Wednesday, August 5, 2009

What's in the Bill?

Here are some things to consider about the new Health Care Reform Bill:

“Managed care as an industry has changed and evolved since its inception in the 1960s and 1970s. It began as a means to contain costs through control of access to, and frequency of, services. It has now become a premier model of the best way to deliver the correct services in the correct setting. The industry is now able to provide better care and wellness based services, using this model, by leveraging the knowledge base to negotiate more appropriate rates. It can also make use of the opportunity provided for quality management in the healthcare marketplace.”

Do you think this is from the Health Care Reform Bill? Think again. It is the Health and Human Services description of Medicaid, the model from which the Health Care Reform Bill has been created.

HHS further describes the history of Medicaid:

“Medicaid managed care grew rapidly in the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. By 2004, that number had grown to 27 million, an increase of 900%.”

This number is staggering. It is a well-documented fact that there is an enormous amount of fraud in the Medicaid system. This is a primary reason why our health care system is in the shape it is in now. It is easy to see from the 900% increase that many have seen the opportunity to defraud the government and have gotten away with it.

Yet, our government now wants the entire population to be covered under this model. Without spending the time to fix what is wrong with their current government run system, we are planning on using a broken model to care for each of us.

How does Medicaid view the treatment of breast cancer? This is important because it will be a harbinger of how the reform bill will view it. (Note that the states are given the “option” to cover treatment, depending on your type or stage of disease.)


“Breast and Cervical Cancer, Tuberculosis, and Sickle Cell Disease are grouped together in this section (Special Coverage Conditions) because they are disease specific. Breast and Cervical Cancer and Tuberculosis are optional Medicaid eligibility groups defined by disease.

The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the Center for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program and need treatment for breast or cervical cancer.”


What happens to the women who were not first screened through the CDC’s BCCPTA? We have someone on the No Surrender Message Forum who is not eligible for assistance because she was diagnosed by her private doctor instead of the CDC’s program.

In the UK, where they also have national health care, if you decide to pay for any part of your treatment yourself, they will take away your national coverage.


Do you know how Health Care Reform will affect your care? Do you think it will be you and your doctor deciding on your ultimate treatment? If you read the bill yourself you will discover that no, your doctor and you will not have the final say. Your future care is decided by the Healthcare Guidance Organization.

This is a group of people appointed to a committee to decide what kind of care you can or cannot get. This means that these folks, some doctors, some politicos, will be the ones to decide whether or not your metastatic disease has spread too far to warrant permitting you to go on that PARP trial, or if you are too old for gamma knife radiation to eradicate that bone met on your spine.

Your doctor will not be making the decisions any longer because like a Hebrew National Hotdog, he will have to answer to a “higher authority.”

This group of people are focused on keeping costs down to improve the bottom line of their budget. The focus is not on improving your quality of life or prognosis.

Which is more important to you? How well the government’s budget is doing or how well you are doing?

I have been reading this bill. If you have or had breast cancer, you should read it, too. This is not political. This is your life. We need to understand this clearly without the hype or the partisanship. If there are parts of it that you are concerned about, speak up now, before they finalize it. Our voices need to be heard because we run the very real risk of losing more sisters than we ever imagined possible.

http://www.cms.hhs.gov/MedicaidManagCare/

1 comment:

Peter913 said...

At 88 my Aunt Betty was doting. Didn't know what planet she was on. Having all the "legal" papers to proxy & Admin. to her, I asked that she be given food, water & pain killers BUT not meds to cure her pneumonia, etc. They, the panel refused!! And that's the problem. If my cancer is local, bring on the Chemo; however, if it has "traveled" to other organs then go the Betty route and make me comfortable so the circle of life can be closed. And that's why I don't want to see any 1,000 page law that gives our government permission to play God!