You stated that capitalism enriches the few at the expense of the many. My point is that the poor (U.S.), because of capitalism have a higher standard of living than the middle class of Western Europe. The Western European system is a socialist system.
Mark
I need to remind you that when the Clinton administration tried to limit executive pay to $1 million per year, companies simply started to use stock options to compensate executives. So, what was the result of the Clinton adminstration regulations???
First, I’ve been thru PD, HD (in-center) and transplant (for which I continue to be very grateful).
All paid for by my Private Insurance. So please, let’s have a little respect.
Second: Let’s all get past the strawmen. The US has had a mixed economy for a long time. Capitalism is required. As we all know from history the rejection of capitalism for collectivism (ie command and control economies) creates horrible disasters, and yes, the politically connected do quite well for themselves, thank you…the non-politically connected do very poorly.
A friend takes Tamoxifen to reduce the chance of repeat breast cancer…again, Private insurance.
Dialysis is a big problem. Expensive…and if you increase the life-expectancy you are increasing the total costs big time. Anyone (public or private sector) is going to be looking at this as a real problem.
The best hope for kidney patients is to have a robust healthcare system, with lots of research…and maybe someday even transplantable autologous organs.
http://www.tengion.com/index.cfm
But here’s their investor list…Warning…don’t look if you hate venture capitalists
[QUOTE=Unregistered;17943]First, I’ve been thru PD, HD (in-center) and transplant (for which I continue to be very grateful).
All paid for by my Private Insurance. So please, let’s have a little respect.
Second: Let’s all get past the strawmen. The US has had a mixed economy for a long time. Capitalism is required. As we all know from history the rejection of capitalism for collectivism (ie command and control economies) creates horrible disasters, and yes, the politically connected do quite well for themselves, thank you…the non-politically connected do very poorly.
A friend takes Tamoxifen to reduce the chance of repeat breast cancer…again, Private insurance.
Dialysis is a big problem. Expensive…and if you increase the life-expectancy you are increasing the total costs big time. Anyone (public or private sector) is going to be looking at this as a real problem.
The best hope for kidney patients is to have a robust healthcare system, with lots of research…and maybe someday even transplantable autologous organs.
http://www.tengion.com/index.cfm
But here’s their investor list…Warning…don’t look if you hate venture capitalists
http://www.tengion.com/about/investors.cfm[/QUOTE]
Excellent post. Costs for dialysis would be greatly reduced by full Nocturnal Home Dialysis.
Mark
Costs for dialysis incurred by dialysis clinics that provide nocturnal home dialysis more than 3 times a week are higher according to all who provide more frequent dialysis. Costs are lower for drugs and hospitalizations and with fewer hospitalizations and hospital days per year, dialysis clinics keep revenues that would have gone to hospitals. As has been posted before, Medicare A/B divide doesn’t allow cost savings in one part (A) to count toward higher costs in another part (B) so Medicare is still waiting for an NIH study to prove what small studies have reported in multiple clinics in the U.S. and overseas. Private insurance companies should see the light with this since all monies come from the same pot, but some still deny coverage for more frequent daily or nocturnal dialysis and some refuse to pay for home training or home dialysis at all. Over the years, I’ve been involved in several advocacy efforts to get insurance companies to pay for home dialysis services.
I’ve heard some who believe that if the bundle of services that dialysis clinics receive includes drugs as it likely will, this may encourage more clinics to offer more frequent treatments even if they cost more to save money on drugs. In the past, dialysis facilities were paid more for providing more drugs and higher doses of drugs because they were separately billable to Medicare (and insurance companies). This had the effect of reducing some providers’ interest in offering home dialysis because patients on home dialysis almost uniformly use fewer drugs. Other providers offered these treatments because they recognized the benefits to patients’ quality of life by doing so.
[QUOTE=Beth Witten MSW ACSW;17950]Costs for dialysis incurred by dialysis clinics that provide nocturnal home dialysis more than 3 times a week are higher according to all who provide more frequent dialysis. Costs are lower for drugs and hospitalizations and with fewer hospitalizations and hospital days per year, dialysis clinics keep revenues that would have gone to hospitals. As has been posted before, Medicare A/B divide doesn’t allow cost savings in one part (A) to count toward higher costs in another part (B) so Medicare is still waiting for an NIH study to prove what small studies have reported in multiple clinics in the U.S. and overseas. Private insurance companies should see the light with this since all monies come from the same pot, but some still deny coverage for more frequent daily or nocturnal dialysis and some refuse to pay for home training or home dialysis at all. Over the years, I’ve been involved in several advocacy efforts to get insurance companies to pay for home dialysis services.
I’ve heard some who believe that if the bundle of services that dialysis clinics receive includes drugs as it likely will, this may encourage more clinics to offer more frequent treatments even if they cost more to save money on drugs. In the past, dialysis facilities were paid more for providing more drugs and higher doses of drugs because they were separately billable to Medicare (and insurance companies). This had the effect of reducing some providers’ interest in offering home dialysis because patients on home dialysis almost uniformly use fewer drugs. Other providers offered these treatments because they recognized the benefits to patients’ quality of life by doing so.[/QUOTE]
Professor of Nephrology John Agar and Director of Barwon Dialysis Clinics:
http://www.nocturnaldialysis.org/bang3.htm Australia
“We have compared the costs generated by our 8hrs/night, 6 night/week nocturnal home haemodialysis (NHHD) program (10 patients) with those of our largest satellite centre operating conventional outpatient ~4hrs/dialysis 3 days per week (sCHD) over a complete 12 month period (July 1st 2002 –June 30th 2003). This data was only collected on patients who completed a full year in either cost centre.”
Nursing
105.34 Satellite costs
28.42 Nocturnal Home Dialysis
Food
1.11 Satellite costs
0 Nocturnal Home Dialysis
Energy
5.00 Satellite costs
0 Nocturnal Home Dialysis
Domestic
3.44 Satellite costs
0 Nocturnal Home Dialysis
Adminstration
2.47 Satellite costs
0.65 Nocturnal Home Dialysis
Maintenance
3.66 for Satellite costs
5.55 for Home Nocturnal Dialysis
Pharmacy
9.34 Satellite costs
4.34 Home Nocturnal dialysis
Consumables
69.90 Satellite costs
57.90 Home Nocturnal dialysis
Cost/Treatment
200.35 Satellite
96.86 Home Nocturnal Dialysis
Cost per week for Treaments
601.05 Satellite
581.16 Home Nocturnal Dialysis
The vast majority of insurance companies have realized that Nocturnal Home Dialysis is much cheaper than In-Center Dialysis.
Those figures are from Australia, Mark, which has a different healthcare system, so they’re not necessarily apples to apples.
We’re not disputing that nocturnal is cheaper–IF the entire costs of care (including hospitalization) are counted. Unfortunately, Medicare doesn’t allow that calculation. Some systems like Kaiser Permanente in Southern California, that get a capitated fee for ALL of each patient’s costs of care, have found significantly lower hospitalization costs with more dialysis. They care, because they get one fee to cover everything. Medicare is screwy in that regard.
[QUOTE=Dori Schatell;17959]Those figures are from Australia, Mark, which has a different healthcare system, so they’re not necessarily apples to apples.
We’re not disputing that nocturnal is cheaper–IF the entire costs of care (including hospitalization) are counted. Unfortunately, Medicare doesn’t allow that calculation. Some systems like Kaiser Permanente in Southern California, that get a capitated fee for ALL of each patient’s costs of care, have found significantly lower hospitalization costs with more dialysis. They care, because they get one fee to cover everything. Medicare is screwy in that regard.[/QUOTE]
You are correct, Home Nocturnal Patients spend two days per year in the hospital. In-Center patients spend 17 days per year in the hospital, per UCLA Nephrology. You are right, Medicare is SCREWY, we agree. Now, are these the same people you want running the health care system? Name three things that the Federal Government does well on a regular basis? I know that we would find Home Nocturnal Dialysis cheaper in the United States than In-Center dialysis. The Canadian Government has figured out that they would save $45,000 in the first year of Nocturnal dialysis and $25,000 in the following years.
Mark
You mean to say that Kaiser Permanente serves the health care consumer in a better way than Medicare? I wonder where I had heard that before now.
Medicare definitely has a fundamental flaw right now–the Part A/Part B “wall,” but that could be fixed if Congress chose to change it. If that wall was removed, it would align the incentives to keep people healthy and out of the hospital. (The issue is how to deal with the premiums and copays. Part A is free; Part B has a premium…)
We are certainly in complete agreement that nocturnal is far superior in costs and outcomes to standard HD.
[QUOTE=Dori Schatell;17965]Medicare definitely has a fundamental flaw right now–the Part A/Part B “wall,” but that could be fixed if Congress chose to change it. If that wall was removed, it would align the incentives to keep people healthy and out of the hospital. (The issue is how to deal with the premiums and copays. Part A is free; Part B has a premium…)
We are certainly in complete agreement that nocturnal is far superior in costs and outcomes to standard HD.[/QUOTE]
“Congress passed Medicare in 1965. In the 20 years before the program’s inception, the cost of a day in a hospital increased threefold. In the 20 years following Medicare, a day in a hospital increased eightfold – substantially higher than inflation over that period. Because of cost controls on government plans, providers increased the cost on everybody else.”
By Freya J. Silverstein, MD
Imagine an in-center hemodialysis program that doesn’t intrude on your daily schedule, delivers better results and makes you feel better than conventional dialysis. That’s nocturnal dialysis. In-center nocturnal dialysis replaces the familiar three-hour daytime sessions, three times a week, with three dialysize-while-you-sleep nighttime sessions.
Sound good? As a Canadian patient of mine once said, “Conventional hemodialysis is like riding a Volkswagen on a dirt road. Nocturnal hemodialysis is like riding a Rolls Royce on a freshly paved surface.” Launched in Canada in the 1990s to improve dialysis outcomes and reduce costs, the first nocturnal hemodialysis regimens were home-based. The first U.S. home programs in
Virginia and New York were so successful that Fresenius Medical Care initiated nocturnal hemodialysis in the United States on an in-center basis, so that more patients could have access to this service.
I can’t take this any longer. Mark, with logic like this – you win! Game over! Let’s talk about other things.
I will do anything to protect high quality care for dialysis patients and individuals who are truly sick. Yes, I agree, now, let us work for that high quality care for dialysis patients and great savings for the most generous taxpayer in the world, the U.S. taxpayer.
Mark
I’ve read part (ok, small part) of the Kennedy healthcare act. Looks like he wants a Medical Home for everyone…I don’t know if Nephrologists would count for a primary care dr., or how much freedom they would have, or if you constantly have to go back “home”. I think Medicare does not require that (unless you have one of the HMOs)
As someone who had to re-enter the hospital shortly after my transplant, the language about reducing/preventing re-admissions leaves me a little worried. Drs. might wind up having to second guess themselves if their is the government looking over your shoulder counting readmissions.
For those who are interested…happy reading!
Check out this article.
A Health Insurance Insider Blows the Whistle on the Industry’s Abusive Practices | OurFuture.org
Source: www.ourfuture.org