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	<title>Comments on: Healthcare Update &#8212; 03-25-2010</title>
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	<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/</link>
	<description>A blog from inside the emergency department</description>
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		<title>By: SeaSpray</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18647</link>
		<dc:creator>SeaSpray</dc:creator>
		<pubDate>Thu, 01 Apr 2010 08:08:06 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18647</guid>
		<description><![CDATA[Chelsea ..it is *not selfish* to believe you should be able to keep the insurance you have worked for and had access to all these years and then feel angry because you could lose it because this administration enacted a HC bill that the majority of the people did not want... because we all could see it had flaws and expenses tied to it in pork pay outs, etc.  It was WRONG the way they did this.It is wrong on so many levels.  Most Americans feel this way.

I do believe we should help the poor. And this country does do a lot to help the poor. We always should.

By financially strapped ..I mean we are paying our bills ..sometimes juggling and not a lot of room for extras at this time. But our ins premiums are automatically deducted from husband&#039;s pay and we would pay our insurance before breakfast.  Not an option ..it is a necessity.  We are not financially strapped because of our insurance premiums. More like the high energy bills (oil,electric and gasoline) and and whatever. And even with insurance ..medical bills. 

But hearing how these premiums are escalating even now, hearing some people are already having to leave *their* doctors because they couldn&#039;t afford the increasing premiums and switched to an HMO that *their* physician does not participate with.  I watched Obama when he adamantly stated that people will not lose their doctors. And yet it is happening. How he can make blanket statements like that without knowing what is in the bill is beyond me. ?  When a patient bonds and trusts a doc and they are familiar with the patient and their med hx ..it is a loss to lose that care.

Regarding &quot;Cadillac&quot; plans, I believe the criteria for that is if it also has an eye plan, dental plan ..that kind of thing. I just consider that an insurance plan ..period. We&#039;ve always had that and thought that was built into most plans.

You are right ..there are people who can&#039;t get those things ..that don&#039;t have insurance. One night at work ..I saw a patient sign himself out ama because he didn&#039;t want to be admitted over night for observation because he wasn&#039;t insured. That is sad.  And he worked but, no insurance. 

But the last stats I heard were that 75% of Americans ARE insured. And so is it fair to now make it more expensive for them and cause their care to be compromised in the future?  

How do two wrongs make a right?

Again ..I am not saying things did not have to be fixed.  There are some good things in the bill.  We should help our poor.

BUT...they should have looked at what they *COULD* fix or do away with systematically ..and not throw the baby out with the bath water.  There are good things in the bill. I wrote more about this in the post put up after this.

Why couldn&#039;t they just enact separate smaller bill that said people stating pre-existing conditions don&#039;t matter, college kids can stay on parents ins,etc. And why couldn&#039;t they encourage free enterprise by opening state borders for product competition for lower premiums and quality of care?  Why didn&#039;t they write tort reform into the bill? Why didn&#039;t they go after tort reform anyway ..before the bill?  And I will ask that about republicans too?  Why didn&#039;t they do something about it?

And as WC pointed out ..having insurance ..does not guarantee access.

WC ..delete any of these things I&#039;ve written if you wish. Repetitive Novellas.  :)]]></description>
		<content:encoded><![CDATA[<p>Chelsea ..it is *not selfish* to believe you should be able to keep the insurance you have worked for and had access to all these years and then feel angry because you could lose it because this administration enacted a HC bill that the majority of the people did not want&#8230; because we all could see it had flaws and expenses tied to it in pork pay outs, etc.  It was WRONG the way they did this.It is wrong on so many levels.  Most Americans feel this way.</p>
<p>I do believe we should help the poor. And this country does do a lot to help the poor. We always should.</p>
<p>By financially strapped ..I mean we are paying our bills ..sometimes juggling and not a lot of room for extras at this time. But our ins premiums are automatically deducted from husband&#8217;s pay and we would pay our insurance before breakfast.  Not an option ..it is a necessity.  We are not financially strapped because of our insurance premiums. More like the high energy bills (oil,electric and gasoline) and and whatever. And even with insurance ..medical bills. </p>
<p>But hearing how these premiums are escalating even now, hearing some people are already having to leave *their* doctors because they couldn&#8217;t afford the increasing premiums and switched to an HMO that *their* physician does not participate with.  I watched Obama when he adamantly stated that people will not lose their doctors. And yet it is happening. How he can make blanket statements like that without knowing what is in the bill is beyond me. ?  When a patient bonds and trusts a doc and they are familiar with the patient and their med hx ..it is a loss to lose that care.</p>
<p>Regarding &#8220;Cadillac&#8221; plans, I believe the criteria for that is if it also has an eye plan, dental plan ..that kind of thing. I just consider that an insurance plan ..period. We&#8217;ve always had that and thought that was built into most plans.</p>
<p>You are right ..there are people who can&#8217;t get those things ..that don&#8217;t have insurance. One night at work ..I saw a patient sign himself out ama because he didn&#8217;t want to be admitted over night for observation because he wasn&#8217;t insured. That is sad.  And he worked but, no insurance. </p>
<p>But the last stats I heard were that 75% of Americans ARE insured. And so is it fair to now make it more expensive for them and cause their care to be compromised in the future?  </p>
<p>How do two wrongs make a right?</p>
<p>Again ..I am not saying things did not have to be fixed.  There are some good things in the bill.  We should help our poor.</p>
<p>BUT&#8230;they should have looked at what they *COULD* fix or do away with systematically ..and not throw the baby out with the bath water.  There are good things in the bill. I wrote more about this in the post put up after this.</p>
<p>Why couldn&#8217;t they just enact separate smaller bill that said people stating pre-existing conditions don&#8217;t matter, college kids can stay on parents ins,etc. And why couldn&#8217;t they encourage free enterprise by opening state borders for product competition for lower premiums and quality of care?  Why didn&#8217;t they write tort reform into the bill? Why didn&#8217;t they go after tort reform anyway ..before the bill?  And I will ask that about republicans too?  Why didn&#8217;t they do something about it?</p>
<p>And as WC pointed out ..having insurance ..does not guarantee access.</p>
<p>WC ..delete any of these things I&#8217;ve written if you wish. Repetitive Novellas.  <img src='http://www.epmonthly.com/whitecoat/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' /> </p>
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		<title>By: Chelsea</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18644</link>
		<dc:creator>Chelsea</dc:creator>
		<pubDate>Thu, 01 Apr 2010 07:01:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18644</guid>
		<description><![CDATA[SeaSpray, if you are financially strapped already, then how affordable is your insurance, really?  There is plenty of rationing here in the US already - just based on finances. Plenty of people work just as hard as your husband but cannot affort insurance, or afford cadillac plans etc. Or can&#039;t get group insurance and are turned down for preexisting conditions.  Even more who did have insurance have now lost it due to the economy. You are very lucky to have what you have and I can understand at being upset that it&#039;s going to change. But it&#039;s a selfish view. It&#039;s amazing how much aide we can provide to other countries in times of crisis, or how much we all can spend on lottery tickets. But we refuse to take care of our own people first. We refuse to see them at all.]]></description>
		<content:encoded><![CDATA[<p>SeaSpray, if you are financially strapped already, then how affordable is your insurance, really?  There is plenty of rationing here in the US already &#8211; just based on finances. Plenty of people work just as hard as your husband but cannot affort insurance, or afford cadillac plans etc. Or can&#8217;t get group insurance and are turned down for preexisting conditions.  Even more who did have insurance have now lost it due to the economy. You are very lucky to have what you have and I can understand at being upset that it&#8217;s going to change. But it&#8217;s a selfish view. It&#8217;s amazing how much aide we can provide to other countries in times of crisis, or how much we all can spend on lottery tickets. But we refuse to take care of our own people first. We refuse to see them at all.</p>
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		<title>By: SeaSpray</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18643</link>
		<dc:creator>SeaSpray</dc:creator>
		<pubDate>Thu, 01 Apr 2010 06:44:32 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18643</guid>
		<description><![CDATA[And I am really angry that we have a quality PPO insurance ..that is affordable and they approved whatever I needed and now the premiums will go up.  And on top of the premiums going up they government will tax the quality (Cadillac) plans 40%.

  FORTY PERCENT!!!  (Except the favored union is exempt from it)

My husband has worked hard all these years and like many Americans we are already financially strapped. I do not want to have to give up this insurance.  I am livid. Seriously!]]></description>
		<content:encoded><![CDATA[<p>And I am really angry that we have a quality PPO insurance ..that is affordable and they approved whatever I needed and now the premiums will go up.  And on top of the premiums going up they government will tax the quality (Cadillac) plans 40%.</p>
<p>  FORTY PERCENT!!!  (Except the favored union is exempt from it)</p>
<p>My husband has worked hard all these years and like many Americans we are already financially strapped. I do not want to have to give up this insurance.  I am livid. Seriously!</p>
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		<title>By: SeaSpray</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18641</link>
		<dc:creator>SeaSpray</dc:creator>
		<pubDate>Thu, 01 Apr 2010 06:39:29 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18641</guid>
		<description><![CDATA[In the biz - I said &quot;When a person has pain day and night ..every time they rise up or sit down ..with every step they take ..which exacerbates to 10 pain the longer they are weight bearing ..and NSAIDS no longer help or they can;t take them for some reason ..that kind of pain is emergent to a person waiting for reconstructive knee surgery. It is not life and death ..but quality of life is diminished because they can’t get out there and do all they would normally do.&quot;

My point was not to say it is emergent as something life threatening ..but that to the person in pain ..in that kind of pain it *feels* emergent to them. 

We have always been able to schedule and get the surgeries we need in a timely fashion in this country. I loathe the idea that we may end up rationed and waiting for tests and procedures that we could always have when we were ready to schedule. I am extremely upset that we could end up with an inferior medical system in which we are denied prompt access to care or possibly denied altogether because of signing this debacle of a HC bill into effect.  They did not read it. They do not understand it ..because they did not read it and because they did not read it, thus don&#039;t understand it they also don&#039;t know the long term effects of this bill and it is wrong that our availability of medical care should be compromised in anyway.

I cannot believe the things I am hearing about regarding what will be the new HC over time in this country. 

I&#039;m not sure what you mean about the gathering data and so perhaps I missed part of that story?

But, I think the death panels are based on how Greece and Europe allocate care.

I have read in medblogs where medical professionals do think we waste billions of dollars in keeping people alive on machines, etc, that do not and will not have any quality of life and would&#039;ve died of natural causes ..old age, etc.  I understand that.

I read a comment by a doc from Greece last year who said that they do not spend money on keeping people alive who are severely injured or elderly and the prognosis is bleak, because the government does not have the money for that. I England ..there are women who have breast cancer, but not allowed to have certain drugs because they are too expensive and they die.  maybe they would have ..but maybe not.  Also, and I don&#039;t recall the country ..but people can be diagnosed with colon cancer but then have to wait to have the surgery..cancer spreads and they die. In US, patients can get in quickly.  Not wait 6 months.

And is is foreseeable that for the sake of budget ..people empowered to make decisions to approve of expensive treatments will weed people based on certain criteria, age, preexisting conditions, etc., and one just has to hope they make the grade for approval. Subjective thoughts at this point .. but as WC pointed out ..having insurance with this plan does NOT mean one will have ACCESS to medical care and if they do ..it may not be QUALITY care.

This is so disturbing and surreal ..I can hardly believe this has happened.]]></description>
		<content:encoded><![CDATA[<p>In the biz &#8211; I said &#8220;When a person has pain day and night ..every time they rise up or sit down ..with every step they take ..which exacerbates to 10 pain the longer they are weight bearing ..and NSAIDS no longer help or they can;t take them for some reason ..that kind of pain is emergent to a person waiting for reconstructive knee surgery. It is not life and death ..but quality of life is diminished because they can’t get out there and do all they would normally do.&#8221;</p>
<p>My point was not to say it is emergent as something life threatening ..but that to the person in pain ..in that kind of pain it *feels* emergent to them. </p>
<p>We have always been able to schedule and get the surgeries we need in a timely fashion in this country. I loathe the idea that we may end up rationed and waiting for tests and procedures that we could always have when we were ready to schedule. I am extremely upset that we could end up with an inferior medical system in which we are denied prompt access to care or possibly denied altogether because of signing this debacle of a HC bill into effect.  They did not read it. They do not understand it ..because they did not read it and because they did not read it, thus don&#8217;t understand it they also don&#8217;t know the long term effects of this bill and it is wrong that our availability of medical care should be compromised in anyway.</p>
<p>I cannot believe the things I am hearing about regarding what will be the new HC over time in this country. </p>
<p>I&#8217;m not sure what you mean about the gathering data and so perhaps I missed part of that story?</p>
<p>But, I think the death panels are based on how Greece and Europe allocate care.</p>
<p>I have read in medblogs where medical professionals do think we waste billions of dollars in keeping people alive on machines, etc, that do not and will not have any quality of life and would&#8217;ve died of natural causes ..old age, etc.  I understand that.</p>
<p>I read a comment by a doc from Greece last year who said that they do not spend money on keeping people alive who are severely injured or elderly and the prognosis is bleak, because the government does not have the money for that. I England ..there are women who have breast cancer, but not allowed to have certain drugs because they are too expensive and they die.  maybe they would have ..but maybe not.  Also, and I don&#8217;t recall the country ..but people can be diagnosed with colon cancer but then have to wait to have the surgery..cancer spreads and they die. In US, patients can get in quickly.  Not wait 6 months.</p>
<p>And is is foreseeable that for the sake of budget ..people empowered to make decisions to approve of expensive treatments will weed people based on certain criteria, age, preexisting conditions, etc., and one just has to hope they make the grade for approval. Subjective thoughts at this point .. but as WC pointed out ..having insurance with this plan does NOT mean one will have ACCESS to medical care and if they do ..it may not be QUALITY care.</p>
<p>This is so disturbing and surreal ..I can hardly believe this has happened.</p>
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		<title>By: Matt</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18549</link>
		<dc:creator>Matt</dc:creator>
		<pubDate>Mon, 29 Mar 2010 20:06:27 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18549</guid>
		<description><![CDATA[Because there aren&#039;t enough facts presented.]]></description>
		<content:encoded><![CDATA[<p>Because there aren&#8217;t enough facts presented.</p>
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		<title>By: DensityDuck</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18541</link>
		<dc:creator>DensityDuck</dc:creator>
		<pubDate>Mon, 29 Mar 2010 17:39:47 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18541</guid>
		<description><![CDATA[The WHO has a definition of a dead baby, and it has a different definition of a live baby, and these two definitions do not overlap.  European doctors will often declare a fetus &quot;nonviable&quot;, which means &quot;born alive but no chance to survive&quot;.  American doctors won&#039;t do that--if the kid comes out alive then the Full Weight Of Modern Medical Science is applied, even for twenty-week preemies who don&#039;t even have lungs yet.

The catch is that European doctors don&#039;t report nonviable fetuses as dead babies, but American doctors do.]]></description>
		<content:encoded><![CDATA[<p>The WHO has a definition of a dead baby, and it has a different definition of a live baby, and these two definitions do not overlap.  European doctors will often declare a fetus &#8220;nonviable&#8221;, which means &#8220;born alive but no chance to survive&#8221;.  American doctors won&#8217;t do that&#8211;if the kid comes out alive then the Full Weight Of Modern Medical Science is applied, even for twenty-week preemies who don&#8217;t even have lungs yet.</p>
<p>The catch is that European doctors don&#8217;t report nonviable fetuses as dead babies, but American doctors do.</p>
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		<title>By: Inthebiz</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18540</link>
		<dc:creator>Inthebiz</dc:creator>
		<pubDate>Mon, 29 Mar 2010 16:51:56 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18540</guid>
		<description><![CDATA[Seaspray, I don&#039;t discount the pain, but it is not, all of a sudden, an emergency.  It is a farily predictable progression.  
And as far as those who say we didn&#039;t even try to keep the parts that work, I am not so sure.  How did ideas about gathering data and finding out what works get turned into death panels?]]></description>
		<content:encoded><![CDATA[<p>Seaspray, I don&#8217;t discount the pain, but it is not, all of a sudden, an emergency.  It is a farily predictable progression.<br />
And as far as those who say we didn&#8217;t even try to keep the parts that work, I am not so sure.  How did ideas about gathering data and finding out what works get turned into death panels?</p>
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		<title>By: Matt</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18535</link>
		<dc:creator>Matt</dc:creator>
		<pubDate>Mon, 29 Mar 2010 14:20:16 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18535</guid>
		<description><![CDATA[You don&#039;t have to believe me.  I can&#039;t give you any more details anyway due to privilege.]]></description>
		<content:encoded><![CDATA[<p>You don&#8217;t have to believe me.  I can&#8217;t give you any more details anyway due to privilege.</p>
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		<title>By: Katherine</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18525</link>
		<dc:creator>Katherine</dc:creator>
		<pubDate>Mon, 29 Mar 2010 01:09:20 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18525</guid>
		<description><![CDATA[Really? I&#039;ve never seen a definition either way.]]></description>
		<content:encoded><![CDATA[<p>Really? I&#8217;ve never seen a definition either way.</p>
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		<title>By: Katherine</title>
		<link>http://www.epmonthly.com/whitecoat/2010/03/healthcare-update-03-25-2010/#comment-18523</link>
		<dc:creator>Katherine</dc:creator>
		<pubDate>Sun, 28 Mar 2010 23:57:20 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4598#comment-18523</guid>
		<description><![CDATA[Rape is not your metaphor.]]></description>
		<content:encoded><![CDATA[<p>Rape is not your metaphor.</p>
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