The Senate Republicans' Health Care Bill

The Senate Republicans' health care bill is apparently even worse than that of their House counterparts. The New York Times says even some Republicans are bad-mouthing it.

One of the obstacles: The money for drug treatment, opioids in particular. [More...]

Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

There would be no "opioid crises" if the DEA and Congress hadn't restricted availability of pain pills by threatening doctors with prosecution and pretending to know better than doctors how many pills someone needs to manage chronic pain.

When people in pain can't get pills, they turn to heroin. Let people have the pills they need or want and there will be no need to turn to heroin or fetanyl. If there's a "crisis" it's one Congress, with help from the Global Holy Warriors of the DEA created.

As for the rest of the Senate Republican's health care bill, while I have only seen media accounts, I'm not surprised it's a disaster. Obamacare is not the problem. It never was. Republicans are the problem. If they get this passed, we will all be the worse for it.

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    Are we great again yet? (5.00 / 1) (#10)
    by desertswine on Thu Jun 22, 2017 at 08:49:18 PM EST
    It's like the country is becoming a grotesque parody of the United States. Sort of like the United Oligarchic States.

    maybe it was a typeo (none / 0) (#14)
    by CaptHowdy on Thu Jun 22, 2017 at 09:02:06 PM EST
    and was supposed to be

    Make America Grate Again


    Well we certainly know (5.00 / 1) (#21)
    by Chuck0 on Fri Jun 23, 2017 at 11:12:25 AM EST
    that the US can't possibly start locking up white people for heroin addiction.

    Is there more chronic pain? (5.00 / 2) (#30)
    by Lora on Sat Jun 24, 2017 at 10:28:47 AM EST
    Are more people in this country living with chronic pain?

    Shouldn't we investigate that piece of the puzzle?

    I live with chronic pain.  It isn't severe, but it is there. It has caused restrictions to my lifestyle for 50 years.

    I have tried many treatments and regimens. I have never had a diagnosis that made sense. I have discovered that a diet that is significantly improved from the SAD (Standard American Diet) makes a significant difference. However it is time-consuming and difficult.  I can't always do it.  There is so little solid research to help people find the sources of their pain and help them combat it.

    I depend on a mild prescription painkiller and Tylenol to help manage it.  The painkiller is regulated.  I hope I can continue to access it.

    I am happy to report that with a combination of very limited and carefully controlled exercise, improvement in diet, and massage therapy, I am able to do more this summer than in many previous summers.  I hope it continues.

    Not to minimize the issue with pain medication, but we also need to take a hard look at chronic pain.

    POLITICO (none / 0) (#1)
    by CaptHowdy on Thu Jun 22, 2017 at 05:46:19 PM EST
    i am suspicious of (none / 0) (#2)
    by CaptHowdy on Thu Jun 22, 2017 at 05:51:32 PM EST
    republican "bad mouthing".  it sounds more like mealy mouthing to me.  they all sound convincable to me.

    i hope im wrong.

    I don't think (none / 0) (#3)
    by KeysDan on Thu Jun 22, 2017 at 06:25:22 PM EST
    you are wrong.  Surely the devious and crafty McConnell has built-in a number of life savers to throw to  electorally needy Republican senators. And, to satisfy the rara avis, moderates.  A minor de-meanification tweak here, a two-year delay in kick-in there, and presto, all aboard the Make America Great Again--if you plan never to get sick, need medicine, or be injured.  And, Trump is helping out with his "I have no tapes behind my back" down the rabbit hole tactic.

    Well as we saw in the house (none / 0) (#6)
    by Ga6thDem on Thu Jun 22, 2017 at 08:12:54 PM EST
    they will all whine and complain about how bad the bill is and then vote for it.

    the reason for the mad rush (none / 0) (#8)
    by CaptHowdy on Thu Jun 22, 2017 at 08:31:06 PM EST
    is clear.  i think if it can just be delayed for a bit it will implode.  the backlash, like the disabled protests in Mitchs office today, is going to be something to see.

    The backlash (none / 0) (#11)
    by Ga6thDem on Thu Jun 22, 2017 at 08:51:46 PM EST
    might be something that has to happen at the polls in 2018. Of course, we will get a preview of that this fall in VA and NJ. According to Ralph Northam voters in Virginia are against Trumpcare 2 to 1. Murphy in NJ is looking to wipeout the GOP with Christie's Lt. Gov as the candidate. I have to say I guess Republicans in NJ are just that stupid to nominate his Lt. Gov.

    i dont think so (none / 0) (#13)
    by CaptHowdy on Thu Jun 22, 2017 at 09:00:08 PM EST
    they are about to leave for the summer recess.  they are going to hear from people. even today and tomorrow there are being protests organized in airports to ambush them.

    this is going to be intense.  i think.  


    I hope you are (none / 0) (#18)
    by Ga6thDem on Fri Jun 23, 2017 at 07:46:13 AM EST
    right and I am wrong.

    Worse, I read somewhere - i think it was (none / 0) (#9)
    by Anne on Thu Jun 22, 2017 at 08:34:13 PM EST
    a tweet - that the plan is for the House to just pass whatever passes the Senate, with no conference to reconcile the Senate bill with the House bill - so...if they can get the bill through the Senate, it's a done deal.  There will be no rescuing it, no one-more-chance to defeat it.

    So many people will be hurt by this - the evil men do, really.


    Well, I already (none / 0) (#12)
    by Ga6thDem on Thu Jun 22, 2017 at 08:53:15 PM EST
    called my rep and told his person that I hope someone runs against him and reminds voters every day of his vote for this odious bill and said candidate reminds voters of medically fragile children dying because of his vote.

    J, seriously? (none / 0) (#4)
    by sarcastic unnamed one on Thu Jun 22, 2017 at 06:36:08 PM EST
    There is a ton of heroin in my area (SoCal). While there probably are some chronic pain sufferers who are using it medicinally, the vaaast majority of users are recreational.

    At least, they're recreational users until they feel like they can't live w/o it any more. Or they're dead.

    NFL QB Eric Kramer's 18 y/o son, Griffen, died of a heroin OD near my home 6 years ago. He was not suffering from chronic (physical) pain. Another kid about the same age who lived a few blocks away, whose mother I volunteered with, died of a heroin OD a few years later. He also was not in any chronic (physical) pain.

    I have no idea how the two started using, though often the gateway is illegally using prescription pain meds, but cheap heroin is available basically everywhere in the US.

    Lastly, why would you use Prince as an example of

    When people in pain can't get pills, they turn to heroin.

    While Prince may have started using pain pills for chronic pain, according to most that knew him well, despite still being in pain, he was absolutely addicted by the time he OD'd. And he could get plenty of pain meds, he didn't turn to heroin.

    What am I missing?

    Though it is certainly no "solution"... (5.00 / 1) (#19)
    by kdog on Fri Jun 23, 2017 at 10:13:10 AM EST
    to the medical/mental problem of addiction (if there is one), readily available and reasonably priced pharmaceutical-grade opiates would lessen the epidemic of overdoses.  aka save lives, in the hope that one day the opiate addict finds the will to kick, with or without the help of doctors or addiction specialists.

    The biggest problem right now is the cheapest and most readily available opiate to addicts is the most dangerous...fentanyl and other additives unknown to the user in unknown dosages.  And pharmaceutical grade opiates being scarce and expensive can be tied to the DEA crackdown on doctors and pharmacists.

    If it was up to me I'd give the pharmaceutical grade sh*t away to addicts for free, coupled with an offer of in or outpatient treatment, also for free.  All taxpayer funded, as has been shown to be pretty effective in parts of Europe.  The toughest of sells to politicians and the public stateside I know, but if we are serious about trying to lessen the body count and heartache to friends/family, as well as lessen associated crimes committed by addicts to fund their fixes...it's the only ticket I can think of.

    To your point, the over-prescribing and marketing of opiates starting in the 90's helped bring us here, to be sure...but the DEA crackdown that followed has only helped the dopeman, while hurting legitimate patients in chronic pain, doctors ability to treat chronic pain, and of course the junkies.

    As to this tax cut bill posing as a healthcare bill, we can only hope Republican senators in states suffering most from this epidemic have half a brain and half a heart to kill it.


    Ya. I hear you. (none / 0) (#20)
    by sarcastic unnamed one on Fri Jun 23, 2017 at 10:51:39 AM EST
    Re: Prince, and others like him, this quote better expresses what I've been trying to say:

    legitimate need and addiction are not mutually exclusive.

    I agree that ham-fisted gvt action regarding legal prescriptions is a problem. I went through it myself a couple years ago.

    I had a major knee surgery and I was given a very low prescription for opioid pain meds (due to the Fed guidelines/crackdowns).

    I got out of the surgery at around noon, and although I took the exact dosage the Dr. prescribed, by 6:00AM the next moring I was still in excruciating pain and had not slept at all, all night long.

    I called the doc and he doubled my prescription, and then told me to take twice what that new prescription said. Finally, at about 10 AM, 22 hours after I got out of the surgery, after quadrupling my opioid pain meds, I was finally able to sleep.

    Toughest night of my life.


    Heard some yokel... (none / 0) (#22)
    by kdog on Fri Jun 23, 2017 at 01:07:47 PM EST
    on talk radio recently saying nobody needs anything stringer than ibuprofen for pain...ever. I didn't know whether to laugh or cry.  Thank god the worst pain I ever had was dental related...but the last major outburst was several years when there were still plenty of percs and dins around on the black market, so relief was had.  Ibuprofen don't do sh*t.

    If you're a legit chronic pain sufferer, I'd think the risk of addiction is the least of your worries.  Not mutually exclusive.


    Gotta say, I don't know how people find (5.00 / 1) (#23)
    by sarcastic unnamed one on Fri Jun 23, 2017 at 01:25:27 PM EST
    oxy, etc., "fun."

    All it did for me, besides numb the pain, was make me nauseous, constipated, and unable to pee.


    Agreed on oxy... (none / 0) (#25)
    by kdog on Fri Jun 23, 2017 at 02:21:32 PM EST
    that just made me nauseous and zombie-ish...too strong to be enjoyable recreationally, imo.  Percs, otoh, that's a mighty fine buzz by my constitution.  Easy for me to see how people got hooked so hard so easy...blissful sh*t, till ya need it just to not be jonesin', then you're f*cked.

    A devil to be dancing with, to be sure...not for the uneducated or reckless.

    Speaking of combating opiate addiction pipe dreams, I'd love to see an investment in research and trials of psychedelic treatments for opiate, cocaine, meth, and alcohol addicts. Maybe Mitch will throw that in the health care bill;)


    Ibuprofen (NSAIDs) (5.00 / 1) (#24)
    by KeysDan on Fri Jun 23, 2017 at 01:29:42 PM EST
    can be as dangerous as listening to talk radio. Long-term or high doses may increase the risk of heart attack and stroke, even in people with no history of same.  And, then their is the issue of stomach and intestinal bleeding. Also, too, the definite limits of it analgesic properties.

    For sure... (none / 0) (#26)
    by kdog on Fri Jun 23, 2017 at 02:22:52 PM EST
    add in the fact they do f*ck-all for serious pain, maybe ibuprofen should be Schedule I.  

    It just depends on how you're wired (none / 0) (#28)
    by jondee on Fri Jun 23, 2017 at 07:08:55 PM EST
    one man's meat is another man's poison.

    The only time I ever had morphine, it was like a long cold drink after wandering in the desert sun for two days. In the span of a few short minutes, I went from detesting everything about the hospital to not wanting to trade where I was for a hammock swaying in the tropical breezes. "I'm good. Would it be ok if I stayed here for an extra couple of days? For observation or whatever?"

    Saw a quote from Ambrose Bierce the other day from the early part of the last century: "Opiates are an unlocked door in the prison of Self -- that leads into the jailyard."



    I'm sorry (none / 0) (#32)
    by Militarytracy on Mon Jun 26, 2017 at 10:10:48 AM EST
    We have gotten behind the surgical pain curve with Josh also. Initial surgical pain is extreme, and once it has come through the veil of pain meds it is very difficult to stop the nerve signal firing.

    A few days after surgery is usually completely different. But the first 48 hrs are their own monster.


    the pain meds. Was very happy to not take them any more.

    You all have been through this often enough (none / 0) (#34)
    by Anne on Mon Jun 26, 2017 at 02:11:19 PM EST
    that you pretty much know the best way to deal with it, what works and what doesn't.  Imagine it is galling when you aren't listened to.

    For people in a sort of one-off situation, it can be hard to know.  When I had the shoulder surgery five years after I had more or less the same surgery on the other shoulder - both for traumatic dislocations and fractures - I was given a nerve block that deadened my arm for hours, well after the surgery.  It was completely weird and creepy to touch my arm - it felt like it belonged to someone else - but I think it maybe settled the nerves to the point where, when it wore off, it wasn't as bad as I was expecting.

    I do not like the pain meds.  I recognize their value, but hate the way they make me feel - banging headaches for one.  Took them at night to sleep for the first couple of days, but made do with Advil during the day.  I don't know if I have a high tolerance for pain or a higher intolerance for the meds.

    Both my daughter and my mother react poorly to morphine derivatives - what should have been a relatively short outpatient stay almost turned into an overnight because my daughter was so sick from the morphine after her foot surgery.  My mom felt worse from the morphine than she did from the post-hip replacement surgery, so she switched out to Tylenol - and got resistance from the nursing staff.

    There's just no one-size-fits-all approach to pain.  I've had former addicts tell me they were convinced their minds "manufactured" pain they could justify taking meds for, because once they got off the drugs completely, they didn't have the pain.


    Yup. Right after my big knee surgery (none / 0) (#35)
    by sarcastic unnamed one on Mon Jun 26, 2017 at 02:59:08 PM EST
    they asked me if I needed a nerve block.

    At first I was unconvinced, but after 10 minutes or so I realized that the pain was rapidly increasing and was pretty bad. The nerve block was fast and welcome relief, but when it wore off 6 or so hours later, the influx of pain was rapid and dramatic and I immediately started the pain pill regimen.

    I had a simple meniscus repair on the other knee about 6 months later, and that was a walk in the park, comparatively.


    Yes, I realize that some individuals (none / 0) (#38)
    by Militarytracy on Mon Jun 26, 2017 at 08:32:09 PM EST
    Can easily develop dependency issues, but others have side affects that make dependency almost impossible. Opioids have an adverse affect on Josh too. If he's taking them it is only for pain. As soon as Ibuprofen can contain things he is all too willing for that to be all he takes.

    Sadly he seems to be slightly allergic to Naproxen. That's such a great pain reliever for some.


    "As for the tax (none / 0) (#27)
    by KeysDan on Fri Jun 23, 2017 at 03:14:57 PM EST
    cut bill posing as a health care bill.." Yes, this is really a wealthcare bill.  And, as if wringing almost a $trillion out of Medicaid to enable almost a $trillion in tax cuts for the rich is not enough, the tax cuts are retroactive--being repealed as of January 1, 2017 (3.8% tax on investment income, including capital gains and dividends for individuals at $200,000/year and married couples $250,000).

    "...we can only hope Republican senators in states suffering most from the epidemic have half a brain and half a heart to kill it."  Despite this low anatomical bar for Republican senators, unless we can find l/2 a brain donor and l/2 a heart donor for the lot of them, hope springs eternal.


    Prince died of an overdose of (none / 0) (#5)
    by Jeralyn on Thu Jun 22, 2017 at 07:48:48 PM EST
    fentanyl, which was not legally prescribed.

    bq. Prince did not have any prescriptions, including for fentanyl.

    Another report from the LA Times: " The 57-year-old musician had no prescription for any controlled substances in the state of Minnesota in the 12 months before he died." His pills were counterfeit. Maybe if he had been able to get prescription pain pills, he wouldn't have turned to the black market and died.

    He was not a recreational user, he had chronic pain.


    could not get prescription pain meds.

    He OD'd several (many?) times over the years, according to people close to him.

    I agree, he was not a "recreational" user when he died.  While he did have chronic pain he was also heavily addicted and had been so for years, according to those close to him.


    According to Wendy Melvoin and Lisa Coleman of Prince's old band the Revolution, who had both remained friends with him even after they went their separate ways professionally, they'd been completely blindsided by his death (as were we all) and had no idea he was an addict.

    Our country's healthcare professionals generally do not do a good job with pain management.

    And now it's a real sticky wicket (none / 0) (#29)
    by jondee on Fri Jun 23, 2017 at 07:29:41 PM EST
    with the people who actually need analgesics to function having a harder time than ever getting them because of all the self-medicators, partiers, profiteers, and all the publicity about over-prescribing.

    Doctors are in a damned if they do, damned if they don't position now.


    I have read (none / 0) (#7)
    by Ga6thDem on Thu Jun 22, 2017 at 08:15:55 PM EST
    that they have had success in Europe in dealing with addiction with letting doctors handle it who wean the users off of the drugs with prescriptions. I don't know but it sounds like something worth trying here.

    The Congressional Budget Office (CBO) (none / 0) (#31)
    by KeysDan on Sat Jun 24, 2017 at 11:30:28 AM EST
    score for the Senate version is to be released early next week.  The CBO for the House-passed bill estimated that 23 million more people will be uninsured by 2026.  

    It is my prediction that the Senate bill, which is just as bad, if not more so, than the House bill, will, never-the-less, will register a CBO score of less than 23 million--probably in the range of 16 to 19 million fewer will have coverage.  The lower number will be hailed as demonstrating the "improvements" over the House bill and will be used to blunt criticism and pave the way for the rush to vote.

    The comparisons between bills needs to take into account the type of coverage that will be available, including facing the choice between higher premiums or higher deductibles, or, maybe, both.  Also, as with the ACA, the Senate bill continues with coverage for preexisting conditions. But, a waiver procedure is available to insurers to provide skimpy, if not, junk insurance.  Statistically, the number not covered will be less than that of the House version,

    The CBO score (none / 0) (#36)
    by KeysDan on Mon Jun 26, 2017 at 03:40:21 PM EST
    for the Senate version is 22 million fewer people will have coverage over ten years.  A little better than the House version of 23 million.  We will not need to wait long for the criticisms of the CBO.

    The Senate now requires consumers with a break in coverage to wait six months before buying insurance (the break is a lapse for 63 days or more, then need to wait the six months).  The House bill calls for a 30 percent premium surcharge for new enrollees who have a lapse in insurance for more than 63 days. (all to get around the dreaded Obamacare mandate to avoid waiting until sickness or injury to obtain insurance).


    the six months thing (none / 0) (#37)
    by CaptHowdy on Mon Jun 26, 2017 at 06:17:51 PM EST
    just seems so stupid to me.  so if you dont buy insurance we sentence you to go to an emergency room for your care.  

    the most expensive and least effective way to provide care.

    i think this thing is deader than Elvis.


    Hope you are right, (none / 0) (#40)
    by KeysDan on Mon Jun 26, 2017 at 08:55:50 PM EST
    but we are dealing with Republicans after all.  They will want to take what they can now, while they have Trump to sign whatever is put in front of him (and it does remove the tax on tanning beds, which is a nice bonus for Trump, unless that orange is just make-up).

    The Trumpcare (senate or house version) is a dangerous health care (wealthfare) monstrosity, but little discussion is had of the damage it does to the economy (almost 20 percent of the US economy); it will be a great job-killer with rural hospitals closing, nursing homes that depend on Medicaid reimbursement, patients avoiding seeking out their health care professionals,  and on and on.


    he does have some money to bribe the (none / 0) (#47)
    by CaptHowdy on Mon Jun 26, 2017 at 09:30:57 PM EST
    so called moderates.  the problem is then he loses the freedumb caucua

    I don't know (none / 0) (#41)
    by Ga6thDem on Mon Jun 26, 2017 at 08:56:57 PM EST
    if two votes against are enough to kill it in committee but it seems that there are that many R's that are voting against it in committee. Actually I hope this monster at least comes up for a vote. I want it on record who voted for it.

    Trump is threatening to not pay the subsidies for insurance if the senate doesn't vote for it. However if next month people's insurance bills double and triple the voters are going to know who exactly to blame.


    Yes, I want a vote (none / 0) (#43)
    by Militarytracy on Mon Jun 26, 2017 at 09:04:41 PM EST
    i cant believe (none / 0) (#46)
    by CaptHowdy on Mon Jun 26, 2017 at 09:29:36 PM EST
    Mitch will put it up unless he is absolutely sure it will pass.

    for the very reason that you want a vote.


    Well, right now (none / 0) (#48)
    by Ga6thDem on Tue Jun 27, 2017 at 09:44:53 AM EST
    they don't have the votes. So I'm sure McConnell is working on getting them. Whether people like Collins will fold is anybody's guess.

    i dont understand this (none / 0) (#39)
    by linea on Mon Jun 26, 2017 at 08:53:01 PM EST
    The Senate now requires consumers with a break in coverage to wait six months before buying insurance...

    what exactly is the senate version saying? it's june. if i decide i want insurance, i have to wait untill december to sign-up under obamacare and then make payments until the next june before im covered? is that what this means?


    Okay. (5.00 / 2) (#42)
    by Ga6thDem on Mon Jun 26, 2017 at 08:59:39 PM EST
    if you lose your job and can't pay the premium you are going to have to wait six months to get insurance. You can't just get insurance when you find a job.

    the intention (5.00 / 2) (#45)
    by CaptHowdy on Mon Jun 26, 2017 at 09:28:04 PM EST
    is to encourage young healthy people to stay insured.  the idea is you cant just wait until get find out you have cancer to buy insurance.

    which is a stupid solution to the problem of people whining about the mandate.  its a mandate by abother name.


    oh (none / 0) (#44)
    by linea on Mon Jun 26, 2017 at 09:25:14 PM EST
    that's bad.

    i'm currently uninsured and looking for a regular job to get healthcare and stable employment.


    Jobs do not provide healthcare. (5.00 / 2) (#49)
    by Chuck0 on Tue Jun 27, 2017 at 03:14:44 PM EST
    They generally provide health INSURANCE. People still think "Obamacare" (the ACA) had something to do with healthcare. It does not. Never did. It was (is?) a health INSURANCE bill. I am exasperated with the conversation about health CARE when it is health INSURANCE. Granted one (INSURANCE) makes it easier and more affordable to get the other (CARE). But they are not one and the same.

    OTOH (none / 0) (#50)
    by CaptHowdy on Wed Jun 28, 2017 at 10:16:44 AM EST
    healthcare can provide jobs.  good ones that can not be out sourced.

    So true. (5.00 / 1) (#51)
    by Chuck0 on Wed Jun 28, 2017 at 10:39:59 AM EST
    And one can feed the other. If we have a populace that is fully covered, then we need more health care workers. Rinse, repeat.

    I think I would question whether (none / 0) (#52)
    by Anne on Wed Jun 28, 2017 at 11:36:00 AM EST
    insurance really does make it easier to get care, because in many instances, the mission of insurance companies seems to be to find ways to make it harder - or at least to make it harder for people to pay for.  Denying coverage for certain things, overriding doctor-prescribed treatment plans and making people take interim steps that don't work and delay treatment, etc.

    They do this because they are in the business of making money, and the only way to make money is to not spend it on the health care that people pay premiums in order to get.

    Anyone who's ever spent hours and hours on the phone with an insurance company or administrator trying to get something covered/paid for can tell you that insurance companies can be more of a barrier to care than a facilitator.

    This is the biggest problem with the debate currently underway: we are not talking about people being able to get care, we are talking about people being able to get insurance.  If every single human being in this country had insurance, what do you think the chances are that their overall access to care, and their health outcomes, would be appreciably better?

    On the other hand, I imagine that if 300 million-plus people had insurance, the compensation of insurance executives and the dividends on insurance company stock would be eye-poppingly huge.

    Insurance is not the answer.  The Senate plan is definitely not the answer.  Even "fixing" the ACA is not the answer.  We should not be treated like assets to be monetized to make others wealthy, but like the humans we are with a right to be healthy.


    it is not (none / 0) (#53)
    by CaptHowdy on Wed Jun 28, 2017 at 11:47:52 AM EST
    but the jump from an insurance based society to a single payer one IMO can  not be made in one step.

    there are now serious conversations about lowering the MEDICARE age to 50.

    this is IMO a major step toward what we really want.


    I definitely think that debating the (none / 0) (#55)
    by Anne on Wed Jun 28, 2017 at 12:19:29 PM EST
    Republicans' bills has brought into greater focus how badly we need to get insurance companies out of the business of gate-keeping our health care.

    Lowering the Medicare eligibility age to 50 would be a good step in the right direction - it would probably lower the cost of Medicare, since it would add healthier people to the pool.

    I may be dreaming, but I could swear that in the early stages of the ACA, there was talk of doing just this - and it got nixed.


    that was then (none / 0) (#56)
    by CaptHowdy on Wed Jun 28, 2017 at 12:30:13 PM EST
    this is now.

    i think that could matter


    If you ever get (none / 0) (#54)
    by Ga6thDem on Wed Jun 28, 2017 at 12:03:43 PM EST
    into a debate with an insurance company regarding coverage do not spend a ton of time on the phone with them. Start writing an appeal for them to review. You are wasting your time talking to someone in customer service who cannot change anything nor can their supervisor. An appeal goes directly to the doctors who do nothing but handle this kind of stuff.

    True. (none / 0) (#57)
    by Chuck0 on Wed Jun 28, 2017 at 01:12:34 PM EST
    I have gotten more than one denial overturned from writing letters (once more than 3). Talking to customer service reps on the phone will you get nowhere. They don't know how to think or go off script.

    Well (none / 0) (#58)
    by Lora on Wed Jun 28, 2017 at 03:01:08 PM EST
    Try getting certain kinds of health care without insurance.

    My mother (who has medicare and a really good supplemental) could not handle a normal physical therapy regimen.  In order for insurance to cover PT, she has to make a certain amount of "progress."  If she does not, PT is cancelled.

    This regimen, which we tried for 3 separate sets of treatment with 2 different therapists, caused my mother so much anxiety that she would have an A-fib episode within 24 hours of a PT visit, like clockwork.

    We could not make it work.  We tried to get her private PT "on demand" without the accompanying pressure to improve.  They wouldn't do it, explaining that if they take private pay patients, the insurance companies consider that to be "competition" and they risk losing the huge business from patients who are insured.

    Can we say "broken...???"


    ... the underlying issue of healthcare delivery in these remote areas is not necessarily the lack of insurance coverage but rather, a chronic and often critical shortage of actual healthcare providers who live in those communities themselves.

    For a resident of limited means and mobility, having to travel a long distance to get to a doctor or dentist can be highly problematic. And so, many tend to forgo such care, until the situation reaches a point where they're finally compelled to present themselves in an emergency room, sometimes under very critical and dire circumstances.

    In Hawaii, which is over 90% rural, the problem is particularly acute because most all specialized care is localized on the urbanized island of Oahu. This means that those residents on the neighbor islands in need of such care have to fly to Honolulu to receive it.

    That's a minimum out-of-pocket expense for the patient of $150 in round-trip air fare. If you're a parent of a minor child who's the patient in need, you can double that air fare cost. And if such care requires you to stay overnight for a day or more and you're not being hospitalized, you can throw in a minimum of $100 per night for a hotel room, as well. Good luck collecting on those incidental expenses from your insurance carrier.

    Those of us who live (or have lived, in my case) in major urban areas aren't necessarily aware of the sometimes significant barriers and hurdles which our fellow Americans in rural communities must often overcome, in order to access the sort of quality health care which many of us otherwise take for granted.

    And I have to admit that as a former cancer patient myself, that prospect crossed my mind when we made the decision to relocate from Honolulu, population of one million people, to Hilo, a town of only 45,000 that's considered "the big city" by those who live in the smaller coastal communities which dot the East Hawaii landscape.

    There are only three hospitals on this island of nearly 200,000 residents -- Hilo Medical Center (just down the road from home), North Hawaii Community Hospital in Waimea, and Kona Community Hospital in Kealakekua on the southern Kona coast.

    The State of Hawaii pioneered the concept of universal health insurance coverage in this country with its landmark Pre-Paid Health Care Act of 1974, which was enacted 32 years before Massachusetts undertook a similar endeavor. So, 95% of Hawaii residents have long had health insurance, and the remainder are covered under Medicaid.

    For many of us on the Big Island, it's not a matter of how we're going to pay. Instead, we worry about where are we going to go in the event we need specialized care, the type which is above and beyond the call of our friendly neighborhood general practitioner or pediatrician.



    Here in GA (none / 0) (#60)
    by Ga6thDem on Wed Jun 28, 2017 at 09:09:07 PM EST
    in some areas the situation is even worse. I worked in the office of rural health for a short time and I will tell you the problem is that no doctors want to locate to these rural areas because they feel they don't make enough money there. So the GA legislature decided that they needed to loosen up the restrictions on being able to prescribe medicine etc. and let nurse practitioners start covering these under served areas. Guess what? The AMA fought it tooth and nail. So what do you do? These people have a hard time even getting a family practice doctor to see and yet still have to drive an hour or more to Macon or Savannah to get to see a specialist.