Health care - administrative incompetence

xjx388 said:
OK, so we've all agreed that Medicare sucks.

Why in the world would we expand it to everyone. :boggled:
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It has significant issues by far, especially since HMOs have gotten their hands on it. Medicare would still be a better option for many than no insurance or crappy private insurance. Let them negotiate drug prices like the VA, and you'd start to use it as a cost control mechanism. It's been well documented that some sort of robust public insurance plan that everyone can buy into would serve as a strong cost control measure, like in plenty of other nations that use multi payer insurance systems (Germany, France, etc.)
 
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kellyb said:
I can't tell if you're joking or not. :o
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I'm not. I was elaborating policy on how people could "save" money to pay for medical expenses in your hypothetic scenario (Hey, I'm a policy geek, I like details). HSAs as they are now, are complete scams (especially since you have to buy a crappy HDHP to use it). They can be used to save up for drugs that a "NICE" equivalent won't authorize Medicare (or whatever government insurance system you propose) to pay for.
 
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Garrison0fMars said:
It has significant issues by far, especially since HMOs have gotten their hands on it. Medicare would still be a better option for many than no insurance or crappy private insurance. Let them negotiate drug prices like the VA, and you'd start to use it as a cost control mechanism.
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So it's slightly better than crappy?

Not good enough.
 
xjx388 said:
So it's slightly better than crappy?

Not good enough.
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Depends on how you define "crappy". I agree in it's current state it has a lot of issues. However, even in it's HMO diseased state, allowing people to buy into it would serve as a cost control measure. I'd certainly take Medicare over what I have now (nothing), or Medicaid.

Also, don't forget it can be changed and improved. I'd imagine there'd be a lot more political will to improve it as more people bought into it after they were knocked off their employer coverage, or were denied because of a "pre existing condition".

By buy in, I do actually mean "buy in", there's a large misconception that Medicare is "free", it isn't. You have to pay premiums and co pays for it, it's just most elderly and disabled don't notice (usually deducted from their social security checks).
 
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I'd also like to point out the problem with Medicare reimbursements isn't because of some vacuum "government" problem, it's because of the inflated costs that private for profit insurance contributes to the "system". There's a reason why we spend nearly 16% of our GDP on healthcare and still don't have universal care.

Also don't discount those Medicare "advantage" (HMO managed care) plans as well who contribute to the cost increases.
 
kellyb said:
And it's just so ironic, if his wife is really an MD PCP.

He's so afraid of health care being in the hands of democracy instead of the free market. We the people would vote to SAVE MD PCPs. We the people don't want insurance company guideline following NP robots as our PCPs!
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Probably off topic, but I'm curious, do we have any real studies in regards to the comparison of NPs to MD PCPs, and how well they really work in comparison? I have no real stake on the issue one way or another, but can it be objectively proven that NPs do fare significantly worse than MDs in primary care?
 
More evidence for why it is necessary to be cautious with the new MAB drugs:

http://canreviews.aacrjournals.org/cgi/content/full/crocontent;2010/1/1
Mutations in Cancer and Therapeutic Resistance: World Without End?

Clearly, an understanding of resistance mechanisms is critical to leveraging the efficacy of the modern generation of targeted therapeutics. However, at a deeper level, the inherent plasticity of cancer cells that allows them to readily select resistance to any targeted therapy is, at root, the fundamental and perhaps inescapable problem posed by cancer as a clinical disease. In principle, there is no end to the mutations—or stable epigenetic alterations—that can and will arise in cancer when selections are imposed by either environmental constraints or therapeutic strategies. In light of this problem, targeted therapeutics as a general approach to cancer, while at some level representing solid mainstream thought in the field, can still be severely criticized. If resistance arises to generalized cytotoxic drugs, which rely on a large number of intrinsic and extrinsic mechanisms of cancer cell killing, won't resistance to targeted therapeutics be that much easier to evolve? In cases where suppressor pathways are to be recruited, such as the p53 pathway, won't selective pressures of a therapeutic using the pathway simply elevate the risk of mutation and thereby promote tumor progression? Viewed in this light, targeted therapeutic development may seem a losing battle against an unending stream of escape mutations that are selected in tumors to drive resistance.
 
Garrison0fMars said:
Probably off topic, but I'm curious, do we have any real studies in regards to the comparison of NPs to MD PCPs, and how well they really work in comparison? I have no real stake on the issue one way or another, but can it be objectively proven that NPs do fare significantly worse than MDs in primary care?
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We use NPs and PAs in practice now. Their scope of practice, which is separate from the current law, says that they have to work under a doctor's guidance. There are also strict rules on how independent they can be (written protocols, no independent decision-making, etc.). Until they change that (which they never will), it's a non-issue.
 
xjx388 said:
We use NPs and PAs in practice now. Their scope of practice, which is separate from the current law, says that they have to work under a doctor's guidance. There are also strict rules on how independent they can be (written protocols, no independent decision-making, etc.). Until they change that (which they never will), it's a non-issue.
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Uh, no it's not. As someone who's had PA's as my "PCP" in the past, I can tell you, the supervising MD is often not even around in the same city (my PA's one was in a totally DIFFERENT county!). Also, NPs in many many states can practice independently, so that's not even true in the case of NPs.
 
Garrison0fMars said:
Probably off topic, but I'm curious, do we have any real studies in regards to the comparison of NPs to MD PCPs, and how well they really work in comparison? I have no real stake on the issue one way or another, but can it be objectively proven that NPs do fare significantly worse than MDs in primary care?
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No, there aren't any studies.
But even if there were, it's kind of complicated.
In the US, the idea of "quality" healthcare is now often determined by things like "physician report cards" which will tell you things like what % of a doc's patients die. Which sounds ok until it leads to docs being less willing to treat patients already more likely to die.
 
kellyb said:
No, there aren't any studies.
But even if there were, it's kind of complicated.
In the US, the idea of "quality" healthcare is now often determined by things like "physician report cards" which will tell you things like what % of a doc's patients die. Which sounds ok until it leads to docs being less willing to treat patients already more likely to die.
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Any extra national studies that may be relevant? I think Canada has NPs as well (with same scope of practice and education).
 
Garrison0fMars said:
Uh, no it's not. As someone who's had PA's as my "PCP" in the past, I can tell you, the supervising MD is often not even around in the same city (my PA's one was in a totally DIFFERENT county!). Also, NPs in many many states can practice independently, so that's not even true in the case of NPs.
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I can only speak for Texas. I know that PAs and NPs can operate a clinic on their own in specified underserved rural areas, but can't practice on their own otherwise. And if they are operating a clinic without physician supervision in Texas, they are breaking the law.

And Medicare will not pay NPs and PAs that practice independently as much as MDs. They are subject to "incident-to" rules. Beyond scope of thread.
 
Garrison0fMars said:
I'd also like to point out the problem with Medicare reimbursements isn't because of some vacuum "government" problem, it's because of the inflated costs that private for profit insurance contributes to the "system". There's a reason why we spend nearly 16% of our GDP on healthcare and still don't have universal care.

Also don't discount those Medicare "advantage" (HMO managed care) plans as well who contribute to the cost increases.
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It's not just insurance companies. We have thousands of millionaire CEO hands (lab companies, imaging companies, etc) in the health care cookie jar over here. Then there's pharma prices, for-profit hospitals, etc.
 
kellyb said:
It's not just insurance companies. We have thousands of millionaire CEO hands (lab companies, imaging companies, etc) in the health care cookie jar over here. Then there's pharma prices, for-profit hospitals, etc.
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Totally. The "hospital association" is just as guilty as well.
 
xjx388 said:
I can only speak for Texas. I know that PAs and NPs can operate a clinic on their own in specified underserved rural areas, but can't practice on their own otherwise. And if they are operating a clinic without physician supervision in Texas, they are breaking the law.

And Medicare will not pay NPs and PAs that practice independently as much as MDs. They are subject to "incident-to" rules. Beyond scope of thread.
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They can practice independently in some states.

Yes, Medicare reimburses NPs less than MDs/DOs, this I already know.
 
Garrison0fMars said:
By the way, I'd like to point out this nation is in trouble when we have mobile clinics popping up that are identical to what they use in third world nations.

http://pnhp.org/blog/2010/12/17/a-spectacle-of-the-health-care-crisis/
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And look...the number of uninsured has grown under Obama/Romney/xgx-care since passage:

http://www.kaiserhealthnews.org/Sto...-Of-The-Uninsured-Keep-Growing-shorttake.aspx

Jun 17, 2010
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Ranks Of The Uninsured Keep Growing
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Nearly 60 million, or just under 1 in 5 people, had been uninsured at some point during the year.
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