tag:blogger.com,1999:blog-1315362208709650810.post2229979791530008031..comments2024-03-28T08:00:17.624-04:00Comments on NewGathering: Unagidon is Back!!David Nickolhttp://www.blogger.com/profile/17769931102661478298noreply@blogger.comBlogger34125tag:blogger.com,1999:blog-1315362208709650810.post-35410247589662074712017-06-05T08:19:16.472-04:002017-06-05T08:19:16.472-04:00Paperwork staff are being reduced in my clinics b/...Paperwork staff are being reduced in my clinics b/c doctors have laptops and have to keep records themselves. My primary and cardio like it fine. In fact, they use their laptops as a teaching tool (and to show me pictures of pets). My oncologist hates her laptop. Connection seems to be slow, and she isn't computer savvy. She always jokes that she needs a "scribe." It means she looks at her computer a lot more than at me.Jeanhttps://www.blogger.com/profile/14702081408526023197noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-26633674474715893762017-06-05T06:40:57.864-04:002017-06-05T06:40:57.864-04:00I agree. Working for a provider is just like worki...I agree. Working for a provider is just like working for anyone else in the sense that they push their workers as hard as they can. When I said "efficiency" I didn't want to suggest that this would be found by squeezing the line staff.Patrick Shannonhttps://www.blogger.com/profile/11952977031779999420noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-25981070281641129842017-06-04T21:13:34.862-04:002017-06-04T21:13:34.862-04:00Katherine, since my primary care joined a healthca...Katherine, since my primary care joined a healthcare group, paperwork staff dropped from four to two, so I guess there's other ways to cut costs. But I know the most hard working are getting squeezed, too. Sometimes it means having a cardio team on call instead of having them in the building. Could mean the difference between life and death.Stanley Kopaczhttps://www.blogger.com/profile/12133446714376982656noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-37203115599572700172017-06-04T20:29:43.223-04:002017-06-04T20:29:43.223-04:00Good point, Stanley. I think the healthcare indust...Good point, Stanley. I think the healthcare industry is very good at squeezing maximum efficiency out of the people actually doing the care, maybe to the point of burning them out. But it is less good at squeezing efficiency out of corporations and institutions.Katherine Nielsenhttps://www.blogger.com/profile/08309113327087187334noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-40205954485837622642017-06-04T20:21:33.572-04:002017-06-04T20:21:33.572-04:00I know two nurses, and they seem to work very, ver...I know two nurses, and they seem to work very, very hard at a very difficult and stressful job (dealing with people, yeesh). I don't know how one can squeeze more "efficiency" out of them without ruining THEIR health. The one nurse who's a guy says people think the person who wipes THEIR ass should get $3/hr but they wouldn't wipe someone elses ass for less than $50/hr. The man has a point.Stanley Kopaczhttps://www.blogger.com/profile/12133446714376982656noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-57936670916452786762017-06-04T20:07:47.081-04:002017-06-04T20:07:47.081-04:00"Efficient" is a loaded word, no? What i..."Efficient" is a loaded word, no? What is "efficient" patient care? Cheapest? Uses least number of interventions? Quickest in and out of the office time? Longevity? <br /><br />I think it's hard for consumers to figure out the quality of care. I am thinking of ditching my current oncologist and going to one I saw during a consult whom I liked better. But just because he was more encouraging and personable doesn't mean I'll get better care, does it? You're more informed going in and buying a car than you are picking out a doctor or clinic ...Jeanhttps://www.blogger.com/profile/14702081408526023197noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-23124527537202592032017-06-04T18:46:27.657-04:002017-06-04T18:46:27.657-04:00It's Medicaid that averages about 80 percent. ...It's Medicaid that averages about 80 percent. Medicare is between 93 and 98 percent<br /><br />But Medicare doesn't deal with prices at all. They calculate a national average and weight it in different ways and then just pays that. The Right doesn't consider this to be a "free market". It is in the sense that there is a limited number of dollars in the reimbursement and providers can get a higher profit if they become more efficient. (The conservatives that participated in the creation of Medicare knew this. I think they used to be higher functioning than they are now). The good affect on health care pricing is that it does create this incentive to hold down costs. The bad affect is that the base reimbursement is still based on averages and not on any negotiation pressures on individual providers. Being based on averages means that the inefficient providers are lumped in with efficient ones in setting reimbursements. This leads the system to pay on its overall mediocrity and it probably pays too much. Now mix into this the growing monopolization that's occurring and the fact that providers are subsidizing themselves with commercial insurance in the manner I outlined in my article and you may see that there is nothing capping costs in an effective way.Patrick Shannonhttps://www.blogger.com/profile/11952977031779999420noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-82860886264909429412017-06-04T18:34:32.207-04:002017-06-04T18:34:32.207-04:00We can't just copy someone else because of the...We can't just copy someone else because of the way the money flows in our system. The cash flows between who pays and who receives would have to be backed out of. For example, on the cash in side, there are all of the businesses that pay for insurance for their employees. Anything we do in the system is going to have to capture these dollars. But how? Do we institute a new tax on corporations. Do we institute a new tax on the public and either require businesses to take the old premium dollars they used to spend on insurance and give it to the workers as a direct payment to cover the new tax? On the payment side, providers are now subsidized by private insurance for the shortfalls they have on the Medicare/Medicaid side. A simple transfer to Medicare for all would eliminate this subsidy. So how do we make them whole? Or should we? Stuff like this. One has to go from what we have to what we want. Since no European or Asian system started out looking like the abomination that ours it, they don't really offer any help for us as a model of how to proceed, as much as they might look like a good model of what to get to.<br /><br />And for what it's worth, I wouldn't start with Trump anyway. I'd start in the Senate.Patrick Shannonhttps://www.blogger.com/profile/11952977031779999420noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-85981725037689653262017-06-04T18:29:40.704-04:002017-06-04T18:29:40.704-04:00That's interesting. Is it correct that Medicar...That's interesting. Is it correct that Medicare is not allowed to dicker over pricing with providers as private insurance companies do? If not, does that explain why Medicare alone pays for 80 percent of costs (and could pay a lower percent I'm the future as costs go up)? Does Medicare have an ultimately good or bad effect on the pricing of health care for everyone? Jeanhttps://www.blogger.com/profile/14702081408526023197noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-65171365652121052352017-06-04T18:18:10.170-04:002017-06-04T18:18:10.170-04:00unagidon here.
I hope you all like the article. ...unagidon here.<br /><br />I hope you all like the article. I'll watch here if you have any questions about it.<br /><br />I have submitted another article (actually, they have an accumulation of my submissions at this point), which addresses the issue of Medicare For All as a solution for our current problem. I argue that is isn't a solution, much as I would like it to be. The reason is the complicated way that the dollars are locked up in the current system and they way that providers are currently paid. Just establishing Medicare of everyone would not in itself unwind all of this stuff. Medicare for all would make a good model for what the system would need to look like. But the unwinding process of converting all of the money from a private to a public system would need to be done in steps. I didn't outline these in what I submitted to Commonweal. But I do point out that Medicare and Medicaid were constructed for the US private market. The US private market has in turn built itself around the public programs. Neither can stand alone anymore.Patrick Shannonhttps://www.blogger.com/profile/11952977031779999420noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-20890759364636605452017-06-04T11:19:04.544-04:002017-06-04T11:19:04.544-04:00America did and does allow editing. Commonweal ne...America did and does allow editing. Commonweal never did. I had a hiccup or two when posting here. I'm thinking I accidentally hit the "publish" button twice. "Publish" sounds a bit highfalutin for the stuff I submit. A button that says "zoink" might be more appropriate.Stanley Kopaczhttps://www.blogger.com/profile/12133446714376982656noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-88260341917482080132017-06-04T10:56:51.927-04:002017-06-04T10:56:51.927-04:00Don't know. I delete mine when I find mistakes...Don't know. I delete mine when I find mistakes. There can never be too much proofreading before hitting the "Publish" button. Didn't the beloved dotCommonweal allow commenters to go back and correct, or am I misremembering. Margaret Steinfelshttps://www.blogger.com/profile/06660518023817721965noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-62804929567478814922017-06-03T22:16:31.918-04:002017-06-03T22:16:31.918-04:00Thanks, you guys. I had no idea there was that mu...Thanks, you guys. I had no idea there was that much to it.crystalhttps://www.blogger.com/profile/05681674503952991492noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-58534581838752217732017-06-03T21:46:20.514-04:002017-06-03T21:46:20.514-04:00I agree that hospice is more a philosophy than a p...I agree that hospice is more a philosophy than a place, there are also some rules that distinguish it from nursing home care.<br /><br />My father was in a hospice run by a hospital for the last few days of his life. When I signed the form for hospice care, they informed me that as long as dad continue to deteriorate or need the care he was getting in the hospital (he had been admitted), Medicare would pay the residential fee as well as the treatment just as in a hospital. However if dad improved then I would be responsible for the residential fee but Medicare would continue to pay for the treatment. I probably had the option to take him home and have hospice care there.<br /><br />The hospice was brand new, less than six months old, a very beautiful place. While a lot of the people that came there stayed for only a short time before death, they built it to be very family friendly with beautiful rooms and a place to cook in case people needed it for a long time. It was like a home away from home, actually a very fine looking home.<br /><br />It was light years away from a hospital, or nursing home, and it was certainly better than trying to keep dad at home. He was getting beyond my ability to manage; I had to ask his sister to stay overnight so that we could take turns sleeping. <br /><br />When you think you'll need this service it is good to check out of the options well ahead of time. I should probably have had dad there two or three weeks earlier. Dad's doctor was no help. When I asked him what do I do if I can't take care of dad, he simply said take him to the hospital. Fortunately I began to look around and had actually scheduled a visit to the hospice but then dad had to be taken to the hospitalJack Rakoskyhttps://www.blogger.com/profile/03755655685437527617noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-15377208716404294752017-06-03T20:22:16.515-04:002017-06-03T20:22:16.515-04:00Is anyone else having trouble with their comments ...Is anyone else having trouble with their comments posting twice? I have had to delete several of mine that were duplicates. Don't know why that happens.Katherine Nielsenhttps://www.blogger.com/profile/08309113327087187334noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-4966784034683319982017-06-03T19:51:23.583-04:002017-06-03T19:51:23.583-04:00This comment has been removed by the author.Katherine Nielsenhttps://www.blogger.com/profile/08309113327087187334noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-32737532690734548892017-06-03T19:48:45.028-04:002017-06-03T19:48:45.028-04:00Though hospice can mean a physical place. Some hos...Though hospice can mean a physical place. Some hospitals, especially in small towns, and some nursing homes as well, have hospice beds. Sometimes families cope at home as long as they can, but get overwhelmed at the last. My mother spent her last several days in a hospice room at the hospital. By that time she was unconscious. Family members kept watch with her there. Katherine Nielsenhttps://www.blogger.com/profile/08309113327087187334noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-66654260820291640382017-06-03T19:29:21.816-04:002017-06-03T19:29:21.816-04:00Hospice is associated with the terminally ill. But...Hospice is associated with the terminally ill. But broadly speaking, it is maintenance care, and the role of hospice could extend to managing a chronic disease like diabetes or COPD or CHF by visiting the patient at home and offering info and encouragement on meds, diet, and exercise. Hospice can also provide occupational therapy and discuss home modifications that make your life easier. Hospice nurses can also put patients in touch with agencies and volunteers that can provide needed services.<br /><br />Hospice is really more a philosophy of care than a physical place.Jeanhttps://www.blogger.com/profile/14702081408526023197noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-31187674338541262272017-06-03T17:54:25.263-04:002017-06-03T17:54:25.263-04:00Crystal, a succession of our friends died in Hospi...Crystal, a succession of our friends died in Hospice care. After watching how they went, we paid an extra $80 a year to have a Hospice license plate on our car. (The extra supports Hospice.) And my wife is cheap.tom blackburnhttps://www.blogger.com/profile/09617525711233538704noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-26100730996431340842017-06-03T17:51:42.558-04:002017-06-03T17:51:42.558-04:00Trump's attention span is five minutes, so the...Trump's attention span is five minutes, so the other 25 would be wasted. The sources for the five minutes are his supporters, not people like me.tom blackburnhttps://www.blogger.com/profile/09617525711233538704noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-72182744850669910672017-06-03T16:43:25.622-04:002017-06-03T16:43:25.622-04:00I have traditional Medicare and I think that's...I have traditional Medicare and I think that's best, at least for me. The down side is that it doesn't pay for everything, but still I think you have more choices about care when you aren't within an HMO kind of thing.crystalhttps://www.blogger.com/profile/05681674503952991492noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-45389076303709085992017-06-03T16:40:12.675-04:002017-06-03T16:40:12.675-04:00Maybe I don't understand what hospice care is....Maybe I don't understand what hospice care is. I've never known anyone who has used it. I thought it was just where people went to die, with pain meds?crystalhttps://www.blogger.com/profile/05681674503952991492noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-71358748120683598822017-06-03T16:34:54.643-04:002017-06-03T16:34:54.643-04:00I had Medicare Advantage only because the Public E...I had Medicare Advantage only because the Public Employees Retirement System chose that plan, it was specially tailored to them; I am now on traditional Medicare. PERS now gives us a voucher to choose what we want; for most retires that is traditional; I chose AARP because it is community rated rather than age rated, and it has Silver Sneakers which lets me use a variety of local fitness centers. Jack Rakoskyhttps://www.blogger.com/profile/03755655685437527617noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-58770385483005314812017-06-03T16:16:10.609-04:002017-06-03T16:16:10.609-04:00Why do you think that? My dad's quality of lif...Why do you think that? My dad's quality of life improved on hospice. Hospice comes to you, reduces the burden of monitoring, helps with occupational therapy, etc. There's no cure for my type of cancer, I have no inclination to participate in clinical trials, and I would prefer a hospice approach. It would be nice to have that choice.Jeanhttps://www.blogger.com/profile/14702081408526023197noreply@blogger.comtag:blogger.com,1999:blog-1315362208709650810.post-23614908803634230602017-06-03T15:39:54.491-04:002017-06-03T15:39:54.491-04:00Jack, glad you are doing better now. I follow Medi...Jack, glad you are doing better now. I follow Medicare issues with interest to try and figure out whether we should go with Advantage or traditional Medicare once I retire and lose my work insurance. It's looking like traditional Medicare is what we will do.<br />About the sleep apnea, I know some people don't like the CPAPs but my husband does well with his. I am grateful for it because I was just about ready to move into the guest room because of the snoring. Katherine Nielsenhttps://www.blogger.com/profile/08309113327087187334noreply@blogger.com