Until we elect officials that will properly fund those types of programs and remove the corruption from it you are probably right. But at least with medicare for all people wouldn't be going in debt and filing for bankruptcy.
American Healthcare continues to go backward
- Thread starter steross
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See public schools. Pay teachers crap then qualified people get jobs elsewhere because they can make a lot more money. Then say the schools are so bad we need to give parents the option of where to send their kids.
Long time public servant here calling BS on this....particularly the hyperbole....more particularly the "empire builders abound in every niche of government" nonsense.
Not interested in trying to change your mind.
You can continue being as wrong as you'd like. Makes no difference to me.
You are right.
When I was the director of a public emergency department in Australia, we hired a lot of doctors. When I was first hired, they had been advertising my position for 5 years. I was the third doc to agree to go there. They wanted 8. I filled it with mostly Americans. By the time I left, we needed and had 10. When I left, 11 Australian docs applied for my position. We built a little "empire."
We also decreased costs by $2.3 million dollars per year in doing so because they no longer were forced to staff the ER with fly-in/fly-out expensive locum docs.
But, that part is never mentioned in the "I hate government" side of things.
I'm currently building another empire in the VA. We are building a tele-emergency department service for the VISN (5 state region). I'm the director of that. It costs quite a bit to run that with 5 docs/5 nurses/ 9 tele-health technicians per day.
These are Vets triaged to be seen within 4 hours by a triage nurse/ 911 refusals etc. To a government hater, it sounds like another boondoggle. Bunch of docs being paid to sit at home and see patients on a video instead of real work.
But, if we don't see them, they go to an ER. The VA foots that bill. Even with that sickly group, we can resolve the problem by telemedicine 2/3rd of the time and send them to a VA lab or X-ray. The current estimates are around $1000 per patient saved. We see around 50 per day.
Yep, building government empires "wasting" money.
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mugatu
Ranger
I went to Walter Reid once for treatment - 2016 timeframe. The building is a maze and confusing. I needed surgery for a salivary stone and was transitioning from active duty to reserves and across the country from my Primary so I had to go to DOD hospital (Tricare told me they wouldnt cover a civilian ENT without me seeing my primary while i was in the ENT office). They looked at me and then told me I could get treatment possibly in 4 months.
Tricare was great for the most part but once you start your way out... it's horrid. I've heard similar from others using VA medicine. Forced restarts of trials to establish care vs continuing existing care approaches that had been working for years.
My mother was a happy healthy 80 year old lady on no medications. Then she started coughing. then she got progressively short of breath. Turns out, she had rheumatoid arthritis that didn't affect her joints but attacked her lungs instead. She tried to book an appointment with a rheumatologist. She was told it would be August. It was April when she called. A terminal illness, to be seen in 5 months.
This was all recent and all civilian. It's horrid.
Our healthcare system is a mess. That is the purpose of this thread.
mugatu
Ranger
Yes it is. People reference the VA as proof that the gov needs to stay out of Healthcare. Instead they need to staff it properly. Delays are horrible across the board - VA and civilian - for anything but a GP check.
I said “a lot of government agencies”. I understand that there is a need for more medical personnel. I meant agencies like the IRS. Have you looked at the “simplified tax code”? It seems to require more paper shuffling than ever before. A lot of it is processed by computers. But the IRS has hired a bunch new people to audit a lot of people.
IRS seeks 102,000-employee ‘right-sized’ workforce – and more money to maintain staffing
The IRS will use Inflation Reduction Act funds to increase customer service and enforcement personnel and grow its workforce through 2029.
federalnewsnetwork.com
You also said “in every niche of government”…..every niche indicates everywhere.I said “a lot of government agencies”. I understand that there is a need for more medical personnel. I meant agencies like the IRS. Have you looked at the “simplified tax code”? It seems to require more paper shuffling than ever before. A lot of it is processed by computers. But the IRS has hired a bunch new people to audit a lot of people.
IRS seeks 102,000-employee ‘right-sized’ workforce – and more money to maintain staffing
The IRS will use Inflation Reduction Act funds to increase customer service and enforcement personnel and grow its workforce through 2029.
If you hate the IRS…just say that instead of insulting a lot of people that are truly dedicated to serving the public.
Well, seems that everything this article says is not happening or is only happening as a last resort.....I'm seeing happen. It has unfortunately put. a huge damper on my "empire building."
VHA tells leaders to rescind job offers only as a ‘last resort’ to manage size of health care workforce
The Veterans Health Administration, in recent memos, put a temporary pause on pulling back job offers, then told leadership and HR officials to only rescind job offers as an “action of last resort.”
federalnewsnetwork.com
HIRING/RETENTION
VHA tells leaders to rescind job offers only as a ‘last resort’ to manage size of health care workforce
The Veterans Health Administration, in recent memos, put a temporary pause on pulling back job offers, then told leadership and HR officials to only rescind job...The Department of Veterans Affairs saw record hiring last year. Now it’s looking to manage the size of its largest-ever health care workforce.
The Veterans Health Administration, in recent memos, put a temporary pause on pulling back job offers, then told leadership and HR officials to only rescind job offers as an “action of last resort.”
VA officials stress that the department still plans to keep growing its health care workforce — albeit in specific, targeted areas, and through a smaller net increase of employees.
However, VA health care job applicants say they’re frustrated by delays and are still waiting for final job offers, even in positions that are still in high demand at VHA.
Meanwhile, federal employee union officials say VHA still has urgent hiring needs to reduce the workload on current VA health care employees.
The IRS doesn't write the insane tax code, Congress does. It is the job of the IRS to enforce it. Do you feel that enforcing the tax code should not include audits? Personally, as someone who pays my taxes, I don't want people getting away with avoiding taxes on their high incomes.I said “a lot of government agencies”. I understand that there is a need for more medical personnel. I meant agencies like the IRS. Have you looked at the “simplified tax code”? It seems to require more paper shuffling than ever before. A lot of it is processed by computers. But the IRS has hired a bunch new people to audit a lot of people.
IRS seeks 102,000-employee ‘right-sized’ workforce – and more money to maintain staffing
The IRS will use Inflation Reduction Act funds to increase customer service and enforcement personnel and grow its workforce through 2029.
If hiring these people improved compliance with tax laws and increased tax revenue to what it is supposed to be by law, would you consider that a good thing or a bad thing?
You’re right. I should have just stuck with a lot of government agencies. There are good even great public servants in government but there are a lot of duds, too. It’s hard to get rid of the duds, though.
That is an issue.
Yeah, and they are filibustering and attacking votes on all types of Healthcare across states demanding extremist things.
Missouri is trying to shore up the Tax structure for Medicaid for the state.
Approximately 12 hours after the Freedom Caucus in the Missouri Senate ended a 40-hour filibuster, one of its members resigned citing the behaviors and actions of the group.
Sen. Jill Carter, R-Joplin, said her departure is best to represent the members of her district.
“Over the past few months, it has become increasingly clear that the values and priorities that some current members of the Missouri State Freedom Caucus profess to champion are not reflected in conversations, behaviors or their strategy,” Carter said in a post on X, the platform formerly known as Twitter. “While I remain loyal to the same conservative principles and the advancement of legislation that benefits our state and my constituents, I can no longer, in good conscience, be part of behaviors and actions behind the scenes that defames grassroots and violates the needs of my constituents.”
The Freedom Caucus began their filibuster when debate on a bill to renew a tax on health care organizations to provide approximately $4 billion for the state’s Medicaid program was brought up for debate. Led by Sen. Bill Eigel, R-Weldon Spring, and a candidate for the GOP nomination for governor, the Freedom Caucus stated two demands as they began the filibuster.
First, they demanded Republican Gov. Mike Parson sign a bill to prohibit funding of organizations affiliated with abortion providers. Second, they wanted a bill changing how voters approve changes to the Missouri Constitution, passed in the House, be brought up for a vote in the Senate.
Fair enough.
I'd say that there are a lot of duds in private entities too. Though you are right, some government employees (particularly at the federal level) have protections for their jobs that are not in place in the private arena (which is mostly employment at will). It's harder to fire some duds in government service than it is in private entities.
If this is too much of a political issue for the Healthcare thread please let me know and I will move it.
Texas man files legal action to probe ex-partner’s out-of-state abortion
As soon as Collin Davis found out his ex-partner was planning to travel to Colorado to have an abortion in late February, the Texas man retained a high-powered antiabortion attorney — who court records show immediately issued a legal threat.
If the woman proceeded with the abortion, even in a state where the procedure remains legal, Davis would seek a full investigation into the circumstances surrounding the abortion and “pursue wrongful-death claims against anyone involved in the killing of his unborn child,” the lawyer wrote in a letter, according to records.
Now, Davis has disclosed his former partner’s abortion to a state district court in Texas, asking for the power to investigate what his lawyer characterizes as potentially illegal activity in a state where almost all abortions are banned.
The previously unreported petition was submitted under an unusual legal mechanism often used in Texas to investigate suspected illegal actions before a lawsuit is filed. The petition claims Davis could sue either under the state’s wrongful-death statute or the novel Texas law known as Senate Bill 8 that allows private citizens to file suit against anyone who “aids or abets” an illegal abortion.
The decision to target an abortion that occurred outside of Texas represents a potential new strategy by antiabortion activists to achieve a goal many in the movement have been working toward since Roe v. Wade was overturned: stopping women from traveling out of state to end their pregnancies. Crossing state lines for abortion care remains legal nationwide.
The case also illustrates the role that men who disapprove of their partners’ decisions could play in surfacing future cases that may violate abortion bans — either by filing their own civil lawsuits or by reporting the abortions to law enforcement.
Under Texas law, performing an abortion is a crime punishable by up to a lifetime in prison and up to $100,000 in civil penalties. Women seeking abortions cannot be charged under the state’s abortion restrictions, but the laws target anyone who performs or helps to facilitate an illegal abortion, including those who help distribute abortion pills.
Davis’s petition — filed under Texas’s Rule 202 by Jonathan Mitchell, a prominent antiabortion attorney known for devising new and aggressive legal strategies to crack down on abortion — follows a lawsuit filed last spring by another Texas man, Marcus Silva, who is attempting to sue three women who allegedly helped his ex-wife obtain abortion pills.
“Mr. Davis is considering whether to sue individuals and organizations that participated in the murder of his unborn child,” Mitchell, widely known as the architect of Senate Bill 8, wrote in Davis’s complaint in March.
Davis’s petition includes no evidence of illegal activity. Davis’s former partner ultimately obtained her abortion in Colorado, Davis claims in the court documents. Mitchell suggests in the petition that people who helped her procure the abortion could be found liable.
Antiabortion advocates have tried various tactics to dissuade women from traveling out of state for abortions. Idaho has passed a law making it illegal for someone to help a minor leave the state for an abortion without parental consent — which is currently blocked by the courts — and Tennessee is pursuing similar restrictions. Several Texas cities and counties have passed local ordinances attempting to stop women seeking abortions from using key portions of high-traffic highways.
Mitchell said in a statement that abortions that occur outside Texas can be targets for civil litigation.
“Fathers of aborted fetuses can sue for wrongful death in states with abortion bans, even if the abortion occurs out-of-state,” he wrote. “They can sue anyone who paid for the abortion, anyone who aided or abetted the travel, and anyone involved in the manufacture or distribution of abortion drugs.”
Molly Duane, a senior staff attorney with the Center for Reproductive Rights, described Mitchell’s statement and general approach as misleading “fearmongering.”
“People need to understand that it is not a crime to leave Texas or any other state in the country for an abortion,” said Duane, who is working with lawyers from the firm Arnold & Porter to represent the woman and others targeted in the Davis case. “I don’t want people to be intimidated, but they should be outraged and alarmed.”
Duane described the woman’s relationship with Davis as “toxic and harmful.”
Davis — who claims in the petition to have helped conceive what he calls his “unborn child” — did not respond to requests for comment. Mitchell declined to comment on Duane’s description of the relationship.
Abortion rights advocates say these types of legal actions amount to “vigilante justice” designed to intimidate people who have done nothing wrong. Duane and other lawyers representing the woman asked the court to redact the names of those involved from the public court filings, out of a concern for their privacy and safety.
The judge agreed to seal the original petition with the identifying information.
“The document at issue contains confidential and sensitive information including the Respondents’ full names ... and sensitive allegations about health care that the Respondents have a substantial interest in keeping confidential,” the judge wrote in an order signed Wednesday.
Over the past two years, many antiabortion activists have grown frustrated by what they see as a lack of enforcement of abortion bans — particularly as abortion pills become more widely available in antiabortion states because of growing online and community-based pill networks.
Some antiabortion advocates are searching for a way to crack down.
“You have laws being ignored systematically — so what are we going to do about it?” said John Seago, president of Texas Right to Life, the state’s largest antiabortion group. The pill networks, he added, “can and should be prosecuted.”
Several district attorneys in conservative areas told The Post that abortion laws are difficult to enforce in practice, largely because they have no clear way to find out about these cases.
“First you would have to have some sort of complaining party … then law enforcement would have to do a full investigation,” said Kent Volkmer, county attorney for Pinal County in Arizona, where the Republican-led legislature has voted to repeal an 1864 abortion law. “I think it’s extremely unlikely that an abortion-related criminal charge would ever be submitted to our office.”
If one of these cases did surface, Volkmer said, it would probably be reported by an employee of a doctor’s office who was aware of the abortion — or by the “purported father.”
Volkmer added that, because of his office’s policy to only prosecute cases with a reasonable likelihood of conviction, he would only anticipate prosecuting what he characterized as an “extreme” situation, such as an abortion that occurred late in the third trimester.
In the Davis case, Mitchell is attempting to depose the woman who had the abortion, along with several other people he writes may be “complicit” in the abortion. If deposed, they would be asked about others involved in the abortion, including any abortion funds or any other entities that provided financial support, according to court records. They would also have to provide all documentation relevant to the abortion.
“Mr. Davis expects to be able to better evaluate the prospects for legal success after deposing [the people listed], and discovering the identity of their co-conspirators and accomplices,” Mitchell wrote in the complaint, which he filed on March 22.
Davis is now awaiting a decision from the state district court.
While the vast majority of Texas abortion funds stopped providing funding for out-of-state abortions after Roe was overturned — concerned for their legal risk amid vague laws they worried might allow prosecutors to target them — many resumed operations in the spring of 2023, reassured by a court ruling that has temporarily blocked some prosecutors from going after people who help Texans obtain abortions across state lines.
“I want people to know we don’t think there’s anything illegal about helping someone leave the state for an abortion,” said Duane, with the Center for Reproductive Rights. “These are Jonathan Mitchell … tactics to discourage people.”
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The Medicare Bubble Has Burst
Government health-insurance program had been a gold mine for private insurers until recently
For years, the privately run Medicare Advantage business generated outsize profit growth for health-insurance giants.
With hundreds of billions of taxpayer dollars flowing to insurers in a fast-growing market buoyed by aging baby boomers, there was little not to like as far as Wall Street was concerned. Companies like UnitedHealth Group UNH and Humana HUM bet big on the program, and investors generally rewarded them for it. Medicare Advantage, in which the government pays insurers a set amount to manage the care of seniors, recently surpassed traditional Medicare’s share of beneficiaries. It was 30% a decade ago.
But the gold rush is over for investors, at least for now. After years of reports, lawsuits and whistleblower accounts accusing big insurers of gaming the system and overcharging the government, the Biden administration has made a series of policy changes that have negatively affected what the plans get paid. Meanwhile, a post-Covid surge in seniors’ medical costs caught insurers by surprise.
....
That by no means signals insurers are about to flee Medicare Advantage (though Cigna CI did agree to sell its business earlier this year). Annual spending on the program, which is now hardwired into America’s healthcare system, is projected to approach $1 trillion by the start of the next decade. And while declining profit expectations have negatively affected share performances, there are still plenty of profits to be made.
Take hard-hit Humana, which is mostly focused on Medicare Advantage. The firm is expected to earn significantly less in 2024, but analysts polled by FactSet still see it making just over $16 per share this year. By 2026, analysts expect earnings to rise back to $26 per share—some $3 billion in net income.
The high cost of covering seniors is likely a temporary problem for insurers, who get to submit their bids to the Centers for Medicare and Medicaid Services every year. While they are limited in the changes they can make, CVS and others said they are planning to exit some counties and cut back on things such as vision benefits to boost margins.
“The goal for next year is margin over membership,” CVS Chief Financial Officer Thomas Cowhey said at a recent conference. “Could we lose up to 10% of our existing Medicare members next year? That’s entirely possible.” By all indications, other large players such as Humana will also be shifting from growth to profits.
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The tougher challenge is on the regulatory side. The Biden administration’s changes, from releasing stingier payment rates to changes in how programs can code patient risk, signal an era of tighter purse strings. With such a big part of their business at stake, the industry’s effort to sway public and policymakers’ opinions is expected to go into overdrive.
“I can assure you that the companies will be investing pretty heavily through campaign donations and lobbying to try to figure out what they can do from a public policy point of view,” said Wendell Potter, a former top communications employee at Cigna Group who is now a critic of the industry.
For decades, policymakers have sought to bring private insurers along as a way to manage soaring Medicare costs. In 2003, Congress passed the Medicare Modernization Act, which created Medicare Advantage as we know it. The idea, in a nutshell, is to bring down costs and improve care by allowing insurers to manage care, much like they do for the nation’s employers.
But critics point to studies showing that Medicare Advantage plans cost the government and taxpayers billions of dollars more than traditional Medicare.
extremely high profits. What’s going on now are long overdue policy changes to bring their pricing and coding practices back into line,” said Dr. Don Berwick, former head of the Centers for Medicare and Medicaid Services.
In the near term, the best hope for a quick shift to insurers’ fortunes could be a Donald Trump win in the coming presidential elections, Fidel said. Republican administrations, which tend to favor privatization of government services, have been more favorable toward Medicare Advantage.
Stillwater Townie
Ranger
So, I wonder if complaints from patients regarding private health insurance companies participating in Medicare Advantage are significantly higher than regular government Medicare.
