"Medicare for All" and psychiatry

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I wonder why there isn’t more emphasis on trying the low hanging fruit first. Like how so much money is spent on the last week of life. Or how ridiculous and time consuming CMS mandates are. Or how the insurance review process works. Or why the government doesn’t just make generic medications. I feel like the system could do much better with some small tweaks that don’t seem that controversial.

Yeah you know the small things. Like the government taking over and running the generic medication industry?

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I wonder why there isn’t more emphasis on trying the low hanging fruit first. Like how so much money is spent on the last week of life. Or how ridiculous and time consuming CMS mandates are. Or how the insurance review process works. Or why the government doesn’t just make generic medications. I feel like the system could do much better with some small tweaks that don’t seem that controversial.
wow, so naive. the things you mention are all extremely controversial and are not small tweaks at all with multiple special interest groups fighting tooth and nail to stop this.
1. whichever you slice it, more money is going to spent in the last week of life then at other time, for good reason. Any talk of rationing (which is essential for healthcare reform) leads to hysteria, cries of death panels, nazism, systematic genocide etc, and the rise of unlikely bedfellows of evangelical conservatives, disability rights activists, for-profit health companies, and catholics banding together. no politician is going near this with a 10 foot bargepole.
2. CMS mandates (presumably MACRA) was the result of almost 20 years of vicious fighting between physicians and the government over repeal of the SGR. without which medicare would have collapsed altogether.
3. insurance reviews exist to cut costs. the only way to alter this process would be to either dismantle health insurance companies altogether or outlaw for-profit insurance companies (most people don't realize that while medicare is "government insurance" it is privately administered by for-profit companies).
4. the government does not make generics because the pharmaceutical industry has fought all its might to prevent any such legislation from being enacted. PhARMA is one of the biggest lobbyists in washington. the ACA deliberately sidestepped the thorny problem of drug-prices because it would never have passed if it did. Obama had to promise not to negotiate drug prices to get their backing for the ACA. This is not to mention that the idea of the government interfering in industry through public ownership is not only pure-blooded socialism, but as fundamentally unamerican as you can get. many people support government generics and most people agree drug prices are too high. but congress is too entrenched in PhARMA money and socialism is still a dirty word.

so your proposals aren't "small tweaks" but radical, are highly controversial, and it would probably be easier to enact Medicare-for-all than your individual proposals, and I'm not all that confident about the chances for medicare-for-all.
 
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Like the US where many insurance plans dont pay for therapy either?
The point wasn't that we're perfect but that Canada is not the best example to use on a psychiatry subforum. But as a very simple counterpoint, it seems to me that some > none.
People are so flippant with their inability to acknowledge all the f-ups within the hospital system that could devastate a patient financially.
Me, too. It sucks. Someone billed the wrong code for the ambulance ride. It eventually got worked out, granted, after a lot of stress. Medicare is not immune from this problem. It's also not how insurance usually works.
 
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Becuz deth panelz r bad. Seriously though, US attitude towards death and end of life care is a huge problem. It's part of why my previously mentioned attendings said they'd rather be sick here than anywhere else. In Europe and Asia, if you get really sick towards end of life you're done. Apparently in the UK when a patient would go into a nursing home after a certain age that was it. Docs would come to the NH, but the residents wouldn't get admitted to a hospital. They get to die. Call it callous, but given the amount of money we spend on futile care I don't disagree with a more limiting approach. These are the kinds of policies that would have to be implemented in order to make socialized medicine work, and some of them would never be accepted by liberals or conservatives in the US.
I'm all about this, the idea that we should continue to provide state-sponsored futile care is ridiculous. People should have to pay out of pocket for such nonsense
 
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wow, so naive. the things you mention are all extremely controversial and are not small tweaks at all with multiple special interest groups fighting tooth and nail to stop this.
1. whichever you slice it, more money is going to spent in the last week of life then at other time, for good reason. Any talk of rationing (which is essential for healthcare reform) leads to hysteria, cries of death panels, nazism, systematic genocide etc, and the rise of unlikely bedfellows of evangelical conservatives, disability rights activists, for-profit health companies, and catholics banding together. no politician is going near this with a 10 foot bargepole.
2. CMS mandates (presumably MACRA) was the result of almost 20 years of vicious fighting between physicians and the government over repeal of the SGR. without which medicare would have collapsed altogether.
3. insurance reviews exist to cut costs. the only way to alter this process would be to either dismantle health insurance companies altogether or outlaw for-profit insurance companies (most people don't realize that while medicare is "government insurance" it is privately administered by for-profit companies).
4. the government does not make generics because the pharmaceutical industry has fought all its might to prevent any such legislation from being enacted. PhARMA is one of the biggest lobbyists in washington. the ACA deliberately sidestepped the thorny problem of drug-prices because it would never have passed if it did. Obama had to promise not to negotiate drug prices to get their backing for the ACA. This is not to mention that the idea of the government interfering in industry through public ownership is not only pure-blooded socialism, but as fundamentally unamerican as you can get. many people support government generics and most people agree drug prices are too high. but congress is too entrenched in PhARMA money and socialism is still a dirty word.

so your proposals aren't "small tweaks" but radical, are highly controversial, and it would probably be easier to enact Medicare-for-all than your individual proposals, and I'm not all that confident about the chances for medicare-for-all.

I stand corrected.

Re the mandates part - I’m talking about things like treatment plans and ridiculous documentation requirements that don’t help anybody.

Re insurance review - I don’t think that is as impossible as you make it seem. We have had great success in Rhode Island, for example, having insurance contracts where there is a target for average length of stay, but then no individual review of patients. It has been terrific. I think more of these types of approaches could help.

But admittedly I know nothing about agendas and implementation, etc.
 
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