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ME/CFS and Beating the Clock
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What the Obama/Biden Victory Means For the Chronic Fatigue Syndrome Community

Discussion in 'Phoenix Rising Articles' started by Phoenix Rising Team, Nov 9, 2012.

  1. Cort

    Cort Phoenix Rising Founder

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    I think one reason the health insurance companies signed onto the act to the extent they did is that it does open a huge new pool of young people to them who will pay premiums and help their bottom line...

    The private companies will be in competition with the two government plans as well..Its going to be really interesting..

    Good point on Medicaid and the poorer services that may be available......I imagine that you'll be able to pick your plan if you're low income; the govt will allow you to participate in Medicaid or it will subsidize your choice of another plan.
    jeffrez likes this.
  2. Dainty

    Dainty Senior Member

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    How is it competition if the government plans are all free to the end user?

    Could you elaborate on this?
  3. taniaaust1

    taniaaust1 Senior Member

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    "Regarding Medicaid. Do you know how much doctors get paid when you visit them with this "free" system? I found out that for an hour long appointment medicaid would only pay $50 to my doctor. "

    Over here in Australia where we already have a free health medicare system.. most doctors do not do 1 hr appointments but I know my last CFS specialist appointment.. for a one and a half hr appointment, medicare paid him just over $100 (i think was ($105). I dont know whether your system is going to work the same but some of these doctors on top also charge the patient what is called here a "gap payment" .. often this is just a very small amount that most patients can afford (eg $25-$30) . He unfortunately had a gap payment of over $200 which I had to pay on top (most doctors thou dont charge like that). This doctor has a very flash house in a very flash area in which he also has his own clinic with a beautiful stream going throu the place etc etc

    Even my other CFS specialist who at times Ive had up to 3hr appointments with him.. and wasnt changing me any gap (so completely free to me) so solely relying on the medicare payment.. seemed to be doing okay money wise (had a big properly, very nice cars etc etc.). This specialist thou didnt precribe meds due to him choosing to have no insurance against someone sueing him for anything as he didnt want to pay those high costs to protect himself when he was choosing to only work part time..(so he got around that issue by doing letters to my GP and telling him what I needed to be on and asking my GP to prescribe).

    All I can say is that Ive never known a doctor here to be poor thou we have a so called free medicare system here.

    Yes doctors do charge a lot to do uni etc but they certainly do do financially MUCH BETTER then a lot of other kinds of jobs. Even at $100 for one and a half hours work to me dont sound bad at all. (When I was able to work.. all I got was under $19 per hour and that was for housecleaning and gardening work which is probably harder then sitting at a desk dealing with patients.
  4. Dreambirdie

    Dreambirdie work in progress

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    This report on the REAL NEWS explains what a single payer plan would look like in Maryland. It also goes into the huge amount of waste (in terms of money and time) that goes into insurance claim management.

    "a recent study looking at a potential single-payer or government-run health insurance plan for Maryland comes to the conclusion there'd be enormous savings over the existing plan."

    http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=8648
    Wayne likes this.
  5. Dreambirdie

    Dreambirdie work in progress

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    I really appreciate hearing about healthcare systems in Australia and Europe. It sounds to me like a much much better deal than what we have here.
  6. HowToEscape?

    HowToEscape? Senior Member

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    Nothing is going to happen unless we fight for it, and we have to make a case that appeals to people outside our circle.

    We should use case (substantial in number) of productive people who can no longer work. There are people with ME who were formerly paying substantial amounts of tax, often being W-2 in the 100-200K range, or athletes & other people who are obviously not sloths. Most people don't know or believe this is possible.

    Let's say there are 1M known to have ME in the US. For this example, let's say 2/3 are under 65 and 2/3 of those had medium skilled or better employment. Because ME is not easily diagnosed, I suspect the currently known cohort skews to the more middle and up simply because they eventually get to a doc who diagnoses ME/CFIDS. Can't prove that, it's just what I see.
    SO, that's about 1/2M who would be paying about $30K/yr each in Federal, payroll and Medicaid taxes. That does not including state and property tax. The loss of Federal tax alone is six billion dollars. The loss of productivity (total output) is likely over 50 Billion. This does not include the trickle of SSA, Medicare or Medicaid received. With better data one could deliver numbers with a firmer foundation, I believe they would also be larger.

    ------ Thus, present ME as an economic loss of >50 billion.
    Is it not worth spending 2% of that (1 B) annually to cure the disease?
    Dreambirdie likes this.
  7. HowToEscape?

    HowToEscape? Senior Member

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    Where?

    First I've _ever heard of someone with ME finding the health system works to effectively treat their disease.
  8. alex3619

    alex3619 Senior Member

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    If this data is accurate, and if it reflects on average the US situation, then projecting these savings across the USA is way over one hundred billion dollars (on the order of $166 Billion) country wide, based on basic admin savings of 3.1 billion, which is only part of it. Thats a huge impost the American public is paying under existing arrangements. Private insurance according to this has administrative costs roughly seven times what the proposed new insurance system would cost. Thats big money. On average its about $533 per person in the USA.

    In comparing a hospital in Canada with USA, of a similar size in doctors in patients, the Canadian hospital needed 2 people to handle insurance, an American hospital they compared this to needs 450. Is this efficient?

    They then go on to analyze other savings. It looks like the average saving in total per person in the USA is over $2200. That is, the insurance could be $2200 cheaper per annum and possibly $2275 per person cheaper. How is this different from paying for big government? Big insurance amplifies the costs.

    The increase in doctor availability due to simplified administration would help ease the burden on poor availability of doctors, though the increase in patients seeing doctors would probably absorb this.

    To put this in perspective though, part three will discuss increased costs. They were not addressed in this talk, this was about savings. Part 3 is here:
    http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=8670

    In Maryland, despite the savings total cost would probably be almost as high, but this would be because of everyone getting healthcare. The benefit to the economy would also make things better. Business administration costs would also decrease substantially, providing a further boost to businesses. It would also make businesses more profitable in Maryland. Reduced costs, increased health, bigger economic growth and increased business competitiveness ... its no wonder some are calling this a no brainer. However this is still all theory. In reality I think some state is going to have to do this, find out the real costs and then the country could decide.

    Here is a written article by the same guy on this topic:
    http://www.dollarsandsense.org/archives/2012/0312friedman.pdf

    On the flip side this would be a state run monopoly. Sure its efficient .. but what is next? Many other essential services are being inefficiently run by being managed by private enterprise (power companies come to mind). Others are much more efficiently run by business than government. Who gets to decide?
  9. Sing

    Sing Senior Member

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    In regard to the cost of medical services for us, having an un-treated or ineffectively treated illness for decades costs a very great deal when you count the expense of seeing doctors and other practitioners to no avail as well as the pay lost from employment. If science could come up with effective means of diagnosis then treatment for us, all this waste could finally stop. The cost of effective diagnosis and treatment would be far less, in comparison with the cost of a disabling chronic illness from time of onset to time of death, because right now the situation is known to be this: no diagnostic criteria yet agreed upon by the medical establishment, no biomarkers or tests, no treatments and no cure. To think that this "no nothing" disease is not expensive, however, is foolish. Let's estimate not only the cost of lost wages but the cost of all those medical appointments and treatments that don't work. Maybe some of us could come up with an estimate. Maybe a researcher could design another questionnaire for this purpose. That is what the government ought to put into its calculations when it weighs how much money to commit to good research, then into the institutional changes necessary in how we will be evaluated and treated.
  10. Snow Leopard

    Snow Leopard Senior Member

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    Which sounds like a catch-22. Researchers don't bother putting in applications, because there is not enough money to get enough funding (and to make a career in CFS research), when asked about the lack of funding, officials claim it is due to lack of applications.
  11. alex3619

    alex3619 Senior Member

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    I use an old figure of 20-30 billion $ for the USA, which for simplicity I call $25 billion. Since the world economy used to be roughly four times the USA, I project a world cost of $100 billion. I have long argued that its crazy to willingly lose a hundred billion per year (this includes lost productivity) and not do much about it. Its crazy politics, crazy medicine, and
    crazy economics. I put a fair research fund for CFS in the USA alone at about $120 million per year, or 20x the current rate. However I think the rest of the world should be thinking about an additional $360 million. The USA should not be one of the few countries to be paying for this.
    Sing and Sasha like this.
  12. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    Or find another profession, with less stress and a more reasonable way to make a living?

    GG
    Dainty and monobear like this.
  13. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    And some people think that Medicare is big reason costs increased so much. the more gov't subsidizes something, the more of it you get with inflation. Look at housing and education as other examples. The gov'ts fix always creates unintended consequences. People react to externalities and internal workings. therefore I doubt that gov't is the solution and this bill is already expected to cost 2 times as much as sold as, and will continue to grow. But hey, we can just print more money, and there will be no consequences, right?

    Didn't doctors actually make home visits back in the "old days"? Which I am sure our bedbound patients would like. No system is perfect, but we should probably go with the one that causes less damage.

    GG
  14. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    Do they post prices in the Netherlands? Because it is hard to find out the price here in the USA, so people cannot smartly shop around, if they have the time.

    GG

    PS Another idea would be Health Savings Accounts, where the money rolls over, so people can start saving at a young age and when they get older they have a pool of money to pull from to take care of themselves. Of course this is not helpful to young people with costly conditions, but I would think something else could be figured out.
    GracieJ likes this.
  15. Sasha

    Sasha Fine, thank you

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    That's my point, though - ME funding is so tiny compared to ME's impact on people in terms of severity and numbers that simply giving us our fair share would hugely increase the ME research funding budget, even if the NIH budget were decimated: literally decimated, cut to 10% of its current size. Cuts in the NIH budget are a complete red herring in the ME funding situation. Fair redistribution is what we need to focus on.
    ggingues likes this.
  16. Sasha

    Sasha Fine, thank you

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    That's interesting. I know pretty much zilch about the US healthcare system but in the UK, our NHS (National Health Service) is paid for through our taxes and everyone can use it, free at point of use. There is never a bill to pay and no lifestyle requirements. There's no such thing as being too poor to afford a heart bypass: if you need one, you get one (or you get on the waiting list, if there is one). There's also, in parallel, a private healthcare system in which better-off people pay health insurance or one-off fees for treatment if they don't want to wait or want an elective procedure that the NHS don't fund, but it's used by a minority (about 8%, according to Wikipedia).
    Lou, Wayne, Valentijn and 1 other person like this.
  17. Bob

    Bob

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    I might be wrong about this Dainty, but my understanding is that a big feature of the new system, is that the US government is going to negotiate to buy into two different private insurance plans itself (one of which must be run by a non-profit), which will both be available for all citizens to buy. These are not medicaid etc, but are normal insurance plans available to citizens to buy, and they will be in competition with all the usual insurance plans.

    Each state can organise this for themselves, or the federal government will provide it to any states that don't organise it.

    I might be wrong, but that's what I've read.
  18. Emma

    Emma

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    Thanks Alex, I've heard that too. But with that reasoning/excuse, they should be able to say that if they just got good enough applications, they would be willing to fund ME/CFS research at a level corresponding to, for example, that of MS, right?

    I haven't been able to watch the CFSAC meetings myself, but I read in this great report from the October meeting: http://www.masscfids.org/resource-library/15/423
    this quote:
    "When many present indicated that a major increase in funding is necessary, for example $100,000,000, Susan Maier seemed to find that totally unrealistic"

    - and yet, as Dr Grobstein points out, $250 million or even $300 million would be adequate and in line with MS research, given the double prevalence of ME/CFS compared to MS.

    It would be interesting to hear the NIH comment on what level of funding they think would be appropriate for ME/CFS. (Cort, any chance you could get an interview with Dr Maier? Or could any of you advocates who are in active dialogue with the agencies try to get through?)
    Valentijn likes this.
  19. Valentijn

    Valentijn Activity Level: 3

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    It seems like they have to have their rate listed somewhere, or maybe they just do that to advertise. There used to be a website comparing the services, but that got bought by one of the insurance companies about a year ago. But health insurance ends up in the news pretty often, so I'd guess most people know what companies are offering the lowest rates for the basic policy - as an example, my insurer and another were even in the English-language Dutch news a few days ago because they're reducing their policy rates by a few euros compared to last year: http://www.dutchnews.nl/news/archives/2012/11/cz_cuts_cost_of_basic_health_i.php

    One article also mentioned that most people (60%?) have never changed insurers during the yearly period when it's possible (November and/or December?). Prices are generally clustered pretty close together, and all at or under the maximum amount they're allowed to charge, so for the basic plan it's a matter of a few euros per month.
  20. Dreambirdie

    Dreambirdie work in progress

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    Hey Dainty--

    What Sasha said. (my bolds) This is what I was previously trying to explain to you. Now I have a concrete example. Thanks Sasha.

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