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Healthcare Reform: what should be done
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LittleDucky




 
 
    
 

Post Sun, May 28 2017, 1:02 am
nylon wrote:
It is not true that single payer systems all have long waiting lists and subpar results. Americans like to use single payer as if it were synonymous with universal healthcare. There are many models. Never mind that it's a myth that you don't wait here either. America is not equally served by physicians.

US maternal and neonatal mortality rates are poor not because doctors practice bad medicine in the sense of any individual decision. C section rates don't correspond well at all to mortality in western countries. Our statistics are poor because while part of our population gets excellent health care, another part gets too little. We spend relatively little on poverty reduction. We give women Medicaid when they get pregnant and then kick them off it three months after they give birth. This means chronic health conditions are not well managed prior to pregnancy. You have women coming in with uncontrolled diabetes or hypertension. And there are racial disparities we don't fully understand that persist even when the statistics are corrected for other issues like insurance or socioeconomic class.

WHO has tried to standardize reporting of births (there is a strict definition for perinatal mortality for example). The gaps persist in a lot of categories. It can't all be explained by differences in reporting. Infant mortality, where the US lags, is all deaths to one year. That is not because of stillbirths. The US does pretty well in perinatal mortality; we do poorly in neonatal and infant.


But not all countries use the WHO standard. The USA does but not every country uses this criteria that counts more babies as alive. Stillbirths aren't part of the infant mortality stats but we count less babies as stillbirth and more as alive. Like babies they know will dies within minutes/hours despite treatment.
We also work to save babies that other countries may not (or cannot). My OB has pictures up in his office of babies who did survive despite being told it was almost impossible- other countries have been found to let the babies die and not do "drastic measures" as it wouldn't help... Just read an article about in in Great Britain I believe but I can't find it now.
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mommy3b2c




 
 
    
 

Post Sun, May 28 2017, 1:11 am
LittleDucky wrote:
But not all countries use the WHO standard. The USA does but not every country uses this criteria that counts more babies as alive. Stillbirths aren't part of the infant mortality stats but we count less babies as stillbirth and more as alive. Like babies they know will dies within minutes/hours despite treatment.
We also work to save babies that other countries may not (or cannot). My OB has pictures up in his office of babies who did survive despite being told it was almost impossible- other countries have been found to let the babies die and not do "drastic measures" as it wouldn't help... Just read an article about in in Great Britain I believe but I can't find it now.


This exactly. I actually was discussing this thread with my husband, and he explained it to me. He is actually an expert in this field.
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marina




 
 
    
 

Post Sun, May 28 2017, 2:47 am
chaiz wrote:
Studies show that when doctors/hospitals apologize for their mistakes there is much less cost in terms of suits and settlements.


My law review article was exactly about this- how to change the rules of evidence to bar physicians' apologies from being used in court against them.
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nylon




 
 
    
 

Post Sun, May 28 2017, 10:21 pm
Infant mortality is all deaths to one year so it's a poor reflection of obstetric care. Perinatal mortality includes stillbirths and there is a specific week minimum - I forget exactly but I think 23 weeks.
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farm




 
 
    
 

Post Mon, May 29 2017, 12:46 pm
So we believe as a country that if someone comes to an emergency room, they are not to be denied care regardless of an ability to pay. But haven't we taken it too far- Medicaid must cover every single medication that is FDA approved? And cannot negotiate manufacturer discounts?
Why can't we allow the whole country to be on Medicaid/VA type healthcare with reasonable (obviously highly debatable/controversial!) cut off over what is universally covered and what isn't. And those that want everything covered/Cadillac plans get via the private sector/employer, etc.
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chaiz




 
 
    
 

Post Mon, May 29 2017, 1:23 pm
marina wrote:
My law review article was exactly about this- how to change the rules of evidence to bar physicians' apologies from being used in court against them.


I read about this too long ago for me to remember properly, but when hospitals or doctors apologized and took responsibility patients felt less of a need to sue. I think people sue because they want justice and accountability. Thank G-D I have never been in that position, but I can understand someone who is a victim of a medical error.
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marina




 
 
    
 

Post Mon, May 29 2017, 8:48 pm
chaiz wrote:
I read about this too long ago for me to remember properly, but when hospitals or doctors apologized and took responsibility patients felt less of a need to sue. I think people sue because they want justice and accountability. Thank G-D I have never been in that position, but I can understand someone who is a victim of a medical error.


This is what I wrote about- the data shows what you wrote, but right now many states and federal courts allow an apology to be used against the doctor, so physicians are directed not to apologize. The rules need to be changed to avoid this
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nylon




 
 
    
 

Post Mon, May 29 2017, 9:31 pm
farm wrote:
So we believe as a country that if someone comes to an emergency room, they are not to be denied care regardless of an ability to pay. But haven't we taken it too far- Medicaid must cover every single medication that is FDA approved? And cannot negotiate manufacturer discounts?
Why can't we allow the whole country to be on Medicaid/VA type healthcare with reasonable (obviously highly debatable/controversial!) cut off over what is universally covered and what isn't. And those that want everything covered/Cadillac plans get via the private sector/employer, etc.

EMTALA only requires that they stabilize you. If you come in with a heart attack or a broken leg, they have to treat you (and then send you a bill). This is useless for any type of chronic condition.

Medicaid has a formulary, so they do not cover all drugs. For example, the expensive new Hepatitis C drugs are not covered unless you meet specific criteria. They also do negotiate prices with the manufacturers. Medicare was expressly forbidden to negotiate when Pres. Bush set up Part D. Again there are formularies for each Part D plan.

Medicaid frequently pays less than the cost of treatment, which is why it can be difficult to get providers to accept it (the exact payment is set by the state so some states have better access than others). Medicare pays less than private insurance also. Often private insurance will do something like make its standard payment to be 125% of the Medicare rate.

It is just as much about how much is paid (because most health care plans in the US pay per procedure or visit) as about what is covered. (Also, about how much treatment we give for certain things.)
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amother
Lawngreen


 

Post Mon, May 29 2017, 9:37 pm
farm wrote:
So we believe as a country that if someone comes to an emergency room, they are not to be denied care regardless of an ability to pay. But haven't we taken it too far- Medicaid must cover every single medication that is FDA approved? And cannot negotiate manufacturer discounts?
Why can't we allow the whole country to be on Medicaid/VA type healthcare with reasonable (obviously highly debatable/controversial!) cut off over what is universally covered and what isn't. And those that want everything covered/Cadillac plans get via the private sector/employer, etc.


Lol EVERY medication? I am getting a huge runaround now trying to get medication for myself that is FDA approved. I think the rule is one in every category. So if your kid needs extended release ritalin but they only approve regular adderal, good luck to you.

P.S. obviously these are not life or death drugs, but still, disproves the pp.
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chaiz




 
 
    
 

Post Tue, May 30 2017, 1:15 am
marina wrote:
This is what I wrote about- the data shows what you wrote, but right now many states and federal courts allow an apology to be used against the doctor, so physicians are directed not to apologize. The rules need to be changed to avoid this


Well if this is what people mean when they say tort reform, then I am all for it.
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nursemomma




 
 
    
 

Post Tue, May 30 2017, 1:26 am
I don't know much about the technical aspect of healthcare, but I have one question.
Why can't Medicaid patients have even a small copay-for ex even $5 for doctors visits, $10-20 on er??
Why do Medicaid patients get to use and abuse medical care, while those with expensive premiums and deductibles think 10 times before going to the doctor?!?
I was once at the ER, and a woman walked into the ER with her daughter for constipation shock
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MagentaYenta




 
 
    
 

Post Tue, May 30 2017, 1:33 am
nursemomma wrote:
I don't know much about the technical aspect of healthcare, but I have one question.
Why can't Medicaid patients have even a small copay-for ex even $5 for doctors visits, $10-20 on er??
Why do Medicaid patients get to use and abuse medical care, while those with expensive premiums and deductibles think 10 times before going to the doctor?!?
I was once at the ER, and a woman walked into the ER with her daughter for constipation shock


Parts of medicaid are administered and paid for by individual states. I live in a state where there are copays for most medicaid patients. These include ER copays as high as $150, Drs. run between $10 and $20.
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nylon




 
 
    
 

Post Tue, May 30 2017, 8:11 am
Many Medicaid patients really can't afford copays. Medicaid also covers a lot of disabled and elderly people who go to the doctor frequently. They're not abusing anything.

Also, dealing with overuse is much more complicated than slapping on a price tag. For example, none of the urgent cares in my area take Medicaid, and many doctors' offices don't have evening hours. If you have an urgent issue, you have to go to the ER.
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