[QUOTE=Bill Peckham;17891]Mark I think your post is deeply misguided. From the point of view of people on dialysis healthcare reform is desperately needed.
I have a new post up Is a robust public insurance plan a threat to the provision of dialysis? My post isn’t exactly what you are talking about but it is another element of the current discussion.
To the points in your post I think CMS could better managing people with CKD5 who use dialysis to help them avoid expensive unnecessary tests and hospital re-admissions by getting rid of the dialysis weekend - every other day dialysis, for instance would cost about $5,000/year but could save that on the Part A side by avoiding one hospitalization which on average last 2.4 days.
Another likely target to generate savings in our corner of Medicare is Epo. Medicare could negotiate the price directly which could save $500,000,000 per year. This with no impact on your clinical care.
One area of debate is the impact of CKD 3 and 4 outreach, screening and education. For each percentage point decrease in the growth in dialyzors the savings are significant. Can that fruit be picked? I don’t know why not.
I think by relying on fear to squash healthcare reform you position yourself outside the debate and dimminish your relevance. Better to review the actual proposals if you would like to influence the direction of debate.[/QUOTE]
Bill:
I know what socialized medicine has done in other countries, such as Great Britain, Canada, and other Western European countries. I would agree, without a doubt, the dialysis industry is in desperate need of reform, along with the medical industry. Having worked in the public assistace department, Medicaid is a lousy payer, as is Medicare. We agree Medicare is a lousy payer, no disagreement. I have have friends, who are Democrats, have stated to me that they are not able to afford the current excessive tax rates. President Obama has prosposed trillions in new spending, without stating how new revenues would pay for these expenses. Costs do not go away because Congress waves a magic wand. I am not a fan of DaVita or the insurance companies. I believe the solution is consumer choice or competition to cut costs, health care is expensive because government is paying 45 percent of claims and there is no competition. Why do you believe other companies lowered their drug prices when Wal-Mart introduced $4 prescriptions, because they are nice people? How would you expect a dialysis clinic to operate when they are not being paid enough to cover costs?
Michael Barone- Almanac of American Politics:
“As Clinton White House deputy domestic policy adviser William Galston points out in the New Republic blog, “Congress has thus far given the cold shoulder to most of the administration’s proposals for raising revenues dedicated to health reform.” So if Democrats want to pass their health bill using the reconciliation process, which requires that they get only 50 votes in the Senate, they will have to come up with $150,000,000,000 in annual revenue or offsetting spending or else add to the $900,000,000,000 in yearly budget deficits projected by the Congressional Budget Office. As Galston points out, the CBO is unlikely to agree with administration projections of savings from comparative effectiveness research. So money is a problem.”
Private insurers are unable to compete with a government health plan. Government is able to use force to get people to comply with National Health Care, while private insurers are only able to use voluntary cooperation with the public. I would agree with Professor Hacker, that Medicare is excellent at cost control. However, many physicians will now not accept Medicare patients because of low reimbursement rates. The other issue that I would have with this proposal is that when I had a serious attack with asthma, I had to take predisone to enable me to breathe. With taking predisone, I had the side effect of acne, all over my back and wall to wall acne on my back. I had to wait two months to see a dermatologist, now, imagine how I felt sitting with my back in the recliner on dialysis for five hours. The shortage of dermatologists is due to the low reimbursement rates for physicians. If the reimbursement rates were high enough, this creates an incentive for high ability people to enter the field of dermatology. This way, I would have been seen immediately and not had to endure months of 24/7 agony. My acne was serious enough to take the drug called Accutane, the nuclear bomb for acne. After a year, my acne has 85-90 percent removed with a couple of more months to take the medicine. Physicians have been entering the profession at a rate of 1 percent per year, due to low reimbursement rates. The funding of the public plan will have to come from somewhere, do you believe people are willing to pay more taxes?
I know of a woman who takes care of two mentally challenged adults who have Medicaid for dental procedures. They have to wait six months for appointment, do you believe that is compassion, when they have high levels of pain in their mouth?
Honestly, I could care less about the stockholders of DaVita. I care about the level of service and care that the patients are receiving. Private insurance and high reimbursement would allow products such as HD+ and the Wearable Artifcial Kidney belt to succeed and flourish. I know that we both support better lives for kidney patients. We can cut costs and reform the medical profession thru competition and consumer choice. I believe you work in business, do your customers have a choice to purchase products from your company or from a competitor? Would the prices that you charge your customers be higher or lower if you did not have competition in your line of the economy? The service for cable television was lousy in the early 1980’s. However, service from the cable company has greatly improved because of the competition from the satellite dish. I am for increased profits to help give greater care to dialysis patients like me. If President Obama wants to reform the levels of profit, maybe he should return some of the millions he earned from the sale of his two books.
Mark