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Health Care Bill
Old 11-10-2009, 11:19 AM   #1
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Health Care Bill

I heard yesterday that the House bill changes the way Medicare patients will get care. Presently they can go to any doctor or specialist they want. Under the new bill they must have a Primary Care Doctor, and get a mother may I slip before going to a specialist.

Has anyone else heard this. I did not find anything on the web, and it may be too soon.

If the above is true, it is certainly another reason for me to oppose it.
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Old 11-10-2009, 12:32 PM   #2
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I heard yesterday that the House bill changes the way Medicare patients will get care. Presently they can go to any doctor or specialist they want. Under the new bill they must have a Primary Care Doctor, and get a mother may I slip before going to a specialist.

Has anyone else heard this. I did not find anything on the web, and it may be too soon.

If the above is true, it is certainly another reason for me to oppose it.
I am not sure I have an answer for you because I am covered by a Medicare Advantage (MedicareComplete from SecureHorizons) and not traditional Medicare. A PCP referral is required (excepting, of course, an out-of-area emergency situation) both by the the Insurance Company and, so far, of every Specialist I have used. For example, I had to have a written referral from my PCP before the Colonoscopy folks would even speak with me. (This was true of my pre-Medicare insurance, also.)

In any event, a PCP is, to put it simply, a darn "good idea" for a multiple of reasons. If nothing else, it prevents you from acting as your own physician and charging into the Brain Surgeon's office demanding immediate attention. (Not to mention, pill shopping.)
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Old 11-10-2009, 12:45 PM   #3
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Yes, apparently true. From the WSJ:

Quote:
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.
Some other goodies for those on/gonna be on Medicare:


Quote:
• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
It's too late to oppose this House bill--it has passed. The pressure points now are:
Your Senators--let 'em know how you feel.
Congressmen: If a bill passes the Senate, it will be coming back for a vote in the House.
Some Congressmen will vote for virtually any bill--they are in "safe" districts and want to gain favor with the Speaker and House leadership. Other congressmen are in a different situation--Democrats in districts that are conservative, some in districts that McCain won. They'll be less eager to support changes that are way far to the left. They'll be hearing from me.
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Old 11-10-2009, 01:09 PM   #4
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Ron,
You say it is a good idea, I hate the idea, and will vote against any political party that attempts to change the freedom of choice I presently have. I have felt little or no desire to charge into my local brain surgeons office, but have used a dermatologist. It was nice to go right to his office, rather than go make an appointment with a PCP, wait two weeks for it, get a referral, wait two weeks to get an appointment and finally get treated. I know many insurance companies work through PCP's, when I had the choice I did not use them. Once more, if you are happy with the idea of an HMO, and you appear to be, that is fine. I see no reason why your choice should be mine. I would assume you would be just as upset if the bill called for the abolition of PCPs, which I think it will as many Medicare Advantage programs will fold.
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Old 11-10-2009, 01:29 PM   #5
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The devil is in the details...

A "home" doctor could be invaluable in advising and coordinating care for someone not familiar with what is available and what is needed.

A "home" doctor could also be the denier of (available and needed) services to keep costs down.
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Old 11-10-2009, 01:45 PM   #6
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Today a Medicare recipient can choose to go to a single care provider and get a referral. Or, if they know what they need (e.g. a dermatologist) they can go there. Under the proposed changes, the patient gets one option--go through the gatekeeper.

We can argue whether this is a good thing or not from a cost containment perspective, but we can't say it will be a benefit to every patient.

It is interesting that this "let me be myself," "let us choose our own way," big institution-hating generation has elected leadership that is so in love with big institutional, one-size-fits-all answers to society's big challenges. I read an article on this recently, can't find it now.
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Old 11-10-2009, 01:46 PM   #7
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taxes will rise, choice and services will decline, = personal liberty will decrease.

It's a bad plan. Hope it fails and changes in our representation come about in 2010.
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Old 11-10-2009, 02:04 PM   #8
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I would assume you would be just as upset if the bill called for the abolition of PCPs, which I think it will as many Medicare Advantage programs will fold.
Nope. Life is too short/busy/fun to get involved in this foolishness.
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Old 11-10-2009, 02:50 PM   #9
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I am currently covered by a "cadillac" plan because I am still employed. I have to go to my PCP and let her decide to treat or refer. What I have found to be invaluable is that she keeps a data base on the very best specialists that she knows and trusts. It has worked great for me. I hope to wander for a couple years after retirement but will try to maintain or find a "home" for that same type of care. That's probably what kept me from partaking in Kaiser for the last 40 years, didn't like to go to the unknown.
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