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Thread: Obama: "We will call you out."

  1. #41
    Senior Member YardleyLabs's Avatar
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    Quote Originally Posted by Gerry Clinchy View Post
    Yardley


    Herein lies some confusion for me. Like you, Jeff, I see no evil in counselling patients on their options & the results of those options. And sometimes that relates to terminal illness, sometimes not.

    The experience roadkill describes seems like part and parcel of the responsibility of being a doctor. The doctor dx's the disease; explains the disease; explains the treatment alternatives and the possible results of each alternative. In the case of a terminal illness, this also would often includes length of possible remission, etc.

    I'm not entirely sure why one would pay an additional fee for doctors doing this part of their job. This intends no offense to the doctors on this board.

    When the discussion goes beyond the purely medical alternatives (in terminal illness), then that should be provided by an attorney and accountant, as that would be their specialty.

    This makes me wonder whether someone anticipates that doctors and PAs will no longer have the time per patient to provide this information, due to the patient load?

    Or is it because fees will be negotiated to the point that this is a vehicle for providing an additional payment through the health omnibus legislation to offset other downard fee negotiation? Due to the rather "vague" nature of this service, would it not be open to abuse? Could each doctor involved in a case check off the "end-of-life counselling" box & the fee get paid multiple times for the same patient?

    Unfortunately, we wouldn't know the answers to my last few questions until the administrative bureaucrats craft the actual rules.

    As I've suggested before, couldn't this type of service be provided for through other existing agencies? Here in PA each of our counties has an "Agency on Aging" for assisting elderly on many items. This service could easily fall into that area. And it could be, perhaps, more effectively handled by such agencies before the highly emotional time of imminent death.

    Yesterday I lost a dear friend to cancer. She was undergoing treatment for diabetes and a bloodclot in her leg. She was taken to the hospital ostensibly for that, & they discovered she had extensive cancer. She refused chemotherapy which, she was told, would extend her life only by a few months. She had watched several friends die who had chosen chemotherapy, and she had already decided what her choice would be.
    I'm sorry about your friend.

    Under current Medicare law, when your friend or other Medicare patient is admitted to the hospital, they must be asked about their preferences for treatment in the event that they are no longer able to direct their care. The unanswered question is where do patients find out what choices they have, which necessarily includes having someone explain that in terms that the patient can understand.

    To do that well costs more than the 6-12 minutes paid for by standard visit rates under Medicare and private insurance plans. For the physician to be paid more, there must be a specific reimbursable service that they provided and that may be billed. That was the reason for including this item in HR 3200. The specific language actually began its life as a proposed amendment to Medicare authored by a Georgia Republican.

    You raise the question of whether or not this counseling should be done by the physician. That's a fair question. I think the answer is that it is a service that should be provided at the moment and in the context where it is most relevant for the patient. If a physician is providing a general physical exam, or delivering bad news, or discussing an impending hpospitalization with a patient, the timing and context are likely to be right. The physician may provide the information directly or the physician may have a nurse or counselor in his office provide the information. However, without reimbursement, it is unlikely that the service will receive the time it deserves. I don't think anyone is prepared to have Medicare establish a special reimbursement program to pay an attorney to help with this, although it would be an interesting service.

    The reality is that the legalities are not that complex (other than the fact that they are different in every state), but part of what is included must be specific instructions for each type of medical service, whether that be medications and other treatment procedures, pain killers, IV nutrition, or even IV hydration. My father's instructions, which he thought about extensively, explicitly prohibited any IV hydration if his condition were deemed by his designated representative (me) to be terminal. That was his way of guaranteeing that he would not linger for long. In the end, that was not what killed him since he actually awakened lbriefly the evening before his death and in his 15 minutes of lucidity ate some eggs and drank some juice. However, throughout his final days he was receiving extensive morphine to eliminate all pain and no IV's were attached to him at any time other than for the administration of morphine.

  2. #42
    Senior Member helencalif's Avatar
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    Quote Originally Posted by Terry Britton View Post
    Currently, ER's are filled up with criminal aliens, and those who don't have insurance, and want others to pay their bills for common non-emergency problems. Those hospital write-offs get passed on to the rest of us in higher medical bills, and higher insurance fees.
    You are correct. My daughter has been in the medical field for 15 years (hospital x-ray, CT scan, MRIs, ultrasounds). Not too long ago she managed that dept for 3 major hospitals in the S.F. Bay Area. She explained to me the term was called "charity care".

    What griped her the most was ...

    The ERs at those hospitals had a lot of uninsured walk-in non-emergencies by foreigners who said they were "just visiting" and got sick; however, their health problems were not sudden. She said it was well known that there were many who come to the U.S. and then were immediately brought to the ER by family to get medical diagnosis, operations, and free medical care and hospitalization because they know they cannot be turned away. They will receive medical care many Americans can't afford though they have no insurance and have no intention of paying, and they don't pay.

    Which is why those who have insurance and do pay, foot the bill.

    Helen Graves

  3. #43
    Senior Member helencalif's Avatar
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    And another medical care cost we are paying for ...

    Same daughter left the job of managing dept's at 3 different hospitals. Could not stand the pressure. She moved to a different city where she is now managing just one imaging dept (x-rays, CT scans, MRI, etc).

    This is near a prison. Inmates who need x-rays, CT scans, etc are brought to her lab. The majority of those prison inmates are brought there for self-inflicted situations such as metal or glass fragments shoved into stomachs, hands, arms, legs, etc. Sometimes they swallow metal and glass. Often there are items shoved up their rectum. (Batteries included.)

    The only reasons she can figure out as to why they do this is: 1) attention, 2) pain medication, and 3) it's a trip to the outside which offers a break to the boredom of prison life.

    We know we are paying for the medical care of prisoners inside the prison (doctors, nurses, clinics, medication inside prison), but did you know you were paying for self-infliction and trips to the outside for X-rays, CT scans, MRIs? At least 2 guards accompany them. They have to be driven to the hospital (car/van and driver, plus 2 guards). You do the math.

  4. #44
    Senior Member Buzz's Avatar
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    Quote Originally Posted by helencalif View Post
    The only reasons she can figure out as to why they do this is: 1) attention, 2) pain medication, and 3) it's a trip to the outside which offers a break to the boredom of prison life.
    I would guess that most of them are not playing with a full deck.
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

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  5. #45
    Senior Member Rick_C's Avatar
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    Quote Originally Posted by dnf777 View Post
    Despite the Fla supreme court and the swift-boating, the last administration won the electoral process by the skin of its teeth, and did not have the majorities in both houses like the current administration does. Yet there were no explanations for anything they rammed through congress, except "trust us, we're from the gov't and need to do this to protect you".

    I think the right should be happy that a little spirited speech is all they've had forced upon them so far. They should be VERY happy that the democrats are free thinking and nearly impossible consensus-formers, or else Obama would have EVERYTHING he wants delivered on a platter. The dems have no "hammer". I would indulge Obama a little speech time, in return for giving the opposition such a forum and opportunity to thwart his agenda, like it or not.
    You CANNOT be serious!

    GM bailout
    AIG bailout
    Cash for Clunkers
    $700 Billion stimulus package that went who knows where...

    Seriously. What flavor was that kool aid?

    The only thing he has not gotten despite having majorities in both houses is Health Care reform...at least not yet.

    His bullying and fire and brimstone speaches are because he knows the only way to get it passed is to shove it down
    our throats without having the chance to taste it. Not to mention before we move into an election year for many senators and congressmen. IF he is not able to get this passed it would be a major defeat. He
    knows this and is now fighting back out of desperation.

    By the people, for the people? Well the majority of the people don't want his health care reform. Unfortunately Obama
    and his followers don't give a damn about anything but their agenda.

    http://www.foxnews.com/politics/2009...e-legislation/
    Last edited by Rick_C; 09-11-2009 at 04:41 PM.
    Rick Curtis ~ Currently in Ontario, CA by way of Spokane, WA and Northern CA.

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  6. #46
    Senior Member Buzz's Avatar
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    Quote Originally Posted by Rick_C View Post
    By the people, for the people? Well the majority of the people don't want his health care reform. Unfortunately Obama
    and his followers don't give a damn about anything but their agenda.

    http://www.foxnews.com/politics/2009...e-legislation/
    If you to to Gallup to read about the poll, it shows that 37% want their rep to vote for the legislation, 24% want them to vote against, and 39% have no opinion. FOX writes so that it reads like 37% are for, and everyone else is against.

    Interesting story:

    The poll, conducted by Anzalone Liszt Research in advance of President Obama's
    address to Congress, showed that 57% of business leaders believe health care
    reform should be an important government policy. They support key elements of
    a reform plan, including insurance exchange (78% favorable), efficiency
    reforms and an oversight commission (71%), requiring insurance companies to
    cover pre-existing conditions (79%) and a public health option (51%).
    http://www.reuters.com/article/press...09+PRN20090911
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

    Raven - Moneybird's Black Magic Marker***
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  7. #47
    Senior Member Rick_C's Avatar
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    In the article I provided - "Nearly a quarter of those polled by Gallup -- 24 percent -- still have no opinion on the issue." This was From last week.

    I was a business owner for several years. Having been there and paid for employee benefits, I can understand why business leaders would be for this plan too. It will save their company's millions of dollars if they don't have to contribute to employee health plans.
    Rick Curtis ~ Currently in Ontario, CA by way of Spokane, WA and Northern CA.

    Little Man Caught It On The River SH ~ "Ace"

    Handlers Handle, Dogs Dog, Judges Judge

    "If you train a young dog for momentum, precision will arrive. If you train for precision, demanding perfection, momentum will depart."
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  8. #48
    Senior Member Buzz's Avatar
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    Quote Originally Posted by Rick_C View Post

    I was a business owner for several years. Having been there and paid for employee benefits, I can understand why business leaders would be for this plan too. It will save their company's millions of dollars if they don't have to contribute to employee health plans.
    We operate a small family business, and the rate at which employee health plan costs have escalated is terrifying.
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

    Raven - Moneybird's Black Magic Marker***
    (Esprit's Power Play x Trumarc's Lean Cuisine)
    Mick - Moneybird's Jumpin' Jack Flash***
    (Clubmead's Road Warrior x Oakdale Whitewater Devil Dog)
    Peerless - Moneybird's Sole Survivor
    (Two River's Lucky Willie x Moneybird's Black Magic Marker)

  9. #49
    Senior Member Uncle Bill's Avatar
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    So little of what you all are arguing about is universal healthcare. It's ALL ABOUT REMOVING YOUR FREEDOMS!!!!

    And it won't matter what form it comes in, once it's signed into law, the camels nose is under the tent...Humpty Dumpty will have fallen. If you can't see the fascist creep in all this, dayum you are soooo blind.

    UB
    When the one you love becomes a memory, that memory becomes a treasure.

  10. #50
    Senior Member dnf777's Avatar
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    Quote Originally Posted by Rick_C View Post
    You CANNOT be serious!

    GM bailout
    AIG bailout
    Cash for Clunkers
    $700 Billion stimulus package that went who knows where...

    Seriously. What flavor was that kool aid?

    The only thing he has not gotten despite having majorities in both houses is Health Care reform...at least not yet.

    His bullying and fire and brimstone speaches are because he knows the only way to get it passed is to shove it down
    our throats without having the chance to taste it. Not to mention before we move into an election year for many senators and congressmen. IF he is not able to get this passed it would be a major defeat. He
    knows this and is now fighting back out of desperation.

    By the people, for the people? Well the majority of the people don't want his health care reform. Unfortunately Obama
    and his followers don't give a damn about anything but their agenda.

    http://www.foxnews.com/politics/2009...e-legislation/
    I believe I noted in that post (or another) that both Obama AND Bush are guilty of these massive bailouts. Do you not remember McCain rushing back to washington and "suspending" his campaign to vote for the bailout? I'm not the only one drinking kool-aid around here!

    Eight years of Bush neocon policies and the largest disaster since the Great Depression, eight months of Obama, and everyone wants to blame HIM!?

    I guess I better start swiggin' the kool-aid, so I can understand where the disgruntled right is coming from. I do understand and share many of the spending concerns, but will not take part in wacko conspiracy panics like Birthers and Death panelers, and Obama youthers! Those claims sap credence from the legit debates.
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

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