Democratic Nominee 2020 Part Deux

[Borderland]

I am rather calm about this. If it takes some viral panic, pun intended, to get Bernie elected, then too bad but OK, we'll survive through four years of Bernie. If he has four years in him, that is.

Tangential to the discussion but I don't see any cure for those who want socialized medicine other than letting them experience that. The rest of us will have to suck it up but I don't think it'll take too long for them to experience that side of Medicare they have no idea about.

I don't think any of those people have a lot of experience with the VA or SSA. The VA went to a means test for coverage a while back. I'm not sure if it still exists tho. Trying to get health care was a nightmare for me and took 3 years. SSA told me I owed them 2K after one year of benefits because they overpaid me. Actually they didn't overpay me but I had to show them their error using their own rules. I have absolutely no problems with medicare but we're talking about a small segment of the population that they manage, basically boomers. Medicare for all would destroy the present system and benefit management would be 10X bigger than VA and SSA combined. I have absolutely no confidence in the fed gov't ability to manage something like that.

[YVK]

Ability to manage is a lesser concern to me.
My first "favorite" thing about it is that, in order to stay afloat, Medicare has been disincentivizing providers and hospitals to deliver care in many ways. The stated intent was to reduce unnecessary care. The result is any care that providers can cut and get away with. Let's see how Americans like rationed care.
My second "favorite" part of it is that CMS sets up their arcane rules, they set up their payment schedule, they sent hordes of reviewers to find these rule "violations", which are usually documentation mishaps (so doctors now get more teaching how to document than treat, and spend more time documenting than treating), CMS then penalizes the organizations, and if you want to appeal, you appeal to... CMS. CMS is a medical equivalent of a CBO, Congress, IRS, courts, and appellate courts, all in one, uncontrolled. Democracy my ass, it is as an authoritarian arrangement as it can be.

[ccmdfd]

Ability to manage is a lesser concern to me.
My first "favorite" thing about it is that, in order to stay afloat, Medicare has been disincentivizing providers and hospitals to deliver care in many ways. The stated intent was to reduce unnecessary care. The result is any care that providers can cut and get away with. Let's see how Americans like rationed care.
My second "favorite" part of it is that CMS sets up their arcane rules, they set up their payment schedule, they sent hordes of reviewers to find these rule "violations", which are usually documentation mishaps (so doctors now get more teaching how to document than treat, and spend more time documenting than treating), CMS then penalizes the organizations, and if you want to appeal, you appeal to... CMS. CMS is a medical equivalent of a CBO, Congress, IRS, courts, and appellate courts, all in one, uncontrolled. Democracy my ass, it is as an authoritarian arrangement as it can be.

Preach on!!!

In my office we had a recent eval by our compliance office regarding Medicare and its rules for sleep studies. MC is reportedly getting ready to really crack down on these as they feel they are overpaying.

So they came up with rules as to who needs, and doesn't need a sleep study. For the most part, the rules make some sense.

But when we follow the rules, and tell a patient they don't need a new sleep study, just CPAP, Medicare comes in and refuses to pay for the CPAP without a new sleep study!!!!

If Medicare feels like they are paying too much, they need to fire their own employees who are the ones demanding all of the sleep studies that we don't want!!!

cc

[SAWBONES]

Ability to manage is a lesser concern to me.
My first "favorite" thing about it is that, in order to stay afloat, Medicare has been disincentivizing providers and hospitals to deliver care in many ways. The stated intent was to reduce unnecessary care. The result is any care that providers can cut and get away with. Let's see how Americans like rationed care.
My second "favorite" part of it is that CMS sets up their arcane rules, they set up their payment schedule, they sent hordes of reviewers to find these rule "violations", which are usually documentation mishaps (so doctors now get more teaching how to document than treat, and spend more time documenting than treating), CMS then penalizes the organizations, and if you want to appeal, you appeal to... CMS. CMS is a medical equivalent of a CBO, Congress, IRS, courts, and appellate courts, all in one, uncontrolled. Democracy my ass, it is as an authoritarian arrangement as it can be.

This is generally true.

Most physicians accept Medicare patients and many also accept Medicaid. To fail to do so would exclude many people with genuine medical needs.

Bean-counters from CMS, whose raison d'etre is the ferreting-out of record-keeping errors, are empowered to sift through physicians' medical records of patient care in order to attempt to bring cases for malfeasance where nonesuch has occurred, but only forgotten "checkboxes".

Patient care, good patient care, more especially so with elderly people, takes time.
Physicians who spend the extra time are not reimbursed proportionately under CMS guidelines.

Expertise and documentable excellence in a particular field or subspecialty of diagnostic medicine is no longer recognized and reimbursed at any higher level under CMS provisions than is mediocre or even substandard care, regardless of whether the former provides genuine diagnostic acumen and a beneficial result and the latter a useless result and missed diagnoses.

The practice of medicine has accordingly become increasingly more frustrating and less rewarding IME over the last couple decades.

[blues]

I feel for you physicians who try to do the right thing by your patients and tip my hat to you.

When I hit Medicare age I opted solely for Part A and decided to let my federal employee health benefits cover everything else. So far, that is the plan when my wife attains eligibility in the future as well.

[Borderland]

Ability to manage is a lesser concern to me.
My first "favorite" thing about it is that, in order to stay afloat, Medicare has been disincentivizing providers and hospitals to deliver care in many ways. The stated intent was to reduce unnecessary care. The result is any care that providers can cut and get away with. Let's see how Americans like rationed care.
My second "favorite" part of it is that CMS sets up their arcane rules, they set up their payment schedule, they sent hordes of reviewers to find these rule "violations", which are usually documentation mishaps (so doctors now get more teaching how to document than treat, and spend more time documenting than treating), CMS then penalizes the organizations, and if you want to appeal, you appeal to... CMS. CMS is a medical equivalent of a CBO, Congress, IRS, courts, and appellate courts, all in one, uncontrolled. Democracy my ass, it is as an authoritarian arrangement as it can be.

Yep, happened to me. My doc, who I like a lot and want to keep, mis coded a wellness exam and the hospital charged me because medicare didn't cover it. No way in hell would I want to be a doctor having to navigate that system. I didn't pay the bill and the hospital was fine with it but I had to communicate with them way more than I felt necessary. I'm very careful now about getting the medicare coverage explained and having them check my insurance first. The last thing I need is some bot disputing my claim and spending hours on the phone trying to resolve it. It's a jungle.

[JohnO]

Put a fork in Biden. He doesn't even know where he is or what decade we are in.

https://twitter.com/i/status/1233443691546714113

[the Schwartz]

Put a fork in Biden. He doesn't even know where he is or what decade we are in.

https://twitter.com/i/status/1233443691546714113

Whoa. I was initially reluctant to believe that Biden is experiencing some sort of mental/cognitive/neurological decline, but it is getting harder and harder to deny.

[JohnO]

Whoa. I was initially reluctant to believe that Biden is experiencing some sort of mental/cognitive/neurological decline, but it is getting harder and harder to deny.

Appears to be undeniable. Is there some reason the DNC hasn't sent the men in white coats and butterfly net to scoop him up?

[ralph]

Whoa. I was initially reluctant to believe that Biden is experiencing some sort of mental/cognitive/neurological decline, but it is getting harder and harder to deny.

True, And I thought his comment at the debate where “150million people have been killed because of gun violence since 2007” was bad... It’s beyond patently obvious that Joe has mental issues, and he should do himself and everyone else a favor, and drop out.. No way is he mentally stable enough to be president..