Medicare, DME suppliers, and CPAP

[PST]

Medicaid and Medicare are NOT the same thing. Medicaid is administered under the states and the benefits and generosity of the benefits range from state to state. There are considerably more younger people receiving Medicaid than Medicare. I've seen quite a few complaints about Medicaid.

You are right. I meant to say Medicare in the last sentence.

[LSAT]

Obviously...based upon last Tuesday's election...the majority of the population is not happy with the overall Health Care Reform Bill that very few of our representatives actually read before voting. This is not 'hatred' toward the president but a disagreement with the way the liberals pushed this program through congress.

1. I truly do not understand what people mean when they talk about the way liberals "pushed" the program through Congress. We had an election in which the Democratic nominee for President and the party as a whole made this a major issue, and the people voted them in. The process took over a year. Amendments were available on the web on a day-by-day basis. The debates were carried on CSPAN and discussed in every news outlet in the nation. We have been fed a lie by Fox News and its subsidiary, the Republican Party, that there was something illegitimate about the way it was passed, but that claim does not correspond to reality. Nothing disappears from the internet, so a person can go back today and see how open the process was. It was the longest and most public national debate about legislation I can remember in my lifetime. There is no excuse for any representative claiming that he did not know what was in the bill.

Interesting comment PST....How about MSNBC and the 4 Liberal commentators they had covering the election on TV. One of these commentators was even suspended because he made contributions to 2 Democratic candidates......They are supposed to be non-partisan.

THIS IS MY LAST WORD ON THIS ISSUE...IT IS REALLY NOT APPROPRIATE FOR THIS BOARD

[PST]

Interesting comment PST....How about MSNBC and the 4 Liberal commentators they had covering the election on TV. One of these commentators was even suspended because he made contributions to 2 Democratic candidates......They are supposed to be non-partisan.

THIS IS MY LAST WORD ON THIS ISSUE...IT IS REALLY NOT APPROPRIATE FOR THIS BOARD

Fox is the holding pen where prospective Republican presidential candidates collect a salary and plan their campaigns. Of the five prominent Republicans not currently in elective office who have publicly discussed their interest in running for President, four are Fox News employees or paid contributors: Sarah Palin, Newt Gingrich, Rick Santorum, and Mike Huckabee. Only Mitt Romney is not. I find that remarkable. Moreover, those candidates use their exclusive contracts with Fox as their excuse for not allowing themselves to be interviewed by other news outlets. There is a thorough story at http://dyn.politico.com/printstory.cfm? ... 12EC95F5F3. If you are a Republican, don't expect to have much influence on the 2012 nomination. Like American Idol, that contest will be a Fox exclusive.

I make no claim for MSNBC's neutrality, but there is really no comparison with Fox. MSNBC suspended its commentator for giving $7,200. Fox commentators also contribute to candidates, but Fox has no rule against it. (Google Hannity Bachmann contribution, for example.) The parent corporation of Fox gave $1 million to the Republican Governors Association for use in the most recent election, and publicly defends its decision to do so. See http://www.washingtonpost.com/wp-dyn/co ... 04338.html.

I too will let this be my last comment on Fox News, which I grant is pretty far afield for a CPAP forum. As for the actual subject of this thread, though, I would still like to have someone explain to me why a trial run of competitive bidding by DMEs is so evil that the only term strong enough to describe it is BOHICA.

[Slinky]

PST, I found the competitive bidding trial worrisome as I can see the "big boys" like Apria and Lincare squeezing out the smaller regional DME providers and local mom & pop providers. My experience has been better, and more caring, service and better equipment from the smaller providers. I did see that some provision has been made to include the smaller providers and to make them more competitive but that provision still leaves me a bit worried.

I've already had a taste of what effect the 2010 Medicare cuts have had on my local 02 provider. In the past I made an out of town trip and my provider made arrangements for a local provider at my destination to deliver a concentrator to my motel. Another time I drove to a distant destination and my provider gave me a 3L concentrator and a supply of portable tanks to take w/me. The 3L concentrator died during the trip and a local provider my provider made arrangements w/provided me w/a concentrator the rest of the time I was there. All at no extra charge, just the regular Medicare reimbursement.

I just recently went out of town again, this time spending one night on the way down and another on the way back w/a friend in Lexington and then 3 nights at a motel at our destination. They provided me w/a Sequal portable concentrator. BUT I had to give them a $500 deposit AND pay a $50 rental for the week. I also took 4 portable tanks just in case of an emergency. When I had a problem w/the Sequal I had to contact the provider they made arrangements w/for emergencies and I had to pay $120 to that local provider for a week's rental (only 3 actual days) out of pocket w/no reimbursement.

Those trips were over a period of 2006 to just last week so its not like I do a lot of traveling. Thank goodness given my recent experience.

[Kevin G.]

If I understand it correct. If we continue with the current system we will pay more and more for health care so we will have less disposable income. Only those who have a good job or are rich can afford health care insurance. Those who do not have health care insurance who get sick will suffer more and likely die young. Those who survive will go bankrupt and will lose their home and have no retirement savings thus ending up on welfare which will be paid for by the taxpayers. I am supposed to want this.

I understand that we do not want this new health care system because it is socialized medicine and the government interfering with how we make our decisions. We are supposed to want the freedom to go bankrupt and die young.

The free market is supposed to be the solution. In my area one of the major hospital chains has got a large enough share that they can dictate prices to the insurance companies. This is well documented and reflected in my medical bills. These free market prices are considerably higher than charged by Kaiser.

I am stuck with my COBRA coverage which is milking me and I cannot change to a different plan because I have a pre-existing condition called sleep apnea. Of coarse I have the freedom not to have insurance. I will experience this freedom when my COBRA coverage runs out.

I have yet to find a DME that gave good service and did not attempt to rip off the system. I will deal with a brick and mortar DME only for a new machine when the insurance company is picking up the bill, otherwise I will find another source for supplies.

Please explain to me why I want the existing system.

In order to correct the problems there will need to be changes. I am willing to put upwith some disruption in order to make things better. I want to be around for a long time.

[roster]

If I understand it correct. If we continue with the current system we will pay more and more for health care so we will have less disposable income. Only those who have a good job or are rich can afford health care insurance. Those who do not have health care insurance who get sick will suffer more and likely die young. Those who survive will go bankrupt and will lose their home and have no retirement savings thus ending up on welfare which will be paid for by the taxpayers. I am supposed to want this.

Kevin, I hope you understand that a free market did not bring you the current mess with insurance. Health insurance has been for decades a very heavily regulated market and in the last fifteen years even more regulations were piled on.

Here in NC our legislature has a very cozy relationship with the major providers in the state and through regulation helps them to avoid failure, to keep high employment in the state, and to keep out competition. We poor consumers are not even allowed to purchase insurance out of state - a travesty of trampling on our human rights. You will find a similar situation in Georgia.

On the other hand, I have a high-benefit life insurance policy with a low premium in a less regulated market. Regulations did not restrict me from buying this from a Chicago insurance company through a San Francisco broker and I had dozens of companies competing for my business.

The health insurance providers in NC all were in favor of Obamacare. I received a letter from the CEO of my provider telling me how wonderful Obamacare will be. Now what message is that sending????

It is telling me that crony-capitalism is growing "cronier" and the regulators and insurance companies will be eating bigger lunches at the citizens' expense.

Deregulate the market for health insurance and you will be amazed at the good things that will happen for us consumers.

Mention deregulation to the top executives of the insurance companies in your state and you will be amazed at how quickly they turn yellowish-green at the thought of having to compete for our business.

[roster]

.... Unfortunately, common sense doesn't rule here, only hostility. If someone hates and despises the President and the Democratic Party enough, then every aspect of healthcare reform is susceptible to one claim or the other -- either it injures the patient or it wastes money. The height of this was the vile and disgusting libel about "death panels." I try to keep politics and friendship separate, but that one ruptured some relationships for me for good. Who wants to be told that they are part of a conspiracy to kill their parents? The effect of these attacks was to scare some legislators from reasonable efforts to reduce costs and give us a less good bill than we could have had.

Careful PST, you are in danger of becoming an example of the type of person you think you are railing against.

[roster]

The height of this was the vile and disgusting libel about "death panels."

Mind you, if government is to pay for health care, government also has an obligation to put limitations on paying and cut off payments at some points. This fact cannot be escaped no matter who holds what office or what power. Try to escape it and eventually the laws of basic economics will rule and the results are never pretty.

[PST]

The height of this was the vile and disgusting libel about "death panels."

Mind you, if government is to pay for health care, government also has an obligation to put limitations on paying and cut off payments at some points. This fact cannot be escaped no matter who holds what office or what power. Try to escape it and eventually the laws of basic economics will rule and the results are never pretty.

A health insurance program has to define what benefits are covered. That is true for any insurance, public or private, now or in the future. I recognize that. That was not the claim made by opponents of health care reform, however. They asserted that care would be approved or denied case by case based on the perceived worth of the patient to society. Sarah Palin expressed it this way on her Facebook page (http://www.facebook.com/note.php?note_id=113851103434):

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

You can surely understand that a person accused of desiring such evil would take offense.

[PST]

Slinky, I appreciate your concern that competitive bidding might hurt the quality of service if it forces some good DMEs out of the market. It is always important to look closely at cost savings ideas to gauge their effect on quality. That's much different, though, than assuming that any cost savings idea originating from this administration is automatically screwing us over just because of the people behind it. The comment that lit my fuse was "Here it comes time to grab your ankles......Thanks to the Three Stooges Barrack, Harry & Nancy." If half the population takes it for granted that no cost savings effort under this president can possibly be in good faith, then we won't get any cost savings. When you have by far the most expensive healthcare system on the planet, that's a bad thing. I favor giving some competitive bidding a trial run, but I am not closed to rational discussion of why this might fail.

I do have a question about your O2 experience, though. I am honestly not aware of any 2010 Medicare cuts affecting DMEs. There is an ongoing issue involving physician reimbursement rates, but that shouldn't affect DMEs. Have their been cuts this year? If not, then the problems you encountered had a different cause.

[roster]

You can surely understand that a person accused of desiring such evil would take offense.

I think you are watching too much Fox News!

Sarah Palin was a disaster when the public went to the voting booths and has no future in public office. So why bother? With cable or satellite TV and a DVR and the internet, I can control very easily what I watch and read. Not that I don't often read opposing views (know the enemy).

You can surely understand that a person accused of desiring such evil would take offense.

Do you really think Sarah Palin was talking about you??

[roster]

That's much different, though, than assuming that any cost savings idea originating from this administration is automatically screwing us over just because of the people behind it.

Just like I have written off Fox News as not being worth my time to watch, I have also done a blanket write-off of Obama/Pelosi/Reid. I don't have the time to take apart (or put together) everything they do or say. I have seen enough to know that Obama is a pragmatist and does not operate on principles. On the economy, he has bought into the failed Keynesian theories as a plank of his pragmatist approach and is totally lost at what to do next. He will eventually abandon the Keynesian principles, not because he believes them wrong, but because he becomes to believe them impractical.

Obama had the same good-intentions pragmatist approach to health care: "Let's think about what works and pass a law (2600 pages) and the problem will be solved." Sorry Mr. Community Organizer, the world does work that way and it did not work that way when you were "organizing communities".

The federal government and the state governments should get out of the way, drop their plans to provide central solutions and central control, and let the 300+ million citizens of this country use you their tremendous ability to solve problems and improve the lives of the citizenry. It has worked in an amazing way over the last two centuries and it can work again if we can get the government foot off the necks of the good individual citizens.

Obama will have to have a major enlightenment and turnaround in his convictions and actions before I will change my paradigm of him. I will pray it happens, but plan otherwise.

[PST]

Do you really think Sarah Palin was talking about you??

Oh, I think that ALL the people in my television set are talking ABOUT me. It's only when I start to think that they are issuing instructions TO me that I have to go back on my medications.

Palin is only an example. The "death panel" story started with Betsy McCaughey and quickly spread among the usual suspects. As to whether they were talking about me, I think you are making light of the pain this caused many good but credulous people. Lots of people believed her, especially among the generation ahead of me. Elderly relatives were shocked and dismayed, even heartbroken, when they found that some of their loved ones supported a law that they thought would consign them to the rubbish bin. It ruined a lot of Thanksgiving dinners last year. It wasn't personal between Palin and me, but it got pretty personal with people who believed her discredited falsehood. I won't deny that I'm still angry about this.

[roster]

.... especially among the generation ahead of me. Elderly relatives were shocked and dismayed, even heartbroken, ....

Surely you jest! The generation that has lived through, or was born in, the depression and has lived through WWII, the turmoil in the sixties/seventies and the coming of the technology age, divorce, illegitimacy, sexual immorality and drug use among their descendants is known by me to be a tough bunch of critters that will not swoon before the measly words of Palin et al.

[PST]

Surely you jest! The generation that has lived through, or was born in, the depression and has lived through WWII, the turmoil in the sixties/seventies and the coming of the technology age, divorce, illegitimacy, sexual immorality and drug use among their descendants is known by me to be a tough bunch of critters that will not swoon before the measly words of Palin et al.

You'd be surprised how upset even the toughest old bird gets if someone tells him that the rules have changed and he's about to get plucked.