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Universal Healthcare? YES, we CAN!

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posted on Jul, 15 2017 @ 09:13 PM
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a reply to: Phoenix


From the article you linked to, I thought this section interesting. Lots of subject interpretation involved. The "police" who determine if a bill should/shouldn't be paid, have too much power.


""No government funded program or government billed invoice will be paid for medical treatment where a lifestyle change will provide a substantially equivalent or superior benefit that the customer refuses to implement.  

The poster child for this is Type II diabetes, where cessation of eating carbohydrates and PUFA oils, with the exception of moderate amounts of whole green vegetables (such as broccoli) will immediately, in nearly all sufferers, return their blood sugar to near normal or normal levels.  

The government currently spends about 25% of Medicare and Medicaid dollars on this one condition alone and virtually all of it is spent on people who can make this lifestyle change with that outcome but refuse.  

If you're one of the few exceptions and it doesn't work in your case you have the burden of proof.  Nobody has the right to light their own house on fire on purpose and then claim FEMA benefits for same.  

This one change alone will cut somewhere between $350 and $400 billion a year out of Federal Spending and, if implemented by private health plans as well, likely at least as much in the private sector.  That's more than three quarters of a trillion dollars a year that is literally flushed down the toilet due to people being pigheaded and refusing to do things that would not only save the money but also save their limbs, eyesight and ultimately their life.""

But this is not the thread, for discussing it in detail. I just wanted to throw that thought out there...




posted on Jul, 15 2017 @ 09:21 PM
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a reply to: TheRedneck

Just looked briefly but will address providing high standards of medical care.

This is already a process that is required. It is called best practice and goes for hospitals and dr's in private practice.

For private practice insurance companies require a dr meet certain standards of care. Some of it is just asking certain questions, other's are recommending certain tests within a particular time frame. Ex either colonoscopy every 10 years or sigmoidoscopy/barium enema every 5 years or fecal smear for blood yearly after age 50.

They have to meet this standard with a high percentage of patients to get a bonus of 10-20k per year from the insurance company. Preventive healthcare is profitable for the Insurance company and hospital. Most of this is CMS requirements.

I used to audit Dr's and clinic's for these standards but the info is about 10 years old.



posted on Jul, 15 2017 @ 09:24 PM
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a reply to: Phoenix

Roll Tide!


I like several provisions in that, specifically
  • Insurance does not cover pre-existing conditions, but also must cover conditions that occurred during coverage for perpetuity. The only issue I see with that is that an insurer could go out of business and leave the patient high and dry. Perhaps an escrow account could be set up when an issue occurs? I need to think on that.

  • Posting prices... I LIKE IT! I wonder how standardized some experimental procedures are, though, and whether it would be practical. For instance, the stent in my heart was a fairly simple procedure, but trying to remove a couple bullets lodged in difficult areas might be much more extensive and costly. But both are heart operations.

  • I especially like that procedures required as a result of procedures should be free. That's just common sense. If I let a mechanic fix my engine and in the process he nicks a brake line, he should fix the brake line on his own dime, not mine. Of course, given the primitive state of knowledge of medicine we have today, I wonder if that would even be workable...

  • All medical records on flash, at the time of discharge! Awesome idea!

I'm going to go through that site more thoroughly and integrate some of those ideas into mine. Thank you!

TheRedneck



posted on Jul, 15 2017 @ 09:26 PM
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a reply to: carewemust

The "police" would be medical determination, but let's discuss elsewhere as The redneck put to much work into the OP to derail his intent which is presentation of what may fix it.




posted on Jul, 15 2017 @ 09:33 PM
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a reply to: carewemust

Actually, I think this is the thread, especially since there are some good ideas on that site that I want to incorporate. I agree with you on that one provision; too costly on the patient, and some lifestyle changes might not be workable in some people. For example, my wife has TWO dietary restrictions... one for the Type II diabetes (which she is already beating! Yay!) and another for migraine triggers. One of her triggers is sucralose, which is a sugar substitute... good for diabetes, but terrible for migraines.

And that's just one example. I can see millions of similar cases, where a person is refused medical assistance because they are too sick with one disease to completely combat another.

That's also why insurance companies should never make medical decisions. My plan makes it illegal for any insurance company to deny medical treatment if two doctors agree it is needed.

TheRedneck



posted on Jul, 15 2017 @ 09:36 PM
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a reply to: Phoenix

My primary concern is we come up with a fix. Whether it's my idea, another suggestion, or a combination of the two, doesn't matter to me.

I just want the stoopids in Congress and on TV to shut up and fix the problem. I'm tired of being denied unemployment because my age would make the mandatory insurance premiums go up under Obamacare.

TheRedneck



posted on Jul, 15 2017 @ 09:36 PM
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a reply to: TheRedneck

You welcome, Rolllll Tiiiiide!!!

Denninger has been on the problem long time, lots of real data, real numbers without political rhetoric.

It'll be worth the time - start with pinned stuff n go from there.

Phoenix



posted on Jul, 15 2017 @ 10:01 PM
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Another thought if I may. Hospital emergency rooms are inundated with people with no insurance or on medicaid. These patients come in with flu or fever or other non emergency symptoms.

Every citizen should be required to chose a physician and if they don't one should be appointed to them.

All physicians should be required to take a certain amount of non insured people.

Most low income people know that emergency rooms cannot turn away a paitient, so that is where they go and the costs are much higher. Hospital's are already required to take, at least a certain number, of patients with no insurance.



posted on Jul, 15 2017 @ 10:03 PM
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originally posted by: TheRedneck

I queried:Who sets prices for procedures and office visits?
Doctors. Of course.

TheRedneck



I gotta problem with that if I am understanding your position.

There are no standards or guidelines?
So, I need stitches.
Urgent care #1 charges $75.00
My doctor charges $50.00
My neighbor's doctor charges $35.00
Urgent care #2 charges $45.00....but if you pay at the time of service, it is $32.00
The ER charges $85.00

And on it goes.
You cannot shop around every time you want medical care.



posted on Jul, 15 2017 @ 10:08 PM
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a reply to: TheRedneck

My point was less that patients were being turned away for no insurance, and much more that if it's up to the patients to submit bills themselves this was going to be more fraud fraught than credit card fraud, identity theft and just as lucrative. Currently because bills are submitted from the medical provider to the insurance company there is little chance that payment will be misdirected.

Under your system, for example a chiropractor or other "less medical" type doctor could be pulling in the bucks with a beefed up patient list without doing much more than paying 20 bucks for their fake patients to sign the claim form.
There I'm sure are more ways to game this than I am thinking of?

Plus expecting people to send in their own claims only works in a perfect world. Currently while most of a procedure is covered you normally have a portion you pay, and getting that in a timely manner is like pulling teeth. Personal responsibility is great, but for some of the population it's a foreign concept. This is going to be nightmarish I think down the road.

Believe it or not I actually think it would be easier to just add everyone to medicare/medicaid and just deduct it from our paychecks. The govt already does an ok job of keeping those reimbursements at reasonable levels and could also bargain down drug prices with some some cattle-prodding. It would clip the wings of insurance companies fairly effectively as well.
Just a thought.



posted on Jul, 15 2017 @ 10:13 PM
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originally posted by: TheRedneck
a reply to: carewemust


That's also why insurance companies should never make medical decisions. My plan makes it illegal for any insurance company to deny medical treatment if two doctors agree it is needed.

TheRedneck


Exactly right. I've worked in the insurance field since 1987. The decisions made by ALL Insurance companies (Life/Health/Home/Car, etc.) are driven by MAXIMUM PROFIT for executives and shareholders. That is what the larger companies are in business for, first and foremost.

If a procedure or treatment regime causes too big of a financial hit, the insurance company will not authorize it, unless a higher force, like the ACA law, requires them too. That's one reason why the insurer stabilization rule is built into the ACA, and also TrumpCare.

Speaking of TrumpCare, the Senate has delayed it's potential vote this week because Senator McCain had a blood clot removed from his eye this weekend.

www.politico.com...

Sounds like a welcome "excuse" for McConnell. I'm sure the tepid little guy will be looking for another one after this week. It will probably be that the upcoming CBO Score scared away the rest of the timid wimp Republicans.



posted on Jul, 15 2017 @ 10:13 PM
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originally posted by: carewemust
a reply to: TheRedneck

The goal of your plan is admirable. But it creates new hurdles. The simplest way to get universal access to care is to enable everyone who doesn't want, or can't qualify for private health insurance, to enroll in one of the programs that already exist. (Medicare and Medicaid) Medicare for those who can afford it. Medicaid for those who can't afford Medicare.


If that idea would be used, there should be a tiered Medicaid for everyone NOT on Medicare.....and Medicare should be for the elderly ONLY.
The disabled got bounced to the new Medicaid.

Those below 100-120% of poverty get it paid for.
Everyone else pays on a scale....say $100 per month if you make $40,000.....up to $400 a month if you make $250,000.
It covers 70-80% of your bills....and would be like Medicare....you could buy a very reasonable supplemental insurance policy.
Deductibles would be $500...or less, depending on income.

And the ceiling on payroll taxes paid for Medicare would go up substantially from what they are today.

The Redneck's Tort Policy would become law.

CoPays would be similar to regular Medicare...or less.



posted on Jul, 15 2017 @ 10:16 PM
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originally posted by: Caver78
a reply to: TheRedneck

Believe it or not I actually think it would be easier to just add everyone to medicare/medicaid and just deduct it from our paychecks. The govt already does an ok job of keeping those reimbursements at reasonable levels and could also bargain down drug prices with some some cattle-prodding. It would clip the wings of insurance companies fairly effectively as well.
Just a thought.


BINGO! Everyone who doesn't want, or can't qualify for private insurance OF THEIR CHOICE, should be able to buy into Medicare if they can afford the $453@ month premium, or take Medicaid, if they can't afford the Medicare premium.



posted on Jul, 15 2017 @ 10:16 PM
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a reply to: TheRedneck

I agree something needs done and done quickly however some the anti-trust laws need be applied and industry needs to not be ones writing the plan.

I'm in limbo coverage wise and nothing is affordable or wise to take on if I'm to leave assets for the kids.

On carewemusts issue Denninger has a point, there are far to many who engorge themselves on high carb high sugar food and beverage that indeed expect everyone else to pay when bill comes due with nary a thought on changing lifestyle.

I see it everytime I grocery shop or eat out.

His and your point that other circumstances may preclude lifestyle change is valid but statistically out of how many millions would that actually be true of?

On personal side this very issue my father fit the poster for this as he did eventually kill himself with Type II and last 10 years his life medicare/medicaid paid vast sums for treatment, operations and intensive care.

It really was un-necessary had he changed his ways, unfortunately he was one that would have benefited with Denningers suggestions because it would have economically forced the action he would not do voluntarily himself.

If smoking was issue rather than type 2 I don't think concept would be at issue but there's loose equivalent in idea proposed - more thought needed to implement so those like your wife not grouped with those who simply eat themselves to oblivion.

I do know for fact most if not all whom drink case cola, eat 3-4 pizzas and fill rest of weeks meals with Mac Cheese are for the most part uninsurable under any real insurance actuarial theory as the risk of event is equal to or greater than 1.

Then it becomes subsidy.



posted on Jul, 15 2017 @ 10:28 PM
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a reply to: DontTreadOnMe

And apply anti-trust laws to that suggestion across the entire insurance, provider, pharmaceutical, testing and device portions of medical industry so that current levels of theft, fraud and price fixing are not locked into that change,

I can agree with.



posted on Jul, 15 2017 @ 10:31 PM
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I'll bow out and leave this thread to those of you who are thinking of the long-term solutions. My #1 goal is to help the many families who call me every week, full of anxiety, because they will not have health insurance coverage available, or affordable to them after 12.31.2017. We need a fix before September 1st. That's when all I.T. departments coordinate with the Government exchanges to prepare for 2018.



posted on Jul, 15 2017 @ 10:31 PM
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a reply to: TheRedneck

I downloaded your proposal.

At a glance is makes sense.

I fear though that giving this to congress would be like giving a tank of slime eels the Declaration of independence and expecting them to form a coherent government.


in order to sell this, congress would have to benefit. They wouldn't raise a finger to help someone if there wasn't a photo op involved.


edit on 15-7-2017 by DBCowboy because: (no reason given)



posted on Jul, 15 2017 @ 10:48 PM
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a reply to: carewemust

That's valid issue,

Short term even were congress to pass anything putting system changes into practice would probably take longer than September and it hard to imagine even by January.

You're right, many will be left in a lurch.

I myself have been in lurch for sometime now.

Suggestions?

Freeze it in position till congress acts via E.O or something similar?

I hear you loud and clear as I'm forced to wing it and hope nothing happens health wise as this mess works way slowly through spaghetti grinder that is our congress.



posted on Jul, 15 2017 @ 10:59 PM
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can you just send some copies of this to the whitehouse?

Mass email it to every senator and representative?



posted on Jul, 15 2017 @ 11:28 PM
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a reply to: Caver78


Under your system, for example a chiropractor or other "less medical" type doctor could be pulling in the bucks with a beefed up patient list without doing much more than paying 20 bucks for their fake patients to sign the claim form.
There I'm sure are more ways to game this than I am thinking of?

Actually, under my system the patient would be required to send in their own forms to initiate the claim. The doctor cannot make first contact on a claim.

But regardless, that sort of thing happens now. It's called "fraud" and is highly illegal. There will always be those who game the system, no matter what system is in place.


Plus expecting people to send in their own claims only works in a perfect world. Currently while most of a procedure is covered you normally have a portion you pay, and getting that in a timely manner is like pulling teeth. Personal responsibility is great, but for some of the population it's a foreign concept. This is going to be nightmarish I think down the road.

Under my system, once the claim is processed and the doctor is notified there is a claim, the doctor must wait for the insurance to pay before even contacting the patient (except for the time-of-service billing, which I am adding in). The claim form must be simple enough to be filled out by a reasonable adult. No more long, complex forms. "Which doctor did you see?" "When did you see him?" "How much did he charge? Attach a copy of your bill." As the Yankees say, badda bing, badda bang, done.

The very fact that personal responsibility is a foreign concept is the root of the whole problem, IMO. I have seen the very thing you mention here on ATS, where the concept is applied to situations where it has no bearing. It becomes obvious that those who post such simply do not understand the concept.

But that concept needs to return. Otherwise there is no escape from a tyrannical, all-consuming government.


Believe it or not I actually think it would be easier to just add everyone to medicare/medicaid and just deduct it from our paychecks. The govt already does an ok job of keeping those reimbursements at reasonable levels and could also bargain down drug prices with some some cattle-prodding. It would clip the wings of insurance companies fairly effectively as well.

That makes a huge assumption: that people all have paychecks. It would remove health insurance from anyone unemployed. It also assumes the government will want to bargain down drug prices; from what I have seen so far, the government is fine with out-of-reason drug prices, even when those prices only apply to our own citizens.

TheRedneck




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