We Need "Hillary-Care" Now

Here's reason number 124,897 on the list of reasons to throw the Republican bastards out of the White House.  Anyone who continues to insist that there's "no difference" between certain Democratic candidates and the Republicans ought to have their head examined ... hope the doctor doesn't leave a scalpel in there though.

Medicare won't pay for hospital mistakes

Sat Aug 18, 4:14 PM ET

WASHINGTON - Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented.

"The rule change announced this month is among several initiatives that the administration says are intended to improve the accuracy of Medicare's payment for hospital patients who receive acute care and to encourage hospitals to improve the quality of their services.

The rule identifies eight conditions -- including three serious types of preventable incidents sometimes called "never events" -- that Medicare no longer will pay for.

Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year.

"Our efforts in this arena and in other payment rules are to ensure that CMS is an active puchaser, not passive payer, of health care," Jeff Nelligan, a spokesman for the agency, said Saturday..."

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Iraq and the Wimp Love Myth

The Spineless Dem has risen again.

Democrats have responded to months of Republican intransigence by cutting deals on GOP priorities like trade and immigration - and have now capitulated completely to Republican demands on Iraq.

Why are the Democrats acting so butter-boned?

A lot of it has to do with their seemingly innate fear of confrontation.  Democrats are afraid that in the great battle of rhetoric and ideas, they still can't go toe to toe with the Bush White House and the Republican message machine. They're also afraid that their liberal, mushy voters won't support hardball politics. But is confrontation for Democrats really such a politically hazardous strategy - and isn't it necessary to achieve the great goals to which we all aspire?

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The Failure of Compromise

In one of Sen. Harry Reid's first radio addresses after the Democratic victories in November 2006, he said the new majority's first guiding legislative principle was "bipartisanship"; Democrats "intend to reach out to President Bush and our Republican colleagues in Congress." The Democrats' last guiding principle would be "results," because "it's time Democrats and Republicans worked together to achieve results."

Four months into the new Congress, how's that game plan working out?

There's not a lot of results. And you can blame all that attempted bipartisanship.

Time and time again, Democratic leaders have sought to accommodate the conservative Republican minority and craft compromise legislation. And in almost every case, it has led to bad or no results.

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How is dialysis paid for?

Here is an article I wrote for a dialysis patient advocates newsletter - a dialysis reimbursement primer.

How is dialysis paid for in the United States? That seems like a simple question but it's a complicated situation so there really is not a simple answer. In 2007 nearly 500,000 people have CKD5 (kidney disease so severe that to live a person needs either a kidney transplant or regular dialysis), over 350,000 individuals treat their CKD5 with dialysis. Medicare calls it End Stage Renal Disease (ESRD), while the FDA uses the term Chronic Renal Failure, no surprise I prefer the term CKD5 instead of End Stage or Chronic ... Failure.

With nearly 500,000 people needing treatment it should be no surprise that there is now a giant industry involved in providing care for all of those people. There are the manufacturers who make the equipment and supplies (from dialysis machines to the needles), there are drug makers (Amgen, Ortho Pharmaceutical) because in addition to dialysis or transplant treatment of CKD5 requires various medication therapies, and there are the providers who provide dialysis and transplantation (Davita, Fresenius and your local hospital transplant center). It is those providers of dialysis that we think of when we talk about how dialysis is paid for but we should remember that they are just a part of a very large industry.

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Looking at healthcare through the dialysis lens

Proponents of healthcare reform point to two buckets of money when discussing the potential savings that could be redirected to expanding access: insurance profits and provider profits. From the point of view of the US dialysis program I can't see how eliminating private payers and/or private providers saves money.

Dialysis is a useful lens to view the question of healthcare reform because it is free of some complicating issues, dialysis has fewer variables. The procedure is as close to a widget as the healthcare system gets making the business model of the dialysis unit fairly straightforward (at least as compared to a large city hospital or probably a busy medical practice or other specialty). And critically access to dialysis is nearly universal in the US (there are exceptions, varying with Medicaid rules i.e. undocumented dialyzors) giving it a status most people want for healthcare generally.

It could be that the US's thirty-five years of experience with its dialysis entitlement (formally known as Medicare's ESRD [End Stage Renal Disease] program) is not relevant but if I can adequately lay the situation bare I think it will be a productive tool with which to test a proposed fix treatment for a very sick system.

There's more...


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