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Politics : Politics for Pros- moderated -- Ignore unavailable to you. Want to Upgrade?

To: LindyBill who wrote (304848)	5/13/2009 8:46:34 AM
From: DMaA	Respond to of 793939

Thought so. So 2017 is a mirage. We are are in big trouble right now.

To: LindyBill who wrote (304848)	5/13/2009 3:24:08 PM
From: KLP	2 Recommendations Read Replies (1) \| Respond to of 793939

FYI: Please read: Observation Stays” and Hospital Payments I can almost guarantee this situation will happen to each of us or one of our family, and even more if our health care in Nationalized. I encourage everyone to read this below….In Dec 2008, in severe compressed spine and ruptured disc pain, I entered the hospital through Emergency. I didn’t know there was such a thing as an Observation Admit….I do now, and we all need to be aware of this Medicare and Hospital care and billing situation… If you have to have surgery, or otherwise are admitted as an impatient admit, it is entirely a different situation. The care is different, and the bills are certainly different. I’m still dealing with the Dec bill over the extremely high cost of “Pharmacy Other” section. The Feb surgery stay bill was entirely different. There are many sources on Google talking about the pros and cons….. medicaresupplementinsurances.com Observation Stays” and Hospital Payments Posted by AnaLise Published in supplement plans There is something called an “observation stay” at many hospitals that has been around and been an issue for many years but few patients and few of us in the public hear about it. Years ago, before healthcare costs went through the roof you would often hear a doctor say to a patient “Let’s keep you here overnight for observation for a day or two and if everything is OK, we’ll send you home.” That was when things were less expensive and less complicated. Now there are clauses and loopholes that have found ways to avoid having to pay for patient care. “Observation Stays” have become one huge loophole. The way that they work is that patients aren’t exactly admitted to the hospital so insurance may not cover some expenses. For example: Judith Quinn was sure she had been admitted to the hospital. After all, she had stayed two weeks on a hospital ward, attended by hospital nurses, eating hospital food and examined by hospital physicians, after suffering a severe seizure. But Quinn, 68, of La Crosse, Wis., soon learned she was mistaken. The hospital’s staff didn’t consider Quinn an inpatient. Instead, they decided she was there for an “observation stay,” a little-known category of medical care. As a result, her Medicare coverage wouldn’t pay for the oral medications she took there or for three weeks she spent recovering in a nursing home after being discharged. Only inpatients get these benefits. Quinn’s case and others like it are raising concern in some medical quarters about observation care—a step up from the emergency room but a step down from a formal hospital stay. More and more patients are being tossed into this category because Medicare and private insurers want to spend scarce dollars on only the sickest people in costly medical centers. Insurers’ criteria for hospital admission are getting tougher by the year. In Illinois, as many as 320,000 people received observation care last year, up from less than 32,000 people a decade ago, according to the state’s hospital association, yet nobody seems to be noticing or doing anything about it and this is leaving numerous patients at great health and financial risk. In some cases observation care makes sense, especially if a patient is too sick to stay at home but not well enough to stabilize. With observation care, doctors can often stabilize the patient, determine the problem, prescribe medication and send the patient home – often in less than 48 hours, saving everyone involved money.People with asthma attacks, kidney stones, dizziness, chest pain and other mild conditions would be good candidates for observation stays. It is extremely important that you or your family find out whether you are actually being admitted or put on observation stay. Even if you are in an observation stay and they admit you for one day at the end of the observation, your medication, nursing home costs and other costs will be covered by Medicare. Without being admitted, you could be open to expenses you are not prepared to pay. The Office of Medicare Services is currently looking into the situation and trying to determine some reasonable solutions. Ms. Quinn’s story is an excerpt from the Tribune.

To: LindyBill who wrote (304848)	5/13/2009 5:00:53 PM
From: KLP	Respond to of 793939

JAMES EDWARDS: Health Care — There’s a Whole World of Hurt Coming If Our Current Public Programs Are Any Guide May 13th, 2009 10:28 AM Eastern foxforum.blogs.foxnews.com By James R. Edwards Jr. Principal, The MITA Group/Former Senior Speechwriter, Republican National Committee As Congress mulls health reform, a key proposal on the table would establish a Medicare-like “public program” — a new government-run health-insurance program. Advocates of a public program say that creating such an option alongside private insurers would enhance competition. People could choose to stay with their current private insurer or opt for the public plan. It would be open to those who don’t qualify for an existing government health program like Medicaid. Either way, proponents say, this would generate more competition, constraining costs. But would such an arrangement deliver the benefits expected? Could a government-operated health insurance plan even compete fairly with private plans? A look at the government health programs we already have suggests otherwise. Medicare insures 40 million seniors and some disabled Americans. For those in conventional, fee-for-service Medicare, the program doesn’t cover all the services or pay adequately for needed care. Most Medicare beneficiaries must buy supplementary Medigap insurance. Medicare poses problems for providers, too. It consistently underpays hospitals and doctors. Hospitals receive a 71 percent rate of reimbursement from Medicare. Doctors collect only 81 percent of what private payers pay. Medicaid, the federal-state health program for the poor, pays providers even smaller amounts than Medicare. Medicaid reimburses hospitals just 67 percent of charges, while paying doctors only 56 percent of their fees. Plus, Medicaid has become a serious cost-driver straining state budgets. State governments must make hard tax and spending choices, in part because of rapidly rising Medicaid costs over which they have little control. Medicaid spending increases on automatic pilot. Medicare, for its part, is nearly broke. Its trustees have warned, “Medicare’s financial difficulties come sooner — and are much more severe — than those confronting Social Security. While both programs face demographic challenges, rapidly growing health-care costs also affect Medicare.” Part A of the program is on the verge of paying out more than it collects. Medicare’s and Medicaid’s predicaments augur some unhealthy consequences. For taxpayers and the private sector, these underpayments force cost-shifting. Providers pass along the difference to private payers, which means many Americans pay more for their private health coverage. The research group Milliman found that Medicare and Medicaid underpayments cost the average family $1,788 a year in extra health costs. This “hidden tax” hits both employers and employees through higher premiums, deductibles and coinsurance. In addition, underpayment by government-run health care causes many practitioners to stop seeing patients in these programs. The Medicare Payment Advisory Commission last summer found that 29 percent of seniors now have trouble finding a doctor willing to take Medicare patients. Medicare’s underpayment and paperwork burdens explain why. Then there’s lagging quality. One third of Medicare patients return to the hospital within 90 days of discharge, the New England Journal of Medicine said. A fifth of patients are readmitted within 30 days. This added $17 billion to Medicare’s costs in 2004. These facts signal problems with the public-health program route. First, the costs of medical care will continue to rise, regardless of whether the government pays what something really costs. Second, government budgets always will strain under the demand placed on its insurance system. The only real tool the government has to constrain costs is price controls. In places like Canada, these lead to direct rationing of coverage, timely access and treatment for patients. We don’t like to call them that, but federal and state governments use price controls. That’s what Medicare and Medicaid underpayments are. The government plan would enjoy the ability to dictate terms. It could offer a generous initial set of benefits at artificially low prices —making it more and more difficult for private insurers to remain competitive. The Lewin Group has estimated that the proposal could displace the private coverage of more than 118 million Americans. At some point, the “public plan” might be the only health plan. No more competition. No more consumer choice. Then, there’s only government-run health care. That would be a botched procedure. James R. Edwards Jr. is a principal at the MITA Group, a Washington, D.C., government relations firm whose clients include health care industry groups. The views expressed are his own.