[fubu]

"Home care agencies abruptly dropped or refused high-needs cases like her father’s as unprofitable"

This story is really, really glossing over what is happening in home health hospice as a whole. For profit hospice organizations are crippling the non profit organizations by taking all the cheap and easy patients offering them slightly better services than the non profits, while dumping all the expensive and unprofitable patients on the non profits who typically try to take every patient regardless of their ability to pay, regardless of Medicaid and Medicare. These non profits are being killed off one by one because of it.

Yet another example of finance style arbitrage damaging the lives of Americans.

[813594]

Do you have any figures to back this statement up? When you say dumping do you mean transferring? Discharging? Revocations? Those events are, and should be, looked at with great scrutiny in compliance surveys.

Home Health Agencies are not the same as Hospice agencies (the article seems to use the terms interchangeably). As far as I'm concerned, nonprofit/for profit in hospice is really just tax status. All Medicare certified hospices agencies follow the same guidelines, bill the same payor, and are paid the same rate. The Medicare Conditions of Participation say you must take patients regardless of their ability to pay (you can't just try, all providers must and it's why you see it printed on their brochures).

Hospice is a service business and differences are found in quality of care.

As for Medicaid, I really only know about Arizona. Since at least 2001 Arizona has approved hospice care for Medicaid (AHCCCS) patients in hospice and in July 2009 started stalling on payment. In January 2010 they made the decision to retroactively eliminate Hospice services as of July 2009. All Hospice providers who cared for patients July 2009-Jan 2010 were now told the accounts would not be paid. This has lead to some providers avoiding contracting with AHCCCS and thus impacted AHCCS patients access to care when they don't qualify for the Medicare benefit. Of course the patients can still contact any local Medicare hospice and seek charity care regardless of their ability to pay.

[jnbiche]

This is why the bastardized system we have now will never work. We must move to single-payer or fully private health care -- no middle ground.

I personally don't even care all that much which route we take, since I think the improvement in either case would be extreme. Unfortunately, both are equally unlikely, because of two-party "democracy".

But the status quo is unsustainable.

[prostoalex]

For majority of people in that situation Medicare would apply, and look how single-payer is working for them:

"Medicare will pay premium rates for up to 100 days of services in a nursing home to rehabilitate patients. While such efforts can be beneficial, government investigations and lawsuits document a pattern of excessive or fraudulent orders for such services, often just before death."

What use is a single-payer system that stays hostage to whatever political party is in charge in Congress, subject to lobbying from corporate and other special interests, and mostly toothless to fight fraud?

Having that much paying power concentrated in a single entity controlled by politicians makes it even more of a target for corruption.

[refurb]

Why must it be single payer or fully private? Plenty of countries with well functioning healthcare systems have a mix.

[jnbiche]

Because in the absence of a single-payer system, the private portion of this system risk arbitrates all the higher-risk patients to the state-supported insurance and/or medical care, thus bankrupting the government and/or non-profit systems. We see this happen again and again.

What countries with well-functioning healthcare systems don't have a base-layer single risk pool under a government system? Of course, almost all of these systems allow supplemental and/or optional private care, but they are still single-payer insurance systems.

[vinceguidry]

Isn't that the whole point of the state from a market economy standpoint? To take care of the things that are unprofitable with compulsion/taxation? You can't bankrupt the government. It's got the power to print money. It can keep going as long as it can do so. It also has the power of legislation. It can regulate prices if it so chooses.

[simonster]

"Fully private" is not really an option. If you kill Medicaid, you also kill people who can't afford health care. The current system certainly isn't great for the poor either, but it's better than nothing. A single payer system would be better than either, but like you say, it's not going to happen anytime soon.

[tn13]

There are number of ways medicaid can be made completely redundant. Destroy the monopoly of AMC on the number of doctors. Let Indian doctors apply for a cap-free H1B and flock to US to give Americans a better health-care.

Oh wait. That will killing American Doctor's job (which is any ways AMC is doing so effectively) and reduce their salaries.

Clearly USA as a society prefers that the the Hospital Staff's salary, Insurance Company's profits and Medical equipment vendor's profits as more important than "public health care".

[jnbiche]

>There are number of ways medicaid can be made completely redundant. Destroy the monopoly of AMC on the number of doctors. Let Indian doctors apply for a cap-free H1B and flock to US to give Americans a better health-care.

This is an excellent potential solution. If you've been to Thailand, India, and Mexico, they all have pretty good healthcare available for a cost that poor, working class families in the U.S. could afford out-of-pocket.

But whereas having cheap software programmers is clearly a god-given right in the U.S., having affordable healthcare is not.

[simonster]

I agree that the impossibility of paying for health care out of pocket in the American health care system, but I don't agree that this would solve the problem.

First, some people don't have any money, because they are mentally ill, homeless, or both. But our current system doesn't really do a good job of caring for these people, so perhaps that doesn't matter.

Second, while I agree that doctors are overpaid, the cost of living in America is substantially higher than in Thailand, India, or Mexico. You will have to pay the doctors more than you would in those countries. You will have to pay staff more as well. You will have to pay more for virtually everything. While working class families could afford health care in India out-of-pocket, it seems possible that those families could not afford the same health care in the U.S., assuming everyone involved is paid the same cost-of-living-adjusted salary.

Third, it's hard to provide good care if you can only give patients drugs that are out of patent. India and Thailand avoid this by refusing to recognize certain patents or granting compulsory licenses so that the drugs can be made affordable (not sure about Mexico). If the U.S. did this, it would get sanctioned by the WTO and the American pharmaceutical industry would cease to exist. Poorer countries profit from richer countries' investment in drug development, but if no one develops the drugs then everyone suffers.

[prostoalex]

Not too familiar with the selection and admission process, but

* can people be denied hospice care based on ability to pay?

* why wouldn't someone in that position go through non-profit institutions first?

[tn13]

The following statement does need some data to suggest that such a trend exists and is indeed closing down non-profits.

"unprofitable patients on the non profits who typically try to take every patient regardless of their ability to pay"