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A really Good Statement On GOP "Healthcare"

Cigar

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Dear Mom,

You won't comprehend this because you have Stage 6 Dementia, but things need to change. The nice congressmen in Washington want to free us from government dependency so we can make better healthcare choices without the stigma of taking handouts from society.

So, Mom, about your Medicaid Aged and Disabled Waiver that pays me a 40 hr/week pittance to care for you at home 24/7: the new HHS Secretary and Medicaid Chief sent our Governor a letter that says people on Medicaid should seek employment if they want to keep those benefits. This may sound unfair considering you're 89, bladder and bowel incontinent, unable to walk unassisted, and often lapse into episodes of uncontrollable whimpering, but if the government decides it's for the best, we'll all need to buck up and contribute our fair share. After all, your 50 year nursing career doesn't necessarily entitle you to a free ride.

I'll probably need to get a "real" job too, because I exploit the system. Never mind that your care would cost the state $78,000 annually in a nursing home versus the $16,000 it pays me; leave the math to those smart fellas in Washington who understand that big government should stop controlling our lives. The important thing is we'll have freedom to choose, and not impose an unfair tax burden on millionaires and the medical industrial complex.

Once I stop taking handouts, I won't be home with you. We should bolster the economy by hiring attendant care, but it costs more than I can earn, and Medicare won't cover it because those warmhearted legislators support family values like looking after our own. You'll enjoy being home alone all day, Mom. You don't really need regular meals or clean Depends, and when you have one of your falls, you can rest quietly on the floor in a puddle of urine until I get off work. Those dear congressmen give us other options, too, such as permanently placing you in a facility to die more quickly and efficiently. Here's another choice: I could stay home and attend you for free! We'll do fine on your Social Security income by sacrificing a few luxuries like groceries, property taxes, electricity, and the car.

There's a bonus, Mom. I won't be forced to maintain health insurance! Remember “Obamacare” that saved my life through early cancer screening? The Republicans devised a better plan. Because I'm over 50 and earn $150 per year above the Medicaid cutoff, my annual premium will increase by roughly $6,000, but I can choose to opt out! I'll still have "access” but not be victimized by the enslaving tax subsidy that let me afford coverage for the first time in 25 years. I'm excited about returning to indigent emergency room treatment and boosting insurance industry profits while taxpayers shoulder the cost instead.

With so many great options it's hard to decide, but here's our new plan, Mom. Under Trumpcare, I'll "choose" to lose health coverage, seek a minimum wage job, and dump you in a nursing home. Between the cost of facility care, a couple of ER visits and perhaps one minor surgery for me per year, and the food stamps and heating assistance I'll need once you and your Social Security income leave the household, I estimate we will save the government roughly NEGATIVE $350,000 over the next 5 years! Multiply that by the millions of people who will lose coverage, and you can appreciate what a sensible and economical plan the Republicans have devised.

You'll be proud to receive depersonalized institutional care instead of burdening society in comfort with your family. The facility gets your Social Security check, and Medicare/Medicaid will cover the balance until you hit the newly proposed block grant funding cap. If you're still alive then, we're unsure what will happen, but we can trust Congress to do what's right. I hear they're formulating a plan to ship the poor, elderly, and chronically ill to arctic ice floes. It's called “Trump Tower North: the Last Resort.” You might even get to see polar bears before they become extinct! Won't that be fun?

I'm so happy that the government wants to stop interfering in our lives.

Love,
Your Freeloading Daughter

P.S. Mom, if you do need a job to keep that Medicaid, I thought of a placement for someone who can't function productively, has no grasp of reality, and relies on government entitlements. 435 congressional seats will open up next year. You appear to be perfectly qualified.

Dear Mom?about your 50 year nursing career & Medicaid... Woman's post PLOWS the GOP



:cheers::bravo::good_job:
 
just to point out that in my experience.. there is a lot of abuse and abuse of seniors in the states paying family members to take care of their parents.

When these folks would be much better cared for in a nursing home... the family fights to keep them at home because they are living in that persons home.. using their money as their own.. and providing absolutely crappy care. Which is why they keep coming back to the hospital.. time and time again.. costing medicare more money...
 
just to point out that in my experience.. there is a lot of abuse and abuse of seniors in the states paying family members to take care of their parents.

When these folks would be much better cared for in a nursing home... the family fights to keep them at home because they are living in that persons home.. using their money as their own.. and providing absolutely crappy care. Which is why they keep coming back to the hospital.. time and time again.. costing medicare more money...

Any argument that has to start out, "in my experience" and is not supported by any sort of research or review is just an unsubstantiated opinion.

In my experience, those are kinda useless in a debate.
 
Any argument that has to start out, "in my experience" and is not supported by any sort of research or review is just an unsubstantiated opinion.

In my experience, those are kinda useless in a debate.

Actually all research generally starts with personal observation. that's why things like case studies etc are important to research.

but thanks for playing anyway.

Oh wait:


The Personal Care Services program, which exceeded $14.5 billion in fiscal year 2014, is rife with financial scams, some of which threaten patient safety, according to a recent report from the Office of lnspector General at the U.S. Department of Health and Human Services.
The OIG has investigated over 200 cases of fraud and abuse since 2012 in the program, which is paid for by the federal government and administered by each state. These caretakers, often untrained and largely unregulated, are paid an average of $10 per hour to help vulnerable people with daily tasks like bathing, cleaning and cooking.
The report exposes vulnerabilities in a system that more people will rely on as baby boomers age. Demand for personal care assistants is projected to grow by 26 percent over the next 10 years -- an increase of roughly half a million workers -- according to the U.S. Department of Labor

https://www.usnews.com/news/health-care-news/articles/2016-11-04/seniors-suffer-amid-widespread-fraud-by-medicaid-caretakers
 
Speaker Ryan already had a swing and a miss on repeal & replace for ACA.

Now they want a 2nd bite of the apple, the house is going for it, AGAIN.

BUT !!

McConnell's (R-KY) marauders are so skeptical about the prospect of house Republicans producing a bill that would pass a senate vote,
senate Republicans are working independently on their own Republican ACA replacement.

GOOD !!

President Trump, the blusterer in chief, wanted to do all kinds of stuff in his first hundred days.
House Republicans tried to comply, and pasted together a tax cut bill under the guise of healthcare reform.
And even if it passed the house, it would not be likely to pass in the senate.

SO !!

How is this going to end? Will ACA ever be repealed? And what after that?

And rather than reinventing the wheel, would it make more sense to find a successful model;
whether single-payer, or some European socialized medicine scheme, and transplant it here?

Or would expanding a domestic U.S. success make more sense?
Some say the VA provides a good level of healthcare at a fair per patient cost.
Might it make sense to expand VA style healthcare to our entire population, and put the final nail in the ACA coffin?
 
just to point out that in my experience.. there is a lot of abuse and abuse of seniors in the states paying family members to take care of their parents.

When these folks would be much better cared for in a nursing home... the family fights to keep them at home because they are living in that persons home.. using their money as their own.. and providing absolutely crappy care. Which is why they keep coming back to the hospital.. time and time again.. costing medicare more money...

Okay, fair enough. Family members who stay home to look after a loved one from time-to-time do tend to take advantage of the health care (Medicare) system. But guess what...so do wealthy people.

I've worked with Social Workers who were case managers for a program called the Medicaid Waiver program. This program essentially allows a private home health service to hire individuals - sometimes a patient's family member - to provide basis in-home care services to clients under the program. About the worse case of fraud I've seen occur on the side of the homecare worker or the poor family member was to claim hours worked when they really did not. As for the wealthy, they simply apply for and get approved for the waiver program when honestly they could afford to hire a full-time nurse. I don't blame them for going the cheaper route, but here's the rub: Often times these wealthy clients lie about their family member's medical situation just to get them on the program. And since the rules don't require home health service providers to obtain any medical records on their client (due to HIPAA patient privacy rules, home health servide providers are classified as "health service agents" and not "health care providers (i.e., doctors, hospitals, urgent care clinics, etc.)"), it's very easy even for sponsors of wealthy clients to lie about the overall health condition of those they apply for home health services for through Medicare (or Medicaid).

So, the cheating goes both ways. Now, maybe many of those sick, elderly individuals would be better served in a nursing home environment, but as the OP "letter" makes clear, nursing homes are very expensive. Moreover, just because such agencies claim to hire trained professionals nurses doesn't mean the elderly clients receive the best professional care. My daughter is studying to obtain her nursing degree and worked in a nursing home while completing her studies. You wouldn't believe the stories she's shared with me about what really happens in nursing homes...stories that will make you gasp and question the professionalism of such provider services.

Sometimes, family can care for their loved ones better and for far less the cost.
 
Okay, fair enough. Family members who stay home to look after a loved one from time-to-time do tend to take advantage of the health care (Medicare) system. But guess what...so do wealthy people.
.

Well.. lets start with the fact that its not the Medicare system. The medicare system does not pay for long term care.

I've worked with Social Workers who were case managers for a program called the Medicaid Waiver program. This program essentially allows a private home health service to hire individuals - sometimes a patient's family member - to provide basis in-home care services to clients under the program. About the worse case of fraud I've seen occur on the side of the homecare worker or the poor family member was to claim hours worked when they really did not. As for the wealthy, they simply apply for and get approved for the waiver program when honestly they could afford to hire a full-time nurse

Wrong.. if the person getting the long term care services has income or assets to hire a full time nurse (which would be considerable given the cost of 24 hour nursing) then they won't qualify for Medicaid.

Often times these wealthy clients lie about their family member's medical situation just to get them on the program

In general wrong.. generally to qualify for Medicaid services there has to be documentation from a healthcare provider such as a physician, therapist, Nurse practitioner etc.

it's very easy even for sponsors of wealthy clients to lie about the overall health condition of those they apply for home health services for through Medicare (or Medicaid).

Yeah that's completely false. Home health services through Medicare have to be referred and certified by a licensed physician or NP, or PA. You don't get to lie about "their overall health condition". and with Medicare they have to be continuously recertified every cert period.

Moreover, just because such agencies claim to hire trained professionals nurses doesn't mean the elderly clients receive the best professional care. My daughter is studying to obtain her nursing degree and worked in a nursing home while completing her studies. You wouldn't believe the stories she's shared with me about what really happens in nursing homes...stories that will make you gasp and question the professionalism of such provider services.

1. however unlike home care.. or even assisted livings. Nursing homes are under stringent regulation and oversight by the states and federal governments. I have had buildings in which we were put on stop admissions because we let independent residents in independent living have access to coffee from a safety dispenser... the state shut us down claiming that it was risky for patients (though they could provide no evidence or incidence in the history of the facility of this being a problem) . When we removed the dispenser from their common area and required them to come to the nursing stations or kitchen for coffee to be dispensed for them (per the state surveyors) . the state then shut us down again claiming that we failed to "provide a home like environment" for the residents .because the residents all complained about the removal of the coffee dispensers.

Under the law.. nursing homes must used licensed personnel.. certified nursing assistants, (cna's), licensed nurses.. licensed therapists, including speech, OT and PT.

In an assisted living or home care (long term) none of this certification is usually required.

Families can care for the loved ones better.. but since there is little oversight.. you don't know.
 
Well.. lets start with the fact that its not the Medicare system. The medicare system does not pay for long term care.



Wrong.. if the person getting the long term care services has income or assets to hire a full time nurse (which would be considerable given the cost of 24 hour nursing) then they won't qualify for Medicaid.



In general wrong.. generally to qualify for Medicaid services there has to be documentation from a healthcare provider such as a physician, therapist, Nurse practitioner etc.



Yeah that's completely false. Home health services through Medicare have to be referred and certified by a licensed physician or NP, or PA. You don't get to lie about "their overall health condition". and with Medicare they have to be continuously recertified every cert period.



1. however unlike home care.. or even assisted livings. Nursing homes are under stringent regulation and oversight by the states and federal governments. I have had buildings in which we were put on stop admissions because we let independent residents in independent living have access to coffee from a safety dispenser... the state shut us down claiming that it was risky for patients (though they could provide no evidence or incidence in the history of the facility of this being a problem) . When we removed the dispenser from their common area and required them to come to the nursing stations or kitchen for coffee to be dispensed for them (per the state surveyors) . the state then shut us down again claiming that we failed to "provide a home like environment" for the residents .because the residents all complained about the removal of the coffee dispensers.

Under the law.. nursing homes must used licensed personnel.. certified nursing assistants, (cna's), licensed nurses.. licensed therapists, including speech, OT and PT.

In an assisted living or home care (long term) none of this certification is usually required.

Families can care for the loved ones better.. but since there is little oversight.. you don't know.

So the solution is more oversight. In would be far more humane (and less expensive) to provide some gov't assistance in the form of daily visits from home health aids. They can assess care, as well as provide needed relief to the family care givers. Typically, people want to remain in their own homes.
 
So the solution is more oversight. In would be far more humane (and less expensive) to provide some gov't assistance in the form of daily visits from home health aids. They can assess care, as well as provide needed relief to the family care givers. Typically, people want to remain in their own homes.

The problem with more oversight is that they then find problems.. and that means that they have to fix them or send the person to assisted living or nursing home care. and there is no mechanism to force people to take better care of their parents. the only option is to remove them from the home. OR try and find someone to come and take care of them.. but if that was easy.. then there would be no need to pay family to take care of them.

So the state currently has little interest in finding problems and providing oversight.
 
The problem with more oversight is that they then find problems.. and that means that they have to fix them or send the person to assisted living or nursing home care. and there is no mechanism to force people to take better care of their parents. the only option is to remove them from the home. OR try and find someone to come and take care of them.. but if that was easy.. then there would be no need to pay family to take care of them.

So the state currently has little interest in finding problems and providing oversight.

This was the strategy used in Wales for my grandparents-in-law. The British gov't provided daily help for families who kept the disabled family member at home plus a stipend to help with costs, plus they delivered medications to the home. Seemed to work well. I am sure there are cases of neglect but neglect occurs in nursing homes,as well.
 
Well.. lets start with the fact that its not the Medicare system. The medicare system does not pay for long term care.

My mistake; I meant to say Medicaid not Medicare.

Wrong.. if the person getting the long term care services has income or assets to hire a full time nurse (which would be considerable given the cost of 24 hour nursing) then they won't qualify for Medicaid.

Of that I am aware. And in that regard I should have been more clear in my overview. There are two different programs under Medicaid that deal with care for the elderly: 1) the Elderly and Disabled Medicaid Waiver program which is what I my commentary is based on (and I apologize for not being clear about this) and 2) the Medicaid Waiver program which is the "asset draw-down" program you're referring to prior to long-term nursing home placement.

In general wrong.. generally to qualify for Medicaid services there has to be documentation from a healthcare provider such as a physician, therapist, Nurse practitioner etc.

Under the Medicaid Waiver program, you are correct. This would not apply to the E/D Medicaid Waiver program, however. Again, I should have elaborated more clearly on this.

Yeah that's completely false. Home health services through Medicare have to be referred and certified by a licensed physician or NP, or PA. You don't get to lie about "their overall health condition". and with Medicare they have to be continuously recertified every cert period.

Again, I wasn't referring to Medicare or the Medicaid Waiver program. What I stated, however, does happen quite often with wealthier clients under the E/D Medicaid Waiver program.

Families can care for the loved ones better.. but since there is little oversight.. you don't know.

Glad we could agree on something.
 
This was the strategy used in Wales for my grandparents-in-law. The British gov't provided daily help for families who kept the disabled family member at home plus a stipend to help with costs, plus they delivered medications to the home. Seemed to work well. I am sure there are cases of neglect but neglect occurs in nursing homes,as well.

Whats interesting about this.. and it happens in other countries.. is this is an example of where there is often shifting of costs from the medical costs.. to retirement costs etc.

.. I saw folks that in the states would have a total knee.. or a total hip..or would go to rehab after a hip fracture or ORIF.

In Britain and in Sweden at the time.. these folks that needed total knees or hips or rehab after hip fracture... would NOT get that care... which would make them less functional at home and the community. BUT.. the system would pay for more home care...so while they weren't as functional and living by themselves as before.. ... they also didn;t have expensive surgeries as well.

I say this because its one of the reasons that many countries have "lower health costs" than the US.. and that's for a variety of reasons.. but one of those reasons is because costs get shifted. So the cost of surgery does not get added to cost of healthcare in Britain...

but that in home invalid services.. get counted in another column.
 
Speaker Ryan already had a swing and a miss on repeal & replace for ACA.

Now they want a 2nd bite of the apple, the house is going for it, AGAIN.

BUT !!

McConnell's (R-KY) marauders are so skeptical about the prospect of house Republicans producing a bill that would pass a senate vote,
senate Republicans are working independently on their own Republican ACA replacement.

GOOD !!

President Trump, the blusterer in chief, wanted to do all kinds of stuff in his first hundred days.
House Republicans tried to comply, and pasted together a tax cut bill under the guise of healthcare reform.
And even if it passed the house, it would not be likely to pass in the senate.

SO !!

How is this going to end? Will ACA ever be repealed? And what after that?

And rather than reinventing the wheel, would it make more sense to find a successful model;
whether single-payer, or some European socialized medicine scheme, and transplant it here?

Or would expanding a domestic U.S. success make more sense?
Some say the VA provides a good level of healthcare at a fair per patient cost.
Might it make sense to expand VA style healthcare to our entire population, and put the final nail in the ACA coffin?
Based upon what the GOP has passed, the only thing they seem concerned with is cutting the ACA tax on rich people. The rest of their idea makes health insurance coverage and costs worse.
 
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