PDA

View Full Version : ObamaCare effects Medicare



Steve Hester
11-26-2010, 05:56 PM
Relative who is an Oncologist is very upset with Medicare right now. He has a new patient who has stage 4 cancer, who SHOULD be covered by Medicare. But Medicare has said they will not pay for Chemo treatment for this patient, but will only pay for Hospice Care when it is needed. And they swore they wouldn't make decisions about who lives and who dies!!!
Osama and crew are not only liars, but who the hell gave them the power to play God?

Pals
11-26-2010, 06:02 PM
Just found out that one of my church members, young mother of two, diagnosed with cancer will not be covered by medicare or any state program for treatment. She lost her job, boyfriend left her and now this. No chemo, no radiation, no hope. It makes me just sick, time for some serious fundraising at our church.

dnf777
11-26-2010, 06:34 PM
Sounds like both of you are making a plea for universal coverage or a public option??

Why don't they just buy health insurance? (I know why, I'm just making the point that our current system is broken)

The problem with Obama's plan, is that the blue dogs and republicans didn't let it go far enough....so that the two above mentioned people would be able to receive the care they need.

Its a shame that those situations are allowed to occur in the USA.

You two seem to blame Obamacare for the above cases. What would they have done a year ago? There have been no changes in eligibility for medicare since the new law went into effect based upon diagnoses.

Buzz
11-26-2010, 07:09 PM
My beef with Obamacare is the same as Dave's. It did not go far enough. I think you will be hard pressed to find any documentation to show that Obamacare has impacted in any way these poor lady's access to cancer treatment.

What passed bears a striking resemblance to what Republicans were proposing back when Clinton took a stab at it, including the mandate. But now it's cast as some kind of socialist takeover of the economy.

I am so weary of this debate.

sinner
11-26-2010, 09:35 PM
any of these folks live in Arizona? Take a look at what the Gov and politicos are doing to the poor, elderly and uninsured. Death squads in Arizona!
Also what do you think the average income for an Oncologists is? $600,000 but that was before Medicare stopped them from being the vendors for chemo drugs. That cut the income by about $250,000 and a number of them are dropping out of their practices they just can't make it on so small an income.
Health care is a mess!

Steve Hester
11-26-2010, 09:52 PM
Sounds like both of you are making a plea for universal coverage or a public option??

Why don't they just buy health insurance? (I know why, I'm just making the point that our current system is broken)

The problem with Obama's plan, is that the blue dogs and republicans didn't let it go far enough....so that the two above mentioned people would be able to receive the care they need.

Its a shame that those situations are allowed to occur in the USA.

You two seem to blame Obamacare for the above cases. What would they have done a year ago? There have been no changes in eligibility for medicare since the new law went into effect based upon diagnoses.

And it doesn't have anything to do with eligibility, it has to do with changes in what Medicare will no longer pay for.

The case I'm talking about is a current diagnosis, just in the last couple of weeks, so yes I can blame it on Obama Care.:rolleyes:

I just don't think you get it. The Oncologist said a year ago, Medicare would have covered the treatment.

dnf777
11-26-2010, 10:07 PM
And it doesn't have anything to do with eligibility, it has to do with changes in what Medicare will no longer pay for.

The case I'm talking about is a current diagnosis, just in the last couple of weeks, so yes I can blame it on Obama Care.:rolleyes:

I just don't think you get it. The Oncologist said a year ago, Medicare would have covered the treatment.


I can't get into a detailed discussion with you on this, neither of us knowing the particulars. I can tell you however, that some changes and limits needed to be put in place.

I will use the extreme example of an otherwise healthy 90 year old with a failing heart. (yes, that situation does exist)
Should medicare pay for a heart transplant? Of course not. That's an easy one. But where do we draw the line? There are very complex formulas used by the bean counters to calculate, based on population statistics, the "cost per year of life saved" for various diseases and treatment options.

To a doctor or a patient, that sounds cold and cruel. But unless there are enough dollars for everyone to get everything they need, it is a harsh necessity. Again, without going into details neither of us is privy to, I would guess the above examples were experiencing just that, on the wrong side of the bottom line.

You shouldn't be surprised though. Many conservatives have been ridiculing medicare and every other gov't agency for being inefficient and imcompetent. Now that they are adopting the same "efficient" business practices of the private insurance companies, they are getting criticized for being death squads. Can't have it both ways.

YardleyLabs
11-27-2010, 05:47 AM
Relative who is an Oncologist is very upset with Medicare right now. He has a new patient who has stage 4 cancer, who SHOULD be covered by Medicare. But Medicare has said they will not pay for Chemo treatment for this patient, but will only pay for Hospice Care when it is needed. And they swore they wouldn't make decisions about who lives and who dies!!!
Osama and crew are not only liars, but who the hell gave them the power to play God?
Having gone through this with my father, I suspect that the patient had previously signed up for the hospice care option under Medicare to obtain coverage for personal care services. If life expectancy is less than six months, Medicare offers patients the option of hospice care , including a wide range of support services in the home that are normally not covered. If you sign up for this, you must also agree that you lose eligibility for all other medical services that are not simply palliative. No chemo, no radiation, no rush to the ER, etc. As the flier provided to my father said, "Death is not an emergency. Please call xxxx when the patient dies and we will assist in making necessary arrangements." If you call, they advise you to contact a funeral home, they then have their physician issue the death certificate, and arrange for pick up of any rented medical equipment, while also filing notices with medicare and canceling other scheduled services. Altogether, it is a great service, but not one to enter into until you have accepted that you will do nothing further to delay death. Medicare does not withhold reimbursement for treatment services simply because the patient is going to die anyway except when this waiver has been signed.

EDIT: BTW, my father died in 2003, so this has nothing to do with Obamacare.

Buzz
11-27-2010, 08:38 AM
From Wikipedia:


Effective at enactment

The Food and Drug Administration is now authorized to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed.[52]

The Medicaid drug rebate for brand name drugs is increased to 23.1% (except the rebate for clotting factors and drugs approved exclusively for pediatric use increases to 17.1%), and the rebate is extended to Medicaid managed care plans; the Medicaid rebate for non-innovator, multiple source drugs is increased to 13% of average manufacturer price.[52]

A non-profit Patient-Centered Outcomes Research Institute is established, independent from government, to undertake comparative effectiveness research.[52] This is charged with examining the "relative health outcomes, clinical effectiveness, and appropriateness" of different medical treatments by evaluating existing studies and conducting its own. Its 19-member board is to include patients, doctors, hospitals, drug makers, device manufacturers, insurers, payers, government officials and health experts. It will not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment. Medicare may take the Institute’s research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input. [53] The bill forbids the Institute to develop or employ "a dollars per quality adjusted life year" (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended. This makes it different from the UK's National Institute for Health and Clinical Excellence.

Creation of task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.[52]

The Indian Health Care Improvement Act is reauthorized and amended.[52]

Steve Hester
12-02-2010, 07:52 AM
Having gone through this with my father, I suspect that the patient had previously signed up for the hospice care option under Medicare to obtain coverage for personal care services. If life expectancy is less than six months, Medicare offers patients the option of hospice care , including a wide range of support services in the home that are normally not covered. If you sign up for this, you must also agree that you lose eligibility for all other medical services that are not simply palliative. No chemo, no radiation, no rush to the ER, etc. As the flier provided to my father said, "Death is not an emergency. Please call xxxx when the patient dies and we will assist in making necessary arrangements." If you call, they advise you to contact a funeral home, they then have their physician issue the death certificate, and arrange for pick up of any rented medical equipment, while also filing notices with medicare and canceling other scheduled services. Altogether, it is a great service, but not one to enter into until you have accepted that you will do nothing further to delay death. Medicare does not withhold reimbursement for treatment services simply because the patient is going to die anyway except when this waiver has been signed.

EDIT: BTW, my father died in 2003, so this has nothing to do with Obamacare.

You suspect wrong. You guys simply can't even imagine that the government is now playing God with people's lives. I guarantee you this will happen more and more until it finally makes the news, then people will believe.

M&K's Retrievers
12-02-2010, 08:14 AM
You suspect wrong. You guys simply can't even imagine that the government is now playing God with people's lives. I guarantee you this will happen more and more until it finally makes the news, then people will believe.

Never will until it happens to them. :(

YardleyLabs
12-02-2010, 08:43 AM
You suspect wrong. You guys simply can't even imagine that the government is now playing God with people's lives. I guarantee you this will happen more and more until it finally makes the news, then people will believe.
As with private insurers, Medicare doesn't determine what medical care you may receive, it simply says what care will be reimbursed by tax payers. There are fewer exclusions from coverage under Medicare than under almost any private plans. However, Medicare has a responsibility for excluding coverage for services that are not reasonable and necessary. Many businesses, of course, have based their entire activity on providing unresonable and unneccesary services to Medocare patients at public expense (e.g. companies offering to give you motorized scooters with no charge if they can't get Medicare to pay). The bill for "Obamacare" included projected savings from Medicare through several specific activities: eliminating subsidies to insurance companies that provided them with special subsidies for offering supplemental service programs, price negotiation for medical equipment and supplies and drugs, and better enforcement of restrictions on unreasonable services. Very few changes have happened so far. The biggest has been high rate increases or termination by many insurers of Medicare Advantage programs. The termination of those subsidies was not based on a belief that these programs were not good. Rather, the cost of the program was extremely high even though few people participated. If the number of people using the programs had grown as projected, Medicare would have been completely bankrupted. Since no one was prepared to ay the cost of extending these benefits to all, the decision was made to eliminate the benefit altogether, saving tens of billions of dollars. Little has been done with respect to other provisions of the plan. However, most agree that reasonable and customary limits on services are critical (similar restrictions have always applied in both private and public plans). However, one person's "waste" is always another person's "living", making controversy inevitable. Itis impossible to tell, from the description, whether or not the decision being referenced has anything to do with "Obamacare" or if the decision is reasonable. Unfortunately, a lot of medical care is given simply to create the illusion of being helpful in an otherwise hopeless circumstance. If better control reduces that abuse, we will all be the beneficiaries.

TN_LAB
12-02-2010, 06:32 PM
Are we talking about a Medicare decision or a decision made by a Medicare Advantage plan?

Steve Hester
12-02-2010, 06:49 PM
We are talking about Medicare. I thought the whole idea of ObamaCare was for every one to have insurance. This man could probably prolong his life for a good while, if he could afford to get the chemo, or if Medicare would pay for it like they should. For the government to make the decision that his life is not worth extending is horrible to me. So what's next? Pull the plug on all the people who are in comas because the government decides it's too expensive and they will probably eventually die anyway? Medicare has become a joke, as will ObamaCare.