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Re: THIS IS HOW CRAZY OUR HEALTHCARE INDUSTRY HAS BECOME - BUT HOW TO FIX IT ??

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@GailL1 wrote:

@john258 wrote:

This is a current event caused by Trump who has messed with the ACA to destroy it which has forced  other levels of govt. to try and save their people. If they come up with a way to fix the problem Trump will just undo that as before, and this will go on until Trump is gone. There will be no fix with the health care problems until Trump is gone. There can be local fixes to  locally caused problems, but in many cases Trump will un do them.  Once again there will be no fixes to health care until Trump is gone, and the ACA returned to what it is supposed to be. If you want to fix health care fix the over riding problem Trump first. What you are doing is trying to live in never never land defending Trump and what he has done by saying we can make improvements, and fix problems which we can not. Trump creates new problems just about every day as his lackeys do their  daily work of destroying health care.

This has nothing to do with President Trump.

I already explained how the probem began - The ACA passage removed the pre-existing condition denial.  Until then, these patients got on Medicare and had no other coverage to handle the part Medicare didn't pay because NO insurance company would insure them (Pre-ACA)

 

Since they now can get private insurance - they get it to help pay their part of the cost - but they aren't paying the premiums for this private insurance - the charitable patient org.pays for it - they pay for it from donations made by the medical service provider so they can get a higher rate of reimbursement.

 

Just go back to the Trump soap opera - I like for my mind to be challenged somewhat with discussion - this thread, with your responses, isn't gettin' it.


It has everything to do with Trump period end of story. You explained nothing as you do not know how the problem began, all you know is what some one wrote how they think it began. If it was local let the locals handle it as they will, but if it comes from the Trump effort to kill the ACA they will not, and I say it came from Trump as that is the root cause of just about all of this. Now you have your writer, and I have what I know about health care so let it play out and we can talk about this in 4 years. No you like your mind to read a lot of articles and then comment on them. When the ACA first started you were on this same path and it got to the point you were taking opposite sides depending which article you had read. You were for and against the same thing, and you and I discussed this them.  This thread is not getting it so we agree. Start it in 4 years and it could be useful.

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Re: THIS IS HOW CRAZY OUR HEALTHCARE INDUSTRY HAS BECOME - BUT HOW TO FIX IT ??

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Message 2 of 14

@john258 wrote:

This is a current event caused by Trump who has messed with the ACA to destroy it which has forced  other levels of govt. to try and save their people. If they come up with a way to fix the problem Trump will just undo that as before, and this will go on until Trump is gone. There will be no fix with the health care problems until Trump is gone. There can be local fixes to  locally caused problems, but in many cases Trump will un do them.  Once again there will be no fixes to health care until Trump is gone, and the ACA returned to what it is supposed to be. If you want to fix health care fix the over riding problem Trump first. What you are doing is trying to live in never never land defending Trump and what he has done by saying we can make improvements, and fix problems which we can not. Trump creates new problems just about every day as his lackeys do their  daily work of destroying health care.

This has nothing to do with President Trump.

I already explained how the probem began - The ACA passage removed the pre-existing condition denial.  Until then, these patients got on Medicare and had no other coverage to handle the part Medicare didn't pay because NO insurance company would insure them (Pre-ACA)

 

Since they now can get private insurance - they get it to help pay their part of the cost - but they aren't paying the premiums for this private insurance - the charitable patient org.pays for it - they pay for it from donations made by the medical service provider so they can get a higher rate of reimbursement.

 

Just go back to the Trump soap opera - I like for my mind to be challenged somewhat with discussion - this thread, with your responses, isn't gettin' it.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: THIS IS HOW CRAZY OUR HEALTHCARE INDUSTRY HAS BECOME - BUT HOW TO FIX IT ??

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@GailL1 wrote:

@john258 wrote:

Well nothing is going to happen to any of this until Trump is gone. Some of the local problems will be solved at the local level. Stop using KHN as a source of really what is going on. I gave you an example of an item you were posting could not happen per them, while they were doing it. Less reading and more understanding is needed. Never quote anything from Texas as that State like Ga thinks you solve the problems by letting them die in the Streets. Here is a suggestion for you. Work on what is wrong in GA where you might do some good because you will be doing something to help rather than read and post it where most people who see it will have no idea what you are talking about. After Trump is gone and the ACA put back to where it should be then come back with all of this, but send it to the people improving the ACA not to me or anyone else in here. If you want to help now join the movement to end Trump in Office in 2020.


This doesn't have anything to do with President Trump.  Where do you get that?

This is a current event.

KHN is the same as California Healthline, they are news outlets,non-profit - https://californiahealthline.org/about-us/ 

Neither KHN, California Healthline nor the Kaiser Family Foundation is affiliated with health services provider Kaiser Permanente.

The patient lived in TEXAS - the article was from PBS.

This subject is a problem ALL over the country.  A solution would help with premium cost; but it would also increase the out of pocket cost for the patients. 

Single payer would probably fix it but at what cost to everybody?

Honestly, john258 - your conversations here are asinine - you don't really discuss anything.

You are focused on Trump - so why not just respond to those post?


This is a current event caused by Trump who has messed with the ACA to destroy it which has forced  other levels of govt. to try and save their people. If they come up with a way to fix the problem Trump will just undo that as before, and this will go on until Trump is gone. There will be no fix with the health care problems until Trump is gone. There can be local fixes to  locally caused problems, but in many cases Trump will un do them.  Once again there will be no fixes to health care until Trump is gone, and the ACA returned to what it is supposed to be. If you want to fix health care fix the over riding problem Trump first. What you are doing is trying to live in never never land defending Trump and what he has done by saying we can make improvements, and fix problems which we can not. Trump creates new problems just about every day as his lackeys do their  daily work of destroying health care.

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Re: THIS IS HOW CRAZY OUR HEALTHCARE INDUSTRY HAS BECOME - BUT HOW TO FIX IT ??

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Message 4 of 14

@john258 wrote:

Well nothing is going to happen to any of this until Trump is gone. Some of the local problems will be solved at the local level. Stop using KHN as a source of really what is going on. I gave you an example of an item you were posting could not happen per them, while they were doing it. Less reading and more understanding is needed. Never quote anything from Texas as that State like Ga thinks you solve the problems by letting them die in the Streets. Here is a suggestion for you. Work on what is wrong in GA where you might do some good because you will be doing something to help rather than read and post it where most people who see it will have no idea what you are talking about. After Trump is gone and the ACA put back to where it should be then come back with all of this, but send it to the people improving the ACA not to me or anyone else in here. If you want to help now join the movement to end Trump in Office in 2020.


This doesn't have anything to do with President Trump.  Where do you get that?

This is a current event.

KHN is the same as California Healthline, they are news outlets,non-profit - https://californiahealthline.org/about-us/ 

Neither KHN, California Healthline nor the Kaiser Family Foundation is affiliated with health services provider Kaiser Permanente.

The patient lived in TEXAS - the article was from PBS.

This subject is a problem ALL over the country.  A solution would help with premium cost; but it would also increase the out of pocket cost for the patients. 

Single payer would probably fix it but at what cost to everybody?

Honestly, john258 - your conversations here are asinine - you don't really discuss anything.

You are focused on Trump - so why not just respond to those post?


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Message 5 of 14

Well nothing is going to happen to any of this until Trump is gone. Some of the local problems will be solved at the local level. Stop using KHN as a source of really what is going on. I gave you an example of an item you were posting could not happen per them, while they were doing it. Less reading and more understanding is needed. Never quote anything from Texas as that State like Ga thinks you solve the problems by letting them die in the Streets. Here is a suggestion for you. Work on what is wrong in GA where you might do some good because you will be doing something to help rather than read and post it where most people who see it will have no idea what you are talking about. After Trump is gone and the ACA put back to where it should be then come back with all of this, but send it to the people improving the ACA not to me or anyone else in here. If you want to help now join the movement to end Trump in Office in 2020.

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Message 6 of 14

@john258 wrote:

Here is some advice to all. There will always be some local problems in any health care system you put in place. These problems will for the most part be solved by local experts. The problem here is when people take a local problem and try and make it a national problem. You can not do that. Let the local experts work their problems if they do nothing then you take it up the line. You have to understand the entire health care system, and when you do you do not get involved before needed.

 

@john258wrote at 11-14-2019 08:55 PM

 

Here are some questions. 1. Were there any rule changes in the ACA per Trump that had an effect on this. (This will take you some time to review all changes to all parts of the ACA). 2. I have a feeling that some one like Kaiser can find a way out of this. An Indemnity type policy could be one way, and they know how to do that in CA.

Right now let CA fix the problem as Trump has the entire system in a mess. The answer. Get Trump out, the ACA back to normal and work toward Single payer system like Medicare. There will always be things like this come up when ever you have changes so you need good LOCAL people to handle, and outside people to only push to get the locals moving. If you recall when the ACA was first be proposed you were against so much you ended up being against what you were for, and we posted to each other about that. Let the locals handle it.


I am gonna try to answer both your above post here since they link in substance ~

 

This is NOT a local problem - it is happening all over the country - non-profit charitable patient advocate organizations teaming up with (related) medical providers to buy patients private insurance via donations from the (related) medical providers in order for the (same)(related) medical provider to receive higher pay for their services than what Medicare pays.

 

The difference in CA is their NEW law to try to curb the practice.  Kaiser Health News is just the source material which I used with this post.  In fact, This KHN story first published on California Healthline, a service of the California Health Care Foundation.

https://californiahealthline.org/news/dialysis-patients-panic-as-financial-life-raft-becomes-unmoore... 

 

Now back to the problem -

This tactic actually came about as the result of the ACA - the elimination of the pre-existing condition to buy health insurance, specifically.  Think about it, especially if you know the system.

  • BEFORE the passage of the ACA, people on dialysis could not get private health insurance, (pre-existing condition denial)  That is one of the reasons why Medicare has always been open to people with End Stage Renal Disease (ESRD) regardless of their age or disability status.  However, if less than 65 years old, in most states, you cannot get a Medigap plan to help cover the patients part of the medical treatment under Medicare and these mount up very quickly if the treatment is often and/or it is expensive.  And even in those few states where a person under these circumstances could get a Medigap plan to supplement their Medicare, their premiums are astronomical.

 

  • With the passage of the ACA, sick people could now buy private insurance - no more pre-existing condition exclusion.
  • It did not take very long for service providers to begin to scrutinize their options here - and figure out a way to get paid MORE than what Medicare paid; or in the case of other chronic diseases being treated, no payments only being subsidized by the non-profit care organizations.

 

  • So a rather lucrative, for the providers, alliance was formed.
  • But the providers knew that they could not buy the private insurance for their patients - a matter of ethics that wouldn't stand up legally.  The providers might be questioned about a diagnosis and treatment.  So the alliance was formed with the non-profit care organization.
  • The service provider DONATES enough money to the non-profit care orgaization to purchase the private insurance for these patients.  They get a charitable donation deduction on their taxes as a bonus.
  • The non-profit care organization buys the private insurance policy and pays the premiums.
  • The service provider gets a bigger rate for service from the private insurance company than what they would under Medicare or under by having no policy in the case of other diseases of this type.

 

  • However, this private insurance coverage of these very sick and expensive treatment patients adds to the cost of insurance for everybody else, thus raising the premium rates for everybody.
  • In the case of ESRD, which often strikes very young people - perhaps as a result of Type 1 Diabetes - this alliance could go on for a very long time since they are MUCH less than 65 years of age.
  • Private insurance also comes in very handy if a kidney transplant comes about - Medicare stops the very expensive anti-rejection drugs after a period of time, leaving the funding for such up to the patient - private insurance gives continuous coverage - maybe not free but in accordance to their formulary.
  • If the condition is diabetes, Medicare also doesn't cover things like insulin pumps - private insurers do.

CA has opted to curtail this alliance via legislation - but it is being challenged in the courts.

Of course, the insurers do not like these third party payers of insurance -

 

Earlier court rulings

NPR 02/14/2017 - Texas Judge Upends Effort To Limit Charity Funding For Kidney Care 

Like many patients with end-stage renal disease, Early, who is completing a bachelor's degree in finance at the University of North Texas at Dallas, turned to a charity for financial assistance to cover his health insurance costs.

 

In granting the preliminary injunction in late January, U.S. District Court Judge Amos Mazzant in Sherman, Texas, criticized the government's administrative process for establishing the regulation and said it hadn't considered the benefits of private individual insurance or the fact that the rule would leave thousands of patients without coverage.

 

Such "third-party payments" by nonprofit groups, health care providers and others are controversial. The federal government has expressed concern that health care providers and organizations they're affiliated with might be inappropriately "steering" patients to marketplace plans instead of Medicare or Medicaid, for which they are often eligible. The public programs reimburse for the dialysis services at lower rates than most private plans. The efforts by charities have also long been a sore spot with health insurers, who say they encourage sick patients who have expensive health care needs to opt for private coverage.

 

Insurers suffered a setback recently when a federal judge temporarily blocked a new rule from the Department of Health and Human Services that was set to go into effect Jan. 13. It would require that dialysis centers inform insurers if the centers are making premium payments either directly or indirectly through a third party for people covered by marketplace plans. Insurers would then have the option of accepting or denying the payments.

 

Insurers were not pleased. "Inappropriate steering and third-party payments increases costs for all consumers, and it risks harm to patients who are often eligible for public coverage options," said Kristine Grow, a spokesperson for America's Health Insurance Plans, an industry group. "We continue to urge [the Department of Health and Human Services] to prohibit these payments when there is alternative coverage for patients."

 

But patient advocates were delighted. "We thought this was an important win for dialysis patients because it not only spoke to the procedural elements of the rule but to the substance, the potential of dialysis patients to have their coverage taken away," said Hrant Jamgochian, the chief executive of Dialysis Patient Citizens, an advocacy group that was the lead plaintiff in the lawsuit.

 

Premium assistance has been critical to improving Early's quality of life. "Without the [American Kidney Fund] assistance I would be living to pay my medical costs," he said. "They give me an opportunity to get a breather from medical costs so that I can live my life outside of my illness."

 

Although some patients, such as Early, are able to undergo dialysis at home, many must spend four hours at a dialysis center three times a week. The process is debilitating and time-consuming.

Just as an asside:  The current Administration is attempting to promote more home dialysis.

 

Sixty percent of the people who receive premium assistance from the American Kidney Fund get help with their Medicare or Medigap plans rather than marketplace or other private coverage, said (CEO of AKF).  Even though the judge's order doesn't apply to people in public plans, she hopes it will discourage insurers that are increasingly erecting barriers to third-party payment.

 

"We want to protect the ability that these individuals have to make the choice that meets their needs," Burton said.

 

American Kidney Fund.org - Health Insurance Premium Program

 

How do you see an indemnity insurance plan helping the patients here ???????

 

 

 

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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"...How did other countries fix it. ? Universal Healthcare is not that difficult...... that the United States is one of the only first world countries to not offer universal healthcare as a right for its citizens....".

 

They did it by raising taxes. No one will do that..........

 

Example: ".... Canada has a higher average practical tax rate than the United States at 28%. Business Insider reports that after taxes Canadians bring home $35,299 annually on average. In the United States the practical tax rate is lower at 18%. As such the average post tax annual salary in the U.S. is $52,344....".


"...Why is everyone a victim? Take personal responsibility for your life..."
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Message 8 of 14

Here is some advice to all. There will always be some local problems in any health care system you put in place. These problems will for the most part be solved by local experts. The problem here is when people take a local problem and try and make it a national problem. You can not do that. Let the local experts work their problems if they do nothing then you take it up the line. You have to understand the entire health care system, and when you do you do not get involved before needed.

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Message 9 of 14

COMMENTS ????  SOLUTIONS ????

 

Medicare for All

 

When calculating cost, also calculate the value of  the benefits. 

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How did other countries fix it. ?   Universal Healthcare is not that difficult......     that the United States is one of the only first world countries to not offer universal healthcare as a right for its citizens. 
 
www.worldatlas.com/articles/countries-with-universal-health-care.html
Currently, 58 countries have universal health care. They include Algeria, Argentina, Bahrain, Bulgaria, Canada, Colombia, France, Germany, Greece, Iceland, Ireland, Israel, and Norway.

 

+++++++++++++++++++++++++++++++++

 

medicare for all countries.jpg

 

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