs and lose money on the premiums? The public plan will be priced at the cost of the estimated claims calculated by an actuary (just like the insurance companies do) plus the cost of administration (which won't include profit like an insurance company does) plus there will probably be something for reserves (which insurance companies are legally required to do).
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
quote:Originally posted by luvs2ride: What about the cost of medical care?????????????
Please share with us how we can reduce the cost of medical care to where it is affordable for everybody without insurance.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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kelmo
Frequent Contributor (1K+ posts)
Member # 8797
posted
Under Obama's health plan, euthinasia is covered.
Posts: 2903 | From AZ | Registered: Feb 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Lies said.. "Funny how when she walked in the shoes of someone else for a moment how quickly her direction changed."
Good point!
BTW- I heard yesterday that the insurance industry is backing this bill.
Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Kelmo, there is misinformation being dissimanted around about the bill as it relates to end of life care. I received an email from the American Pain Foundation about this.
The bill includes Medicare reimbursement for doctors to talk to their patients about their end of life wishes. This means that time a doctor spends talking to a patient about options like what conditions they would want to be on life support or be resuscitated can be reimbursed. Patients do not need to have the conversations. The reimbursement is limited to once every 5 years.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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posted
- "If you don't have employer insurance, you can still buy private insurance. It's not going to be employer insurance or the public plan._
that is the problem, you cannot just buy into a private plan as cheaply as an employer sponsored plan. If you could why are so many without insurance?
As for how will the public plan be cheaper...more people in the plan, less cost for premiums per person.
The government plan will be nationwide, the private plans vary from state to state with different costs, rules and regs.
I am a member of a Nationwide BCBS PPO but have to deal with the office and claims people at whatever state or district my labwork, office visit etc is done at...I have dealt with claim reps all over the country.
I agree that should stop but no where in this proposed bill do I see opening up the insurance market so people in any state can get any insurance offered anywhere.
Costs state to state are different unless you are in a Federal Plan...
As for the government having unlimited resources, they can tax at will and print money at will.
Private enterprise can't do that I can't do that
If a private insurer starts to loose money they shut down
If the government plan looses money they take it from somewhere else
Posts: 130 | From Central NY | Registered: Jul 2009
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There are FOUR healthcare Lobbyists for EVERY MEMBER of Congress! This is going to be like "defeatng the Emperor", BUT we are "THE PEOPLE", and if we band together, we will have power in numbers.
"Health providers, insurers and pharmaceutical companies have taken multiple approaches to winning over the federal lawmakers shaping the legislation.
The health sector boosted its campaign contributions compared to the last presidential cycle, to $167.7 million in 2008 from $123.7 million in 2004.
The various health industries have also steadily increased their lobbying efforts, from $448.1 million in 2007 to $484.4 million in 2008.
So far this year, the sector has paid lobbyists $126.8 million to do its bidding on Capitol Hill. And those expenditures will only increase as the chairs of the five main committees working on health care legislation continue to iron out the details:
Will the plan include a government insurance option? Will Congress mandate that all individuals, including the 47 million that are currently uninsured, purchase health insurance?
And where will the money come from to pay for the reforms?
The health sector--which includes some industries that are diametrically opposed to one another in their answers to these questions--
eclipses all other sectors but the financial sector in lobbying spending since 1998, putting $3.4 billion into its efforts."
-------------------- "SEVEN LYME FACTS THAT COULD HAVE SAVED ME" VISIT ME AT:
luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
posted
Lymelearned said:
"Health providers, insurers and pharmaceutical companies have taken multiple approaches to winning over the federal lawmakers shaping the legislation."
Doesn't this prove our government is corrupt? Why are the politicians taking bribes? Why is lobbying allowed?
Cottonbrain,
My mother loves her medicare too, so I ask "why don't we just expand eligibility for medicare and medicaid?" Why do we have to scrap them and start with a new "insurance" plan? And why is it the insurance companies are onboard with this government plan? They are you know.
I saw the Bill Moyers show. I really like him. Here is what struck me about the show.
Why weren't the surgeons and the hospital brought before a review board for allowing the young girl to die when they had the power to save her life? Why didn't they offer to do the surgery at a reduced cost the family could afford?
Why did the lady with breast cancer have to put up a $30,000. deposit on surgery? The entire surgery should not cost more than that.
Why isn't anyone mad about the outrageous fees being charged for medical care?
Each of the insurance execs when asked if they would rescind their denial of payment, said "No. We acted within the law." And they are right.
The government completely controls insurance companies. I repeat "The government completely controls insurance companies." All the government has to do is change the rules and the insurance companies have to comply.
This is a government organization that controls insurance companies. Go look at the rules and regulations for your state. This isn't right wing propaganda. This is truth.
We are focused on the wrong enemy.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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