What does anyone here think about the health care discussions happening behind closed doors?

It's despicable.

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The political system is broke and it's a joke.

I thought Pres. Obama said his Administration would be "open" or something like that?

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Doing the right thing isn't always the same as doing the easy thing.

Actually, he said if he was elected the discussions would occur on C-Span.

One thing I question is if he was in a position to make that 'promise' on the campaign trail. He is the executive branch. Can he dictate how the legislative branch chooses to conduct themselves?

I think they should be embarrassed for taking it behind closed doors myself.

It should be against the law it affects every single one of us. My Mom thinks it's behind closed doors because he's extorting them for their yes votes.

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The political system is broke and it's a joke.

I believe that is part of the "chicago" style of politics!

If there wasn't something to hide, then they wouldn't do it behind closed doors!

Ridiculous, but not surprising. It is sad when the people we elected are allowed to get away with it. (Although I did not elect him)

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Check out my homepage http://julie.mycoupons.com/

AHHHHH... I do think it is interesting how those who were such strong Obama supporters are seeing his true colors.....

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Be careful what you wish for.....

Obama needs to shovel some snow!

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Ya know... I have to wonder if he truly had a "Mr. Smith goes to the White House" vision of his presidency, or if all along he planned to make this such a closed, secret process.

Hearing him in those old clips from the campaign trail, well... he sounds so... almost naive and innocent about the way things seem to transpire in Washington. He seemed to have this vision that it would all be so nicey-nice, with people sitting around a table with the C-Span cameras rolling and congressmen making concessions and negotiating and feeling all warm and fuzzy as they behaved with grace and love.

Surely he had to know it would never be as simple as all that.

"he sounds so... almost naive and innocent " Ummm no I would say he is a GOOD.. no a GREAT bull****ter...

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Be careful what you wish for.....

Right... which is why I said "sounds". :-)

I have to agree with this. Especially since he came out of Chicago, and that whole "political machine" thing or whatever they have going on up there. It's sad. Really and truly. Are there no honest political figures in this country. I'm having serious doubts about people in general.

Just a bad day for me, so don't mind my ramblings

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Doing the right thing isn't always the same as doing the easy thing.

Yep.

YouTube - obama C span

I heard last night that Cspan is not too happy with the White House either as I'm sure they were excited about Obama's promises.

Obama is part of the executive branch. He has the option of vetoing or signing legislation into law. That is his only role. I never heard him make any promises on behalf of Congress.

Now, the actual reason that they're doing this behind closed doors is so that they can debate the actual issues. With cameras present, there would be the same old theatrics with falsehoods about death panels and whatever else the GOP wants to throw out there.

This is important business. It's important that things be done right. As far as CSPAN goes, they know how Washington works and being upset with the White House for something that Congress has done might be something that you hear on Fox news, but, it isn't true.

What a wonderful job you have all done in heaping the blame on the wrong person. Go Fox!

Oh, my.

Did you even watch the youtube link?

They aren't in hiding because it's too important for Americans to know. In fact, even the very thought of that is anti-American. It's supposed to be all about WE the people. This is not a matter of national security.

I'll tell you why they are doing this behind closed doors. It's because they're porking it up to keep as many votes on board as possible. It has NOTHING to do with the super-sincerity of the politicians. Does the name Ben Nelson ring a bell?

Both sides of the aisle are not represented in that closed room.

Again, I ask: Did you watch the clip? It's Barak, in his own words, describing how he wants all sides to be represented and for it to be an open debate for everyone to hear.

Double dog dare you to listen to him.

ETA: I've found it puzzling that Obama made those statements because he has no authority over congress and their processes. However, read the quote below and please tell me exactly when HE has facilitated these 'negotiations' he speaks of as the EXECUTIVE branch. WHEN does 'negotiating' take place in this process? Certainly not between the time both sides of the house approve the same bill and send it on up to him. At that point, it's sign it or return it. So WHEN is this promise of his to take place?

It's almost like he really didn't have a grasp on how things are "supposed" to work exactly.

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Melissa

I've know of some awesome river view properties you might be interested in buying.......lol

YouTube - IF AIR TRAVEL WORKED LIKE HEALTH CARE

But... what do you think about the closed nature of the discussions?

Just another broken promise.

Doesn't bother me one bit. Between a straight party vote and all the summer hysteria about death panels and such, it is quite obvious no civil discussion will occur. I want basic changes started and if this is what is required to get there - so be it.

If you care, read a book called "Best Care Anywhere: Why VA Health Care is Better Than Yours."

I really can't get involved any further in this discussion. Have fun though.

How many "closed-door" discussions have other administrations had?
I think it's just part and parcel of politics.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

I agree it does not bother me one bit and I am still for Obama and know I made the correct choice in voting him into office. Peace. Catherine

It's necessary. I have already explained why.

Republicans have chosen to exclude themselves from having any influence in this legislation. They chose to stand up repeating faricated "facts". They'll do that whenever there's a camera turned on.

We the people chose a republic instead of a democracy.

Obama has had input but will not be part of the final negotiations unless called upon by Pelosi or Reid.

If we got rid of the Senate, we would better resemble a Democracy.

True EXCEPT for all the specfic promises Obama made about this very topic, over and over again. He was supposed to "change" things and this is one of the very specific things he promised to do.

I don't have a problem with the closed door discussions, I understand it. But Promising that it would be on C-Span was a bad move. He should have know specific promises like that would come back to bite him in the butt.

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Once the game is over, the king and the pawn go back in the same box.

Read my lips!

This will be his downfall. The desk will lose control sooner than they ever imagined.

You "believe" it's necessary, and offered "your" explanation. It doesn't make it true.

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Melissa

Oooooooooo. No, we sure don't want anyone with a dissenting voice that we can bribe to be heard. Dissent is just such an annoyance.

He's
Going
Down
Come the next election. Congress will soon be red. Mark my words!

To wowitsdark he is going down mark my words, he still has 3 years to fix the mess ex President Bush and his cohort Dick Cheney left our country in and if he President Obama does not get relected which Bush should never ever have been elected a second term bad bad bad mistake . Then who do you think will do a better job and do you honestly feel who ever is elected after the next 3 years when his term is over do you think that person will still be better and fix the mess???. Peace. Catherine

I don't need to read a book, I live it on a daily basis. While I do agree, many aspects of VA Health Care (and by that I mean, all military health care.....HA, just try getting seen for something at a VA Clinic) are "good", I would not say it is better than everyone else's health care. I've been trying to get an eye exam for my kids since November.

I do agree SOMETHING needs to get done.

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Doing the right thing isn't always the same as doing the easy thing.

Public service announcement for those who are unaware:

The VA is not the DoD. Children (except in extremely rare circumstances) would not qualify for Veteran's benefits.

For starters, to be under VA health care, it isn't automatic. Some of our vets spend YEARS trying to navigate the system both to become qualified, and, to secure appointments. Many die before achieving (for lack of a better word) that status. I say achieving because VA health care should be theirs, it shouldn't be a fight and a hassle.

It is a fact that many were turned down automatically because of the sheer numbers overwhelming the system....with hope they'd go away and not come back. These are veterans who may or may not have retired from the military, but have an honorable discharge. Generally, their health situation is what qualifies them.

Children do qualify for veteran's benefits of the service member who could be active duty, or retired. Depending on location and medical situation, they could be seen on or off base, but not at a true VA hospital.

We, as a nation, do not take proper care of our veterans.

dl

As a veteran, one of the benefits my DH receives is health care coverage (Tri Care) for himself and his family. He, as the Veteran, can be seen for certain things in the VA Clinic. Otherwise, he has to go to his PCM (Primary Care Manager) just like we do.

When I made my statement, I basically lumped both types of healthcare together, to make it somewhat simpler for people not familiar with the "system". However, I see now, that I need to clarify things a bit.

If DH is seen for something connected to a service related disability, he can be seen at a VA Clinic (not the same as us being seen on base at a MTF-Miltary Treatment Facility). It's rather complex and confusing, and STILL takes quite a while for him to be seen.

I removed myself from the "Prime" option (which is like an HMO) after having many problems receiving acceptable medical care. My children will be removed from that as well at the end of this month. For WHATEVER you need to be seen for, you must first go to your PCM, which they assign to you, and for us, it is 45 minutes away. If THEY think you need to be seen by a specialist, they can refer you, either within the same building/network, or to a provider out in town. In my situation with the eye dr., this is not a special thing, they do eye exams there, and have very limited openings, AND, only schedule for 2 weeks at a time. Let's not forget they close the entire medical facility on the 1st Wednesday of each month for training.

Some aspects of this health care are nice....you can get lab work done at the same building, pick up your prescriptions, x-rays. However, you can bank on an entire day lost if you need to go there for pretty much anything. And, often times, my DH is sent 1.5 hours away to be seen for his service related conditions.

It is virtually impossible to explain to someone who has not lived it, but, hopefully I have been able to convey a small piece of it. And, let there be no mistake, this care if not free.

Again, I agree, something needs to be done, and we need a starting point to at least have a work in progress.

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Doing the right thing isn't always the same as doing the easy thing.

I apologize for using the broad term benefits. This issue I am addressing is a model of health care, not trying to get into the system. Yes, children and spouses qualify for CHAMPVA and TRICARE, bereavement counseling, and a few other specific things. These are reimbursement issues. This care is not provided by VHA generally. If a TRICARE family member wishes to seek care at a VA facility, it can be done in some situations, but it is at as a space available to assure our Veterans are cared for first.

VHA health care is evidence based, totally electronic, and focused on a lifetime relationship where prevention and early care is the goal. Of course, that isn't sexy and it doesn't pay as much. In my 30 years involvement with the health care industry, I have not seen better care and more appropriately provided. It is no wonder the political pushback is so very strong to changing our current model of health care.

Most back surgeries are not beneficial and may actually do more harm. There is little evidence they help the majority of those who undergo the surgery. But, it is an amazing cash cow for back surgeons. Proper rehab and weighloss isn't sexy or lucrative. But, the evidence is quite clear those are more appropriate for back injury.

There is a little town in Ohio and the incidence of angioplasty is 4 times the national average. People studied the citizens of this town to determine what about them and their lifestyle made them so much more likely to require this very invasive medical procedure. Guess what --- the people were average, it was a medical group in that town who happened to be quite fond of the money performing angioplasty brings in.

Thank you for the apology. It is hardly ever admitted any more - when one is wrong. I appreciate that.

aia conveyed it much better on her last try. It is difficult for those who haven't served on active duty, or had a direct connection to understand how the military and VA health systems work ( and don't work ! ). I 've had my share of frustrations through the years and our promised free health care for life costs us. The annual cost is very reasonable however, and I must say, hasn't gone up in almost 10 years. I can't believe that, but it's true. Part of the problem is that civilian physicians aren't re-imbursed in a timely manner, nor on a cost effective basis and many are choosing to not accept military.

Agreed, a lot needs to be fixed.

dl

I wasn't apologizing for being wrong. I wasn't IMO. I was apologizing for not recognizing the conversation has swayed from VHA health care to VA and DoD benefits in general and for using term benefits too loosely.

And, yes, a lot needs to be fixed and this is a start. If anyone "goes down" for this, good for them! The future of quality health care shouldnt be political, nor should it be controlled by the insurance industry or Wall Street.

"Most back surgeries are not beneficial and may actually do more harm. There is little evidence they help the majority of those who undergo the surgery. But, it is an amazing cash cow for back surgeons. Proper rehab and weighloss isn't sexy or lucrative. But, the evidence is quite clear those are more appropriate for back injuries."

I would like to see the evidence.... To be honest there are three people that I know who had back surgery and it was the best thing for them... weight loss was not an issue in any of those cases....

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Be careful what you wish for.....

John P. Kostuik, MD, and Simeon Margolis, MD, Ph.D. Low Back Pain and Osteoporosis. The John Hopkins White Paper on Low Back Pain and Osteoporosis, 2002.

I am not talking about people with structural problems or disease. But, taking that population out of the equation, fewer than 5% of people with back pain are candidates for surgery, yet surgeons are more than happy to operate $$$.

Of course the three people you know think it was the best thing for them. Perhaps you somehow know the few people for whom back surgery is actually necessary for recovery. Stranger things have happened.

RE: Back surgery

Do a search for St. Charles Bend in Oregon. Patients there are twice as likely as anywhere else to get back surgery. 10/10,000 Medicare beneficiaries receive back surgeries there, where the national average is 4/10,000. They found a way to make $$$, clear and simple. And "we" are paying for it. There is absolutely no evidence surgery is the best treatment. None. But, we do know that is the treatment that yields the most money for doctors and hospitals. And, we pay for it. Stupid system we have.

5 Operations you don't want to get. #5 = back surgery

5 operations you don't want to get -- and what to do instead - CNN.com

Back to topic (at least for me): the discussions behind closed doors are nothing more than broken promises by our president. Sure, others before him had closed down discussions but they also didn't promise to have "transparency" (that I know of). It doesn't surprise me and in fact, I expected it. I also expected the bribes to get it passed. That's the way government works. I'll scratch your back if you scratch mine. Is it right? Heck no but that's how it's been done for ages. Exactly why I would never vote in such *healthcare*.

My dad gets VA care. It took him over 25 years to convince them to give it to him. It was a long hard fight. doesn't help that he now has to drive either a couple hours into Denver to get care of 1.5 hours to WY as those are the closest places

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Proud to say I haven't shopped at a Wal-Mart since Sept 2003

What does VA have as far as peer review/panel reviews? What I mean is: What keeps an MD (VA doctor)from recommending and performing surgery with little to no one to answer to.

From my perspective: I have seen numerous MDs, both in private practice and @ the VA level, and Indian Health Services who were content to treat a patient conservatively until they (the MD) thought that someone else--like Work Comp--would be paying for the treatment and OMG! The patient now needs surgery. It's amazing how the patient suddenly is so much worse. Further, I have seen VA and Medicare attempt to lay everything onto the work comp claim--from high blood pressure, to eczema to glaucoma!
So, while I know that VA gives good care--they and their MDs are just like every other MD on the planet: Willing to do/provide surgeries if they are going to get paid for it.

I see MDs all the time who wouldn't recommend surgery--unless it was work comp.
For example: the Christmas we got the Wii, ex was downstairs playing on it. He ended up torquing his knee and tearing his meniscus. Was a small tear. But, because it was on our private insurance, he was treated conservatively. It was 6-8 weeks before he even got an MRI. Had that been an injury alleged sustained at work? Claimant would have had an MRI within a week, and referred to orthopedic surgery. And probably had surgery within 6-8 weeks!

My point is: MDs are not making decisions based on evidence/objective findings. They are making decisions based on money. And should someone (namely me) question them, they get all pissy and bent out of shape. If ever you wondered why insurance is so high---look at the work comp rates in your state. That reflects on overall insurance rates.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

Peer reviews are the cornerstone of VHA care. A VHA MD would not recommend or perform unnecessary surgery for many reasons - the most important being there is no reward for unnessessary treatment and surgery. The reward is actually found at prevention and early treatment.

When HMOs started, many touted how well they would treat diabetics best by monitoring and early intervention. This decreased amputations, eye disease, and kidney failure. Well, the problem was that diabetics flocked to these HMOs, but the payment for prevention and monitoring isn't good. So, the HMOs that provided better care went under financially. Sad, but our current system does not reward the best care. It pays for treatment.

Additionally, systems don't communicate with each other. So, if I have blood drawn and tests done at hospital A and then go to hospital B for emergency treatment, the tests have to be redone.

If I go to doctors A, B, and C for treatment, C doesn't know what A and B recommended or what drugs were prescribed.

VHA is driven by what are known as "quality measures." Everything from mortality, to immunization, to infection rates is tracked and compared to expected thresholds. These are not only tracked by facility and specific units, but by services as well. VHA requires facilities to address areas where they fall below expected thresholds. Additionally, VHA requires disclosure to patients and/family if something unusual happens. The person is then provided with their options (ie: law suit). Additionally, every complaint to an oversight body is investigated and the results of the investigation are made public.

My daughter works for an optician and his wife who runs the office is constantly harassing the staff about coding. Try to make it "medical" ie dry eye...so that the office makes more. A good deal of the patients are medicaid...

I am quite sure this goes on all over and until it stops, nothing the govt does is going to change it.

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Melissa

I agree that the system is whacked.

And while I am sure you know more about the VA system than I; but from my anecdotal viewpoint, what you describe is not the case.
VA, like just about everything, in theory is great! Unfortunately theory does not always equal practice.

In this state, work comp fee scale pays far more than private insurance, medicare and VA---it behooves the MDs to make it work comp.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

It isn't theory.
- in 2003 the New England Journal of Medicine used 11 quality measures and compared feee for service with VA facilities and the VA outscored them.
- in 2004 - the Annals of Medicine compared VHA with commercial managed care and found the VA provided better care to diabetics in 7 of 7 quality measures.
- in 2006, a study found the life expectancy of the elderly in the VA system was significantly higher then those enrolled in Medicare Advantage.

for the last six years, the VA has received higher consumer satisfaction ratings than any public or private sector health care system.

A survey by the University of Michigan found 69% of VHA patients were seen within 20 minutes of their scheduled appointments. (that happens rarely for me.) And, 93% report seeing a specialist within 30 days of when they wanted the appointment.

Additionally, VHA is a shining star of patient safety. Seriously. Electronic records, medication ordering, pharmacy, etc has made medication errors almost extinct in VHA.

And added bonus to a system that excels when patient care excels - between 1995 and 2004, the cumulative increase VHA care cost was 0.8% and the Medicare/Medicaid cost was 39.4%. Mind you, VHA patients are generally sicker, poorer, older, have more substance abuse and mental health needs than the general population. More than 30% smoke.

VHA doesn't have an incentive to overtreat. Indeed, NO health care system should have this incentive, but that is just the type of system we currently have.

Nice try. You spoke about children and now want to change the subject. I should have known you couldn't admit being wrong. Keep on, iyo, that you are always right. Back to business as usual.

dl