806 replies to this topic

[cousin it]

Not VA, but something to think about.

The very critical issues of medical errors and patient safety have received a great deal of attention. In November 1999, the Institute of Medicine (IOM) released a report estimating that as many as 98,000 patients die as the result of medical errors in hospitals each year.

http://www.ahrq.gov/qual/errorsix.htm


The report is about 10 years old, so I think that the numbers have gone down since there has been a concert effort to reduce errors.

It was a med error that killed my mother.

[Macker]

I only use one VA Hospital on Long Island, when absolutely necessary and the others in my area are totally mismanaged and gross. (Honestly I golf there more or less) The times where I did have to receive hospital care, it was on a ship or in a hospital that was believed to be the better and closest hospitals. I did have to go to the VA for follow ups but made sure I was medically cleared so I didn't have to go back. No matter where you go, there is a wait time regardless, yes if you know someone wink wink things are better. Durham NC and the satellites/clinics were pretty good, better than Virgina because of probably sheer volume. Some days are better than others. I have a friends that said they have great VA care in Arkansas, Wisconsin and Alaska. I'm sure volume is lower as well. I believe I posted this once before that the Bronx VA, which has been notorious for bad care going back 40 years has been going under major construction and updating. We have been going through the construction process for about 3 years now. I noticed how bad the place was before and saw so many management workers compared to actual care workers that I felt sad. The wait times were bad and the care was like a bother to the staff. There is another more updated VA in Queens NY. One newer building surrounded by WW2 generation type buildings. We have been working on that site for a few years as well because they were to build an additional building or 2. They seemed so much better as for care workers compared to management staff. The nurses seemed to be more compassionate and it was much cleaner all around. I would think that the people who work in the health care system and are actively serving should be able to stay in the military active or reserves and work in the VA systems. They are experienced and more compassionate for the people they care for. As for keeping the facilities operating and in good shape, again use the military members who have the background who would be happy to repair these facilities. This is a definite opportunity for service men and women to have employment after being deployed to come back to a job. This could also be expanded to other fields as well but the VA Health systems is the area that needs the upkeep and most care at this current time. The powers that be (bean counting desk jockeys) just can't see this viable solution to many problems in the system. It would eventually save money over time and there would be more money to pay workers better. There could be extra added things like golf courses, ball fields and catering halls that could be available to vets and service members for a small fee and also available to others outside the service community for regular fees. This money could be used to add revenue for other activities and keep maintenance costs lower. All these things could bring more Vet's back to the VA Health Care System and reduce the costs of outside Medicaid and insurance fee's. There are approx. 25% cancellations visits due to wait times at VA Medical Hospitals. There are also many Vets w/o health care that could be corrected. IDK...What do I know???

[Mr. Roboto]

http://www.thedailys...ealther-skelter

[Mr. Roboto]

Your Stake in the Health Overhaul

For months, politicians have been debating how to overhaul health care. Now it’s time for consumers to start paying attention.

The bills that lawmakers are beginning to move forward are sweeping enough to affect nearly everyone—no matter where people get their insurance. Some of the effects are obvious. For instance, if you’re uninsured, you’d be much more likely to have coverage under the proposals now being considered. Other effects are harder to guess, like the ultimate impact on the workplace health benefits that cover about 160 million Americans.

Under the proposals Congress is considering, nearly all Americans would be required to have health insurance. Insurers would no longer be able to reject people because of pre-existing health conditions. New regulations would mandate minimum benefits that every insurance plan would have to cover.

What’s less clear is how Congress would pay for the effort, and those decisions could have a big consumer impact. The wealthiest might pay more taxes. To cut costs, lawmakers have already trimmed the proposed subsidies that would help middle-income people buy health insurance, and those may get cut further.

Democrats want the House and the Senate to pass bills before lawmakers leave for their August break, though they are looking increasingly unlikely to make that deadline. The House bill has run into growing static from some moderate Democrats. The Senate plans to merge two separate bills before a final vote. One from the health committee is done, but the other, from the Finance Committee, isn’t ready yet. President Obama has said he wants to sign a bill into law this year.

As the debate ramps up, here are some of the issues that could affect consumers the most.

Insurance Changes

If a health overhaul passes, all health plans would have to meet certain guidelines in order to qualify as adequate coverage. Most people’s current insurance would likely be grandfathered in, but if you changed plans, your new one would have to meet those guidelines. Currently, the federal government doesn’t have such a mandate. “We’re actually defining health insurance for the first time,” says Karen Pollitz, a professor at Georgetown University Health Policy Institute.

The House bill, for instance, says that health plans must cover hospital stays, prescriptions and maternity care, among other things. Preventive care would have to be covered at 100%. The House bill also bans lifetime and annual caps on payouts. Also, consumers couldn’t be forced to spend more than $5,000 out of pocket for care in a year, or $10,000 for a family. The Senate health bill is fairly similar. It also requires family plans to cover children until the age of 26.

The House bill also says health plans must have an actuarial value of at least 70%, which means the insurance covers an estimated 70% of health-care expenses. The higher the actuarial value, the less consumers have to pay out of pocket. The Senate health bill sets the minimum at 76%, and some lobbyists suggest the Senate Finance bill could include a bottom value lower than the House’s, possibly 65%.

Consumers should keep an eye on where that number goes, since one way to bring down the bills’ cost might be to make these plans less generous. The current proposed values are actually less rich than the typical employer preferred-provider plan today, which has an actuarial value of around 80% to 84%, according to a Congressional Research Service report. It’s also skimpier than a standard Blue Cross Blue Shield PPO plan offered to federal employees, including members of Congress, the CRS says. However, it’s richer than many plans now sold on the individual market.

For example, one plan that would meet the minimum requirements for the House bill would have a $1,500 hospital deductible and require the consumer to pay 25% of hospital bills, prescription-drug costs and doctor bills, according to an analysis by the Lewin Group, a consulting unit of insurer UnitedHealth Group Inc. The total family deductible could be $3,000, with the out-of-pocket annual limit set at $10,000 for a family. The premium per person would be almost $300 a month, or about $750 a month for a family policy.

One huge question mark is how much help consumers would get from the government if they had to buy the newly mandated health plans. Under the bills Congress is considering, the poorest would be eligible for an expanded Medicaid program. For those who have to buy private plans, the House and Senate health bills offer subsidies to people making as much as 400% of the federal poverty level, which is around $88,000 for a family of four. Even with a subsidy, that family could spend as much as 11% of its income on premiums in the House bill, or 12.5% in the Senate health-committee bill. The other Senate bill, from the Finance Committee, may offer subsidies only up to around 300% of the poverty level, though the final proposal isn’t yet clear. “The big issue is, can I afford what they require me to get?” says Robert Blendon, a professor of health policy and political analysis at Harvard University.

For those not eligible for subsidies, the bills so far don’t cap premiums, though the Senate health-committee version would allow people who couldn’t afford any plan to be exempt from the requirement to have coverage.

The premium levels couldn’t be tied to how healthy the consumer is. The House and Senate health bills would let insurers set premiums based on age, but premiums could vary only up to a 2-to-1 ratio. The Senate Finance bill is likely to allow more variation. Narrow, age-based premium limits would tend to produce better rates than before for older folks, but worse prices for the young.

Premiums could also be affected if there were a so-called “public plan,” or new government-provided health insurance. The Congressional Budget Office suggested the House version would have premiums about 10% lower than private insurance. The broader impact of a public plan has been hotly debated; supporters argue it could help rein in insurance costs, while opponents say it could crowd out private insurance.

Paying for the Overhaul

Lawmakers are scrambling to cut the costs of the bills and find revenue to pay for what they do propose. Some new taxes are almost guaranteed to be part of the mix. What’s not clear yet is who would be paying them.

The House bill includes a surtax that would affect married couples making more than $350,000 a year and individuals with incomes above $280,000. According to the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution think tanks, the surtax, which is at a higher rate for the biggest earners, would affect 0.5% of individual filers and 2.8% of married filers. For a married couple making between $500,000 and $1 million total, the average increase would be around $2,600 a year. A single person in that category would pay on average around $3,000 more.

But that plan is running into resistance from moderate Democrats in the House and is also unlikely to fly with Senate Republicans. House leaders may tweak the tax to hit only people with the very highest incomes. It’s not yet clear what the Senate Finance bill will include, though it is likely to be a package of smaller taxes. Finance Committee Democrats have said they are looking at fees on health insurers, which industry officials say could be passed along to consumers as charges. Another possibility that has sparked debate is taxing the most generous health-insurance benefits offered by employers.

Another potential proposal would be to limit the tax protections that now apply to flexible-spending and health-savings accounts. Neither of the two existing bills do this. The House bill does have a provision that would prevent people with those accounts from using them to pay for over-the-counter medications.

Employer Coverage

Lawmakers may require most employers to provide health benefits or pay a penalty. To avoid the penalty under the House bill, the employer would have to pay at least 72.5% of the premiums for individuals, or 65% for families. The Senate health committee bill would require the employer to contribute at least 60% of the premium for employees. The Senate health panel’s bill would also allow employers to be more aggressive in tying workers’ premium payments to wellness programs.

In the long term, some employers might decide to get out of the business of offering health benefits once workers have new insurance options. The Congressional Budget Office projected a slight increase in employer-provided insurance over 10 years under the House and Senate health-committee bills.

But some analysts believe there could eventually be a shift away from employer coverage, particularly if there’s a low-cost public plan.

There are some other provisions tucked into the bills that could have wide-ranging impact if they end up in a final package. The Senate health committee bill would create a new federal long-term-care program that consumers could buy into. Among other things tacked onto the bill, it would require big restaurant chains to start disclosing calories on their menus.

http://online.wsj.co...1417970322.html

[cousin it]

One of the draw backs that I see with this plan is that, there will be some that slip through the system for whatever reasons. Of those, some won't seek treatment because they will be afraid of being charged with a crime(his plan appears to make it criminal to not have insurance), out of those, some will die. That is fucked up. We need real socialized medicine, not the bullshit that is being proposed.

[Mr. Roboto]

White House appears ready to drop 'public option' WASHINGTON – Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system. Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers. Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his three core principles of reform. Health and Human Services Secretary Kathleen Sebelius said that government alternative to private health insurance is "not the essential element" of the administration's health care overhaul. The White House would be open to co-ops, she said, a sign that Democrats want a compromise so they can declare a victory. Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own. With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims. "I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing." Obama's spokesman refused to say a public option was a make-or-break choice. "What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday. A day before, Obama appeared to hedge his bets. "All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it." Lawmakers have discussed the co-op model for months although the Democratic leadership and the White House have said they prefer a government-run option. Conrad, chairman of the Senate Budget Committee, called the argument for a government-run public plan little more than a "wasted effort." He added there are enough votes in the Senate for a cooperative plan. "It's not government-run and government-controlled," he said. "It's membership-run and membership-controlled. But it does provide a nonprofit competitor for the for-profit insurance companies, and that's why it has appeal on both sides." Sen. Richard Shelby, R-Ala., said Obama's team is making a political calculation and embracing the co-op alternative as "a step away from the government takeover of the health care system" that the GOP has pummeled. "I don't know if it will do everything people want, but we ought to look at it. I think it's a far cry from the original proposals," he said. Republicans say a public option would have unfair advantages that would drive private insurers out of business. Critics say co-ops would not be genuine public options for health insurance. Rep. Eddie Bernice Johnson, D-Texas, said it would be difficult to pass any legislation through the Democratic-controlled Congress without the promised public plan. "We'll have the same number of people uninsured," she said. "If the insurance companies wanted to insure these people now, they'd be insured." Rep. Tom Price, R-Ga., said the Democrats' option would force individuals from their private plans to a government-run plan, a claim that the nonpartisan Congressional Budget Office supports. "There is a way to get folks insured without having the government option," he said. A shift to a cooperative plan would certainly give some cover to fiscally conservative Blue Dog Democrats who are hardly cheering for the government-run plan. "The reality is that it takes 60 percent to get this done in the Senate. It's probably going to have to be bipartisan in the Senate, which I think it should be," said Rep. Mike Ross, D-Ark., who added that the proposals still need changes before he can support them. Obama, writing in Sunday's New York Times, said political maneuvers should be excluded from the debate. "In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain," he wrote. "But for all the scare tactics out there, what's truly scary — truly risky — is the prospect of doing nothing." Congress' proposals, however, seemed likely to strike end-of-life counseling sessions. Former Alaska Gov. Sarah Palin has called the session "death panels," a label that has drawn rebuke from her fellow Republicans as well as Democrats. Sen. Orrin Hatch, R-Utah, declined to criticize Palin's comments and said Obama wants to create a government-run panel to advise what types of care would be available to citizens. "In all honesty, I don't want a bunch of nameless, faceless bureaucrats setting health care for my aged citizens in Utah," Hatch said. Sebelius said the end-of-life proposal was likely to be dropped from the final bill. "We wanted to make sure doctors were reimbursed for that very important consultation if family members chose to make it, and instead it's been turned into this scare tactic and probably will be off the table," she said. Sebelius spoke on CNN's "State of the Union" and ABC's "This Week." Gibbs appeared on CBS' "Face the Nation." Conrad and Shelby appeared on "Fox News Sunday." Johnson, Price and Ross spoke with "State of the Union." Hatch was interviewed on "This Week."

[Mr. Roboto]

I can't believe that the Dems are going to wuss out on this. On the other hand maybe government option was never in the cards, and merely a bargaining chip this entire time. I still don't know why they would do that though, I think they could have pushed it through. I'm not annoyed yet, just trying to process what is going on.

[cousin it]

I know man, it fucking sucks! Me sez, either abolish Medicare/Medicaid, and the VA, or make the shit available to all.

[Mr. Roboto]

That's what I'm sayin', seems some people want to have it both ways....

[cousin it]

Can we all sing along;

Kumbaya-

Now,that is the shit.

[cousin it]

What is complete without the Heepee version

[cousin it]

If I had a Hammer... I would beat the stink out of some shit.

[Macker]

Promises Promises.....Hey this does kind of sound like the whole Social Security reform.....What ever happened to that?

[Mr. Roboto]

White House claiming it's not off the table now.....guess we'll see. I think something will happen, just have no idea of what it will be. Maybe death panels?

[freedom78]

Promises Promises.....Hey this does kind of sound like the whole Social Security reform.....What ever happened to that?

You mean the reform proposed under Bush?

Thank God that didn't happen...it would have lost half its value during the DOW fall from 14,000 to 7,000. People are hard up now, but that could have been a catastrophe.