Re: Doc choice

November 9, 2009

Anyone who has a PPO or HMO is familiar with this concept. The insurance company tells us which doctors we can and cannot see and which tests they will and will not pay for, which hospital we must go to and where we have to go to have our labs drawn. If I have any extra money left after paying their exhorbitant premiums I can go to any doctor that I choose, though. We're all going to have to get used to PA's and NP's. My brother-in-law just had major surgery at a large teaching hospital. He saw the surgeon once in his office before surgery. While in the hospital he never, not once, saw the surgeon, he saw only the NP that works with his medical group. She made rounds, wrote orders, checked his incision, ordered his discharge, etc.

a

Too bad you have no choice.

Val

November 9, 2009

Bill has to go to joint committee?

I don't expect things to be like it is/was, anyway.

Dr's aren't getting paid on time or are getting lower fees.

(not from AARP as far as I know).

And still there are several health groups advertising they can do it

(Medicare) at lower cost.

Thinking out loud, regardless of the system, even a Nurse Practioner must

send patient as diagnosed to the spec. for sever stuff. They can do many

things a Dr doesn't want to bother with. They can dispense prescription

drugs, except the heavies which no Dr wants to prescribe now anyway.

Regards

Doc choice

From the bill (H.R. 3962) passed in the night Saturday:

Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment

system, in which patients choose which doctors to see and doctors are paid

for each service they provide, toward what's called a " medical home. "

The medical home is this decade's version of HMO-restrictions on care. A

primary-care provider manages access to costly specialists and diagnostic

tests for a flat monthly fee. The bill specifies that patients may have to

settle for a nurse practitioner rather than a physician as the primary-care

provider. Medical homes begin with demonstration projects, but the HHS

secretary is authorized to " disseminate this approach rapidly on a national

basis. "

A December 2008 Congressional Budget Office report noted that " medical

homes " were likely to resemble the unpopular gatekeepers of 20 years ago if

cost control was a priority.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

One can always choose any Dr they want in the US.

On Nov 8, 2009, at 6:45 PM, Valarie <val@...> wrote:

Too bad you have no choice.

Val

November 9, 2009

Before a joint committee, it

still has to pass the Senate.Â I don't

think it will, at least in its present form.Â

I do recall a Senate version had " medical homes " in it.Â We'll see.Â

The issue for me is not NPs, it is lack of choice.

Val

From:

hyperaldosteronism [mailto:hyperaldosteronism ] On

Behalf Of jwwright

Bill has to go to joint committee?

November 9, 2009

Here is a study that my VA Dr R. PETER MOGIELNICKI was part of

http://www.springerlink.com/content/gl7r34l062443346/fulltext.pdf?page=1

>

> Before a joint committee, it still has to pass the Senate. I don't think it

will, at least in its present form. I do recall a Senate version had " medical

homes " in it. We'll see. The issue for me is not NPs, it is lack of choice.

>

> Val

>

> From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of jwwright

>

> Bill has to go to joint committee?

>

November 9, 2009

I can tell you from what both my father and mother went through Dartmouth does

this. They told us in was because of Medicare.

Medicare does change there rules. IT was around 2000 when this seemed to

Medicare rules

This is what it now says on medicare web site.

Section 6: List of What Original Medicare Covers

Hospital Care (Inpatient) (For Outpatient Services, see page 43.)

Medicare Part A covers inpatient hospital care when all of the following are

true:• A doctor says you need inpatient hospital care to treat your illness or

injury.• You need the kind of care that can be given only in a hospital.• The

hospital accepts Medicare.• The Utilization Review Committee of the hospital

approves your stay while you are in the hospital.Medicare-covered hospital

services include the following: a semiprivate room, meals, general nursing, and

other hospital services and supplies. This includes care you get in critical

access hospitals and inpatient mental health care. See page 41. This doesn't

include private-duty nursing, a television, or a telephone in your room. It also

doesn't include a private room, unless medically necessary.

In 2008 YOU pay for each benefit period: Days 1 - 60: $1,024 deductible Days 61

- 90: $256 coinsurance each day Days 91 - 150: $512 coinsurance each day Beyond

150 days: all costs You pay for private-duty nursing, a television, or a

telephone in your room. You pay for a private room unless it's medically

necessary. For information

> >

> > Before a joint committee, it still has to pass the Senate. I don't think

> it will, at least in its present form. I do recall a Senate version had

> " medical homes " in it. We'll see. The issue for me is not NPs, it is lack of

> choice.

> >

> > Val

> >

> > From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of jwwright

> >

> > Bill has to go to joint committee?

> >

>

November 9, 2009

I think that except for Medicare hospitals can still charge what ever they want.

So if you were in hospital more then 4.6 days you would be billed for this time.

If you don't pay it does go on your credit report. By law if medicare is the

payer they can not charge you any more then 20% of the 4.6 days cost.

> > >

> > > Before a joint committee, it still has to pass the Senate. I don't think

it will, at least in its present form. I do recall a Senate version had

" medical homes " in it. We'll see. The issue for me is not NPs, it is lack of

choice.

> > >

> > > Val

> > >

> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of jwwright

> > >

> > > Bill has to go to joint committee?

> > >

> >

>

November 9, 2009

Why can't they give us a grant

and let us go buy wherever we want and whatever we want. I hate being on a plan that is looked

upon as inferior.

Val

From:

hyperaldosteronism [mailto:hyperaldosteronism ] On

Behalf Of Francis Bill

Any one that has medicare and been in hospital soon learn they don't

have many choices. Medicare tell Dr and hospital what they will pay them. Dr or

hospitals can not charge any more the medicare will pay. So

some don't take medicare. If you have to go in hospital Medcare will tell

hospital to keep you only until you are stable then you go to nursing home if

you need more care. Nursing homes realy don't have proper help to take care of

many that medicare sends to them.

November 10, 2009

Unless something changed Medicare isn't controled by the state. States can have

laws that all insurances in the that state have to abide by.

Medicaid is controled be each state but still have to use federal guidelines.

If we were part of AIG then we would not have to worry about our health care

needs. AIG probleme are due to greed not because of lack of money. Now all tax

payers are fnding this greed.

>

> All costs will be increased to meet the money allowed.

> I don't think Medicare is flawed if you compare it to 1959, eg.

>

> An Austin, TX, AARP rep is saying that our Medicare will not be changed

> with the new House plan.

> That may be just Texas. And I do think states regulate what happens in the

> state.

>

> Confusion is there are plans here that say they will pay ALL costs, just

> sign with them and pay their supplement. Some medicare " ADVANTAGE " plans

> have no monthly fee, but there is a copay.

>

> They get from medicare your gov't contribution and use it " better " ,

> supposedly.

>

> Thay's why I say it's different here.

> I use AARP, because several of those " advantage " plans have gone bankrupt,

> and further my Dr likes AARP.

> They don't like the agents that are lowering pay to ther Dr's, and get

> behind in their payments.

>

> I find wherever I go, hospital, Dr lab tests, I am never charged for

> anything and I never get a bill that is to be " unpaid " . SOME vaccines, like

> shingles are not fully paid but covered under " drugs " .

>

> You know, part of the reason we need a systemized plan is to get rid of the

> gimmicks and the gimmickers.

>

> Regards

>

> RE: Re: Doc choice

>

> Why can't they give us a grant and let us go buy wherever we want and

> whatever we want. I hate being on a plan that is looked upon as inferior.

>

> Val

>

November 10, 2009

> >

> > Before a joint committee, it still has to pass the Senate. I don't think it

will, at least in its present form. I do recall a Senate version had " medical

homes " in it. We'll see. The issue for me is not NPs, it is lack of choice.

> >

> > Val

> >

> > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of jwwright

> >

> > Bill has to go to joint committee?

> >

>

November 10, 2009

Actually, bondholders are funding the greed - or at least backing it while the company is liquidated for a profit. No one's taxes have gone up to bail out AIG and the money borrowed will eventually be repaid from the proceeds of the liquidation.

Bindner

From: Francis Bill <georgewbill@...>Subject: Re: Doc choicehyperaldosteronism Date: Tuesday, November 10, 2009, 9:58 AM

Unless something changed Medicare isn't controled by the state. States can have laws that all insurances in the that state have to abide by.Medicaid is controled be each state but still have to use federal guidelines. If we were part of AIG then we would not have to worry about our health care needs. AIG probleme are due to greed not because of lack of money. Now all tax payers are fnding this greed. >> All costs will be increased to meet the money allowed.> I don't think Medicare is flawed if you compare it to 1959, eg.> > An Austin, TX, AARP rep is saying that our Medicare will not be changed> with the new House

plan.> That may be just Texas. And I do think states regulate what happens in the> state.> > Confusion is there are plans here that say they will pay ALL costs, just> sign with them and pay their supplement. Some medicare "ADVANTAGE" plans> have no monthly fee, but there is a copay.> > They get from medicare your gov't contribution and use it "better",> supposedly.> > Thay's why I say it's different here.> I use AARP, because several of those "advantage" plans have gone bankrupt,> and further my Dr likes AARP.> They don't like the agents that are lowering pay to ther Dr's, and get> behind in their payments.> > I find wherever I go, hospital, Dr lab tests, I am never charged for> anything and I never get a bill that is to be "unpaid". SOME vaccines, like> shingles are not fully paid but covered under "drugs".>

> You know, part of the reason we need a systemized plan is to get rid of the> gimmicks and the gimmickers.> > Regards> > RE: [hyperaldosteronism ] Re: Doc choice> > > > Why can't they give us a grant and let us go buy wherever we want and> whatever we want. I hate being on a plan that is looked upon as inferior..> > Val>

November 10, 2009

No, Medicare is entirely national and Health Care Reform won't change it, unless you are offering or using a Medicare Advantage Plan. Offering them will become less profitable - however this many not lead to a decline in care - especially since care under Medicare, especially involving prescription drugs - will improve in the general plan.

Bindner

Web Directory (links to my sites and blogs):

http://www.geocities.com/mikeybdc/index.html

http://mikeybdc.blogspot.com

From: jwwright <jwwright@...>Subject: Re: Re: Doc choicehyperaldosteronism Date: Tuesday, November 10, 2009, 11:12 AM

All costs will be increased to meet the money allowed.I don't think Medicare is flawed if you compare it to 1959, eg.An Austin, TX, AARP rep is saying that our Medicare will not be changedwith the new House plan.That may be just Texas. And I do think states regulate what happens in thestate.Confusion is there are plans here that say they will pay ALL costs, justsign with them and pay their supplement. Some medicare "ADVANTAGE" planshave no monthly fee, but there is a copay.They get from medicare your gov't contribution and use it "better",supposedly.Thay's why I say it's different here.I use AARP, because several of those "advantage" plans have gone bankrupt,and further my Dr likes AARP.They don't like the agents that are lowering pay to ther Dr's, and getbehind in their payments.I find wherever I go, hospital, Dr lab tests, I am never charged foranything and I

never get a bill that is to be "unpaid". SOME vaccines, likeshingles are not fully paid but covered under "drugs".You know, part of the reason we need a systemized plan is to get rid of thegimmicks and the gimmickers.Regards RE: [hyperaldosteronism ] Re: Doc choiceWhy can't they give us a grant and let us go buy wherever we want andwhatever we want. I hate being on a plan that is looked upon as inferior.Val

November 10, 2009

All costs will be increased to meet the money allowed.

I don't think Medicare is flawed if you compare it to 1959, eg.

An Austin, TX, AARP rep is saying that our Medicare will not be changed

with the new House plan.

That may be just Texas. And I do think states regulate what happens in the

state.

Confusion is there are plans here that say they will pay ALL costs, just

sign with them and pay their supplement. Some medicare " ADVANTAGE " plans

have no monthly fee, but there is a copay.

They get from medicare your gov't contribution and use it " better " ,

supposedly.

Thay's why I say it's different here.

I use AARP, because several of those " advantage " plans have gone bankrupt,

and further my Dr likes AARP.

They don't like the agents that are lowering pay to ther Dr's, and get

behind in their payments.

I find wherever I go, hospital, Dr lab tests, I am never charged for

anything and I never get a bill that is to be " unpaid " . SOME vaccines, like

shingles are not fully paid but covered under " drugs " .

You know, part of the reason we need a systemized plan is to get rid of the

gimmicks and the gimmickers.

Regards

RE: Re: Doc choice

Why can't they give us a grant and let us go buy wherever we want and

whatever we want. I hate being on a plan that is looked upon as inferior.

Val

November 10, 2009

, the ultimate plan is to put all old people into managed

care by making them have " medical homes. " Â For now, they are supposed to be

demonstration projects.Â God help us if

this bill ever becomes law.Â I had an HMO

once and it nearly killed me before I escaped.Â

Rather than be part of a managed care again, I will choose death.Â And if I have a choice, it will never be

AARP.Â That organization supports the

socialization of all health care.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Bindner

No, Medicare is entirely national and Health Care Reform

won't change it, unless you are offering or using a Medicare Advantage

Plan. Offering them will become less profitable - however this many not

lead to a decline in care - especially since care under Medicare, especially

involving prescription drugs - will improve in the general plan.

Bindner

November 10, 2009

Medicare is socialized medicine.

The only way around it is to provide incentives for employers to fully cover retirees and ex-employees who have retired in their own systems (either through an insurance plan or through the direct provision of care) as a way to avoid paying taxes for socialized medicine. You are correct that the current reforms will lead to socialized medicine, since the current for-profit model for health insurance is unsustainable and unreformable (meaning the planned reforms will eventually cause such firms to fail or consolidate, leading to some kind of government controlled or heavily regulated insurance). This is why the insurance industry is fighting so hard - however if they admitted it we would see single-payer sooner than later.

Bindner

From: Valarie <val@...>Subject: RE: Re: Doc choicehyperaldosteronism Date: Tuesday, November 10, 2009, 11:59 AM

, the ultimate plan is to put all old people into managed care by making them have "medical homes." For now, they are supposed to be demonstration projects. God help us if this bill ever becomes law. I had an HMO once and it nearly killed me before I escaped. Rather than be part of a managed care again, I will choose death. And if I have a choice, it will never be AARP. That organization supports the socialization of all health care.

Val

From: hyperaldosteronism [mailto:hyperaldost eronism@gro ups.com] On Behalf Of Bindner

No, Medicare is entirely national and Health Care Reform won't change it, unless you are offering or using a Medicare Advantage Plan. Offering them will become less profitable - however this many not lead to a decline in care - especially since care under Medicare, especially involving prescription drugs - will improve in the general plan.

Bindner

November 10, 2009

Or a congress person. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Nov 10, 2009, at 11:32 AM, jwwright <jwwright@...> wrote:

Semantics.

Medicare is a gov't funding plan.

Entities providing Medicare services are regulated.

Medicare supplement plans are licensed, bonded, else they couldn't be sued

for not paying.

If not licensed they can't sell their plan here. AARP maintains a rep in the

legislature.

Medicare advantage plans claim to offer hearing, visual and dental coverage

as well.

From your description, your state is different.

Dr's can choose to not accept Medicare patients, but if they admit to a

hospital, that hospital will be receiving funds from Medicare.

Medicaid is gov't plan IMPLEMENTED by the state.

How they integrate those plans will be interesting. I view it as a managment

change in Washington.

Regards

Re: Doc choice

Unless something changed Medicare isn't controled by the state. States can

have laws that all insurances in the that state have to abide by.

Medicaid is controled be each state but still have to use federal

guidelines.

If we were part of AIG then we would not have to worry about our health care

needs. AIG probleme are due to greed not because of lack of money. Now all

tax payers are fnding this greed.

November 10, 2009

Medicaid is really two separate programs - one for the poor and one for the elderly. They should be separated.. Now, it is an interesting question whether the part that is for the elderly should be altogether federal or whether Medicare as a whole should be administered by the individual states. It should go one way or the other, although it can't be funded that way or else Florida and the Midwest will go broke.

Bindner

Web Directory (links to my sites and blogs):

http://www.geocities.com/mikeybdc/index.html

http://mikeybdc.blogspot.com

From: jwwright <jwwright@...>Subject: Re: Re: Doc choicehyperaldosteronism Date: Tuesday, November 10, 2009, 2:32 PM

Semantics.Medicare is a gov't funding plan.Entities providing Medicare services are regulated.Medicare supplement plans are licensed, bonded, else they couldn't be suedfor not paying.If not licensed they can't sell their plan here. AARP maintains a rep in thelegislature.Medicare advantage plans claim to offer hearing, visual and dental coverageas well.From your description, your state is different.Dr's can choose to not accept Medicare patients, but if they admit to ahospital, that hospital will be receiving funds from Medicare.Medicaid is gov't plan IMPLEMENTED by the state.How they integrate those plans will be interesting. I view it as a managmentchange in Washington.Regards [hyperaldosteronism ] Re: Doc choiceUnless something changed Medicare isn't controled by the state. States canhave laws that all insurances in the that state have to abide by.Medicaid is controled be each state but still have to use federalguidelines.If we were part of AIG then we would not have to worry about our health careneeds. AIG probleme are due to greed not because of lack of money. Now alltax payers are fnding this greed.

November 10, 2009

Semantics.

Medicare is a gov't funding plan.

Entities providing Medicare services are regulated.

Medicare supplement plans are licensed, bonded, else they couldn't be sued

for not paying.

If not licensed they can't sell their plan here. AARP maintains a rep in the

legislature.

Medicare advantage plans claim to offer hearing, visual and dental coverage

as well.

From your description, your state is different.

Dr's can choose to not accept Medicare patients, but if they admit to a

hospital, that hospital will be receiving funds from Medicare.

Medicaid is gov't plan IMPLEMENTED by the state.

How they integrate those plans will be interesting. I view it as a managment

change in Washington.

Regards

Re: Doc choice

Unless something changed Medicare isn't controled by the state. States can

have laws that all insurances in the that state have to abide by.

Medicaid is controled be each state but still have to use federal

guidelines.

If we were part of AIG then we would not have to worry about our health care

needs. AIG probleme are due to greed not because of lack of money. Now all

tax payers are fnding this greed.

November 10, 2009

Right,

Graham says it's dead on arrival at the senate.

Leiberman says he'll filibuster, if it contains a public option.

Maybe the best solution is if they continue to argue it for the next 100 yrs

and we will fix it ourselves.

Regards

Re: Re: Doc choice

Or a congress person.

Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

On Nov 10, 2009, at 11:32 AM, jwwright <jwwright@...> wrote:

Semantics.

Medicare is a gov't funding plan.

Entities providing Medicare services are regulated.

Medicare supplement plans are licensed, bonded, else they couldn't be sued

for not paying.

If not licensed they can't sell their plan here. AARP maintains a rep in the

legislature.

Medicare advantage plans claim to offer hearing, visual and dental coverage

as well.

From your description, your state is different.

Dr's can choose to not accept Medicare patients, but if they admit to a

hospital, that hospital will be receiving funds from Medicare.

Medicaid is gov't plan IMPLEMENTED by the state.

How they integrate those plans will be interesting. I view it as a managment

change in Washington.

Regards

November 10, 2009

ï»¿

Soon to become one group.

Re: Re: Doc choice

Medicaid is really two separate programs - one for the poor and one for the elderly.

Bindner

November 10, 2009

Yes, Medicare is socialized but an HMO is not yet required.Â There is no other choice for people over

65.Â There are so many free-market

reforms that could be made if only the controllers were willing to turn loose

with control.

BTW, Medicare has $74 TRILLION in unfunded liabilities.Â That is unsustainable.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Bindner

Medicare

is socialized medicine.

The only way around it is to provide incentives for

employers to fully cover retirees and ex-employees who have retired in their

own systems (either through an insurance plan or through the direct provision

of care) as a way to avoid paying taxes for socialized medicine. You

are correct that the current reforms will lead to socialized medicine, since

the current for-profit model for health insurance is unsustainable and

unreformable (meaning the planned reforms will eventually cause such firms to

fail or consolidate, leading to some kind of government controlled or heavily

regulated insurance). This is why the insurance industry is fighting so

hard - however if they admitted it we would see single-payer sooner than

later.

Bindner

November 10, 2009

, you have no idea what you're talking about.

Medicaid and Medicare are two totally separate programs.Â

Medicare is for those over 65.Â

While people have no choice in insurance, it is not a welfare

program.Â People paid into it for many

years while employed (although not enough).Â

Medicaid is a welfare program.Â

Medicaid is administered by the states with federal supplementation.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Bindner

Medicaid is really two separate programs - one for the

poor and one for the elderly. They should be separated.. Now, it

is an interesting question whether the part that is for the elderly should be

altogether federal or whether Medicare as a whole should be administered by

the individual states. It should go one way or the other, although it

can't be funded that way or else Florida and the Midwest will go broke.

â€¢

November 10, 2009

Why should they worry? They have a very good taxpayer funded plan. But don't force it on the public is the matra.

Clarence E. Grim, BS, MS, MD

Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today.

On Tuesday, November 10, 2009, at 03:22PM, "jwwright" <jwwright@...> wrote:

>

Right,

Graham says it's dead on arrival at the senate.

Leiberman says he'll filibuster, if it contains a public option.

Maybe the best solution is if they continue to argue it for the next 100 yrs

and we will fix it ourselves.

Regards

Re: Re: Doc choice

Or a congress person.

Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

On Nov 10, 2009, at 11:32 AM, jwwright <jwwrighteastex (DOT) net> wrote:

Semantics.

Medicare is a gov't funding plan.

Entities providing Medicare services are regulated.

Medicare supplement plans are licensed, bonded, else they couldn't be sued

for not paying.

If not licensed they can't sell their plan here. AARP maintains a rep in the

legislature.

Medicare advantage plans claim to offer hearing, visual and dental coverage

as well.

From your description, your state is different.

Dr's can choose to not accept Medicare patients, but if they admit to a

hospital, that hospital will be receiving funds from Medicare.

Medicaid is gov't plan IMPLEMENTED by the state.

How they integrate those plans will be interesting. I view it as a managment

change in Washington.

Regards

November 10, 2009

My guess is if they could make money on it they would be on it now.

Clarence E. Grim, BS, MS, MD

Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today.

On Tuesday, November 10, 2009, at 06:32PM, "Valarie " <val@...> wrote:

>

Yes, Medicare is socialized but an HMO is not yet required. There is no other choice for people over

65. There are so many free-market

reforms that could be made if only the controllers were willing to turn loose

with control.

BTW, Medicare has $74 TRILLION in unfunded liabilities. That is unsustainable.