OBAMACARE sets a price on the value of each year of your life

A real life example from England, where they already have these guidelines.

Obamacare (PPACA) sets a price on the value of each year of your life.  If the cost of treatment exceeds the "value" of your expected remaining lifespan (as determined by IPAB, a group of government bureaucrats)... YOU WILL NOT GET TREATMENT.

Let's take a real life example from England, where they already have these guidelines. A 66-year-old woman slipped, fell and hit her head.  She came to the hospital unconscious due to the bleeding (subdural hematoma) that was compressing her brain. This is a life-threatening emergency.

The Neurosurgery (Brain Surgeon) Resident doctor recognized what was happening and started getting her ready for surgery to stop the bleeding and drain the blood from her brain. As he was shaving her head, the Chief of Neurosurgery walks up and says "What are you doing? You have to STOP that right now! She's 66 years old... she goes to the Recovery Room, (not the Operating Room)".

The Resident doctor says, "Are you kidding me... we can save this woman's life... this surgery is easy... it's 'bread and butter.'"

"NO... she is 66 years old... she's over the age limit... she goes to the Recovery Room," orders the Chief of Neurosurgery.

They watched her die over the next 3 days.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Brian October 11, 2012 at 09:56 PM
If this claim is factual, show me an independant source which backs this story up. This specific story, from England, with the 66 year old unnamed woman. and the unnamed brain surgen resident who knew she could be saved but yet was forced to watch her die because "she was over the age limit". BTW, I'm not blogging, Dr Appleby is blogging and I'm just a commenter asking for facts and not stories. There is zero credibility in this story without any names and sources. There is nothing for me to even try to research to prove it happened.
Diogenes October 12, 2012 at 01:57 AM
With regard to Robin's original, as of yet unsubstantiated, anecdote - such a story would be truly tragic. As tragic, however, and quite real is that 18-20% of US residents will die in an ICU and 27% of Medicare dollars are spent on the last year of life... Regularly, at Danbury Hospital, there are men and women in their 80's and even their 90's undergoing surgery to have defibrilators and pacemakers surgically placed in their chests, only to suffer painful rehabilitation, and die within months of the surgery. This surgery and the subsequent hospitalizations that these patients suffer is paid for, no questions asked, by Medicare, under the current system. If the tea party radicals had the slightest idea as to how their tax money is being spent, there would be sudden support for the mythical "death panels." This is the synergistic nature of sefishness and hipocracy. The reality is that change is hard and the first iteration of major change is never perfect. Tough. Harden up; suck it up; and stop the hipocracy and fearmongering.
Linda Taylor October 12, 2012 at 02:09 AM
Without question there is need for healthcare reform in this country. Is PPACA the answer? Does ANYONE really know what is encompassed in the 2700 pages? There ARE many physicians closing their practices because they can't afford the expense of switching over to EHR(electronic health records). Hospitals are merging and soon doctors will actually just become government employees. Your health care decisions are no longer between you and your doctor. Our doctors can sit and consult with patients and decide the best plan of care and the best medication and then the patient finds out it is not covered under their insurance so back we go to the drawing board. Insurance companies are dictating healthcare. H. Ferguson is on the money.
Linda Taylor October 12, 2012 at 02:10 AM
AND one further note..if Obamacare is so spectacular why is Congress exempt?
Dr. Robin Appleby October 12, 2012 at 11:51 AM
I am doing a series on Obamacare (PPACA). I think it very important that we know and discuss what is in this, over 2700 page bill, since it will drastically affect our lives (and deaths), our jobs, taxes, the doctor-patient relationship, government control over our lives, etc., etc. Obamacare radically alters almost everything. It will drive most doctors out of private practice forcing them to be employees of hospitals. It will drive many, many doctors out of medicine altogether. Huge shortages of physicans are coming as more doctors are retiring, often due to the frusatrations of government regulations, lawsuits (there is NO tort reform in Obamacare), and declining reimbursements. Obamacare causes immense loss of jobs and will cut millions of jobs to part time so the companies dont have to pay for PPACA (see Red Lobster/Olive Garden). It will bankrupt the insurance companies (by design) as a stepping stone to Socialized/Governmen-run/single payer Medicine. Obamacare will set up groups of unelected bureaucrats to give the "guidelines", "suggestions", and financial incentives on how to practice (rewards for the 'team' to withhold care). The government will have ALL your medical records. You can be confident that it will never leak out. Obamacare radically changes the relationship of the citizen to the government. These issues very much need to be discussed.
JohnnyW October 12, 2012 at 01:54 PM
"Carp"? He's full of fish? On a different note, Obamacare is a stolen from others ideas: Do you remember what most of the law is based on? Romney's healthcare law in Massachusetts.
JohnnyW October 12, 2012 at 02:02 PM
But do you really think for a minute, that all the health care problems in the country can be solved by getting President Obama out of office? Or for that matter that they Started when he took office? You need to think back to the Regan and Clinton era's to remember when healthcare was reasonable.
Dr. Robin Appleby October 12, 2012 at 02:09 PM
Dr. Jill Vecchio, a radiologist in Colorado, is a radiologist in Colorado. She has done extensive research into PPACA. She has an excellent series of 7 Youtube videos that are the best I have seen out there. You can Google Dr. Jill Vecchio or go to Youtube. It will be very worth your while to spend some time with Dr. Vecchio.
Ken October 12, 2012 at 03:57 PM
I heard the story about Darden Rest. and the potential move to make employees part time. In the rest. business most employees are already part time employees. Trying to link their status as part timers to ACA legislation is a BIG stretch. Employers that typically do employ people on a full time basis that attempt to move these employees to part time status as a way around ACA insurance requirements would likely be viewed as engaging in a legal sham. This would be an illegal act by the employer. An employer could still change benefits, lay people off or even choose to pay the penalties defined in ACA for not offering coverage. (Businesses with 51 or more FTE employees will be fined $2,000 per employee(excluding the first 30 employees) if they do not offer coverage for employees who average 30 or more hours per week. There are somewhat similar rules currently in place regarding employers that prevent employers from calling employees independent contractors. If an employer does this to avoid withholding, workers comp, unemployment and the employer match for SS and Medicare they can face serious consequences. I think the same premise of employer legal responsibilities can easily be expanded to prevent an employer from undertaking a bad faith effort and approach to get around the over 50 full time employees, 30 hours per week insurance requirements of the ACA.
Mary Davis October 12, 2012 at 04:15 PM
@Locoguy/Diogenes/Doctor Could you please tell us, did you see and treat non-emergency patients, who had no insurance and no money, in your office or did you send them to the Emergency Room to be cared for ?
Diogenes October 12, 2012 at 09:46 PM
Robin- You have totally underestimated the destructive power of Obamacare. You missed: -The plague of blood; -The plague of frogs; -The plague of lice; -The plague of flies; - The plague of pestulence; - The plague of boils; - The plague of hail; - The plague of locusts; - The plague of darkness; and - The death of the first born. You also failed to mention that burried into page 2,696-98, the bill describes how we will all start to bleed from the eyeballs and the subsequent imprisonment of our people by an army of zombies from Iran who will then proceed to devour us one by one.... Yes, indeed, it is the end of times if we do not intervene! Let's discuss...
Diogenes October 12, 2012 at 09:53 PM
The radical socialist organization known as the AMA (American Medical Association) has endorsed Obamacare. Not because it is a perfect bill, but because it is better than the status quo. They too have have conducted "extensive research" and they even have their own website! Maybe their website is not quite as popular as Youtube, but still readily found through Google. I would suggest that they are a more credible source of information than a single wack-job in Colorodo. Dr. Appleby may even have been a member at one time or another, since they do represent most practicing physicians as a lobying group in Washington DC...
Michael Gianfranceschi October 13, 2012 at 12:20 AM
Diogenes, you"re very good at spitting vitriol and making baseless statements. You portray tea party people as radicals and call adoctor whom you don't even know a wack-job. Dr. Appleby is trying to educate us about this law. Have you read the law? all 2700 pages? I doubt it, so why don't you stop drinking the kool-aid keeep your yap shut ...you might actually learn something.
Diogenes October 13, 2012 at 12:30 AM
I personally stopped reading right after page 2,698. The part where we were being snacked on by Zombies. If you are hoping for education here, I don't really think that you are in the right place. If you believe the opinion of the AMA is baseless, then I agree that education is something that is sorely needed.
Diogenes October 13, 2012 at 01:06 AM
The act, word for word, is available at: http://www.healthcare.gov/law/full/index.html.
Diogenes October 13, 2012 at 01:16 AM
The link to the AMA's take on the bill is available at: http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/affordable-care-act.page By the way, in case my earlier sarcasm was too subtle... The AMA is actually fairly conservative. Yes, "fairly conservative" is a relative phrase, which might mean "radically socialist" to a true Dyed in The Wool, Card Carying, Member of The Tea Party (previously referred to in short form as "wack-job" but in long form, I prefer "hipocritical wack-job"). Learn away - I wouldn't want to stand in the way of a good education.
Linda Taylor October 13, 2012 at 01:39 AM
OKAY..The whole country is going to be covered....everyone is going to get top-notch care...there will no-waiting for services,,,there will be PLENTY of physicians to care for all...current recommendations for preventive healthcare will not change and physicians will see no loss of revenue. Hmmm..sounds like Nirvana.........Who's paying for it?
Diogenes October 13, 2012 at 02:16 AM
Okay - An uninsured teen goes to the emergency room with a sore throat. It costs $300 instead of the $75 it would have in a primary care office. The Hospital collects no money from the the patient. Who pays? The Hospital? Nope. You do. A Medicare patient goes to the hospital in congestive heart failure. They treat the patient, stabilize them, then discharge them in 3 days. They treat the patient and discharge them quicky, because the Hospital gets paid the same dollar amount whether the patient is there for 3 days or 10 days so, obviously, they make more if the patient stay is as short as possible. In their haste, however, they make a mistake in the patient's medication dosage at the time of discharge. The patient takes the incorrect dose, as prescribed, and has another exacerbation. They are back at The Hospital 7 days later, for another inpatient stay. Who pays for the 2nd stay? The Hospital? Nope. Medicare does (you do) [and the patient suffers needlessly]. Welcome to todays health care. Hmmmm...Nirvana? Hardly, but all of the fear mongers want to tell you how bad change will be. The new law attempts to eliminate that waste and replace incentives based on the quantity of treatment with ones that reward quality. How much will be saved by eliminating waste (and fraud)? Maybe enough to actually end up saving money while improving the system. To understand what we are changing to, you first need to know what we are changing from!
Linda Taylor October 13, 2012 at 11:32 AM
Diogenes..but I DO understand!! I am right in the middle of it! I deal with it EVERYDAY!Incentives for docs based on treatment..ok so a patient comes in and has a persistent problem that requires several visits..as I understand it, and I know you will correct me if I am wrong here, subsequent visits will not be covered . I am also disturbed by the intrusive nature of EHR. Are you aware of MEANINGFUL USE? I watch as physicians struggle with the new EHR as Docs spent more time looking at the computer than looking at the patient. THEY don't like it anymore than the patient. Medicine's overhaul should have first started with Torte reform.
Linda Taylor October 13, 2012 at 11:42 AM
excuse me, Tort reform..
Linda Taylor October 13, 2012 at 01:39 PM
To Diogenes/Locoguy/doctor As Mary asked you, did you see and treat non-emergent patients ,who had no insurance and no money, in your office or did you refuse them care and send them off to the Emergency room to be treated ?
ROBERT "BOB" APPLEBY October 13, 2012 at 03:54 PM
Locoguy/Diogenes & any other names you create. The OBAMACARE train wreck aside, You failed to mention extra ways to Bill or "treat" the patient! Ex: "Patient" has "Chest Pain" & instead of 911 they call local "Doc in the Box". Doc says come on down! Pt. drives (or driven by spouse). Doc "sees them right away" (no HIPPA paperwork for 45 mins in germ infested waiting rm). Doc sees the Pt. & says "YUP I'll dial 911"! Ambulance arrives at employee entrance & it's locked. Wasting no time, they wheel the cot thru the main entrance. Once inside the receptionist, nurse, & Doc scold EMS for using the main entrance (where other Pts anxiously wonder why an Ambulance was called to a building full of Doctors). Now the Pt is Billed from the Doc that dialed 911, EMS that cared for the Pt (Nitro? Oxygen? IV? etc) the Ambulance ride will be around $1,000+/- & Medicare will only cover around $232+/- of that expense. The Pt. arrives at the Hospital (should've gone in the 1st place). Doc immediately BILLS aka"schedules a follow up" to 2nd guess care received by Hospital Docs. (Hospital Docs employed by the same conglomerate as the Primary Care Docs?) Pt. & spouse now need a ride from the Hospital, as they left their vehicle at the Primary Care Facility! Welcome to "Doc in the Box" care, this is how it works NOW...Imagine the "CHANGE WE CAN BELIEVE IN" as we move "FORWARD" when more Bureaucrats are involved? I'm Bob Appleby, and I approve this message!
Ken October 14, 2012 at 01:28 AM
E&M visits do not have a global period associated with them. This means each visit is usually considered a separate patient-provider encounter if it is on a different date. (A quick exception that comes to mind with regards to subsequent visits is suture removal, it is not a separate CPT billable code.) As for persistent conditions if you are referring to chronic conditions such as hypertension, RA, Diabetes, nephrotic, ocular type issues, etc. these types of conditions require routine follow up and are reimbursable for each visit. Check your CPT-guidelines for full information on global period guidelines. You also correctly point out that tort reform (malpractice courts?) is an important part of any plan to control medical costs.
Ken October 14, 2012 at 01:31 AM
I meant to add that E&M visits on different dates even with the same ICD-9 code should typically be reimbursable encounters.
Diogenes October 15, 2012 at 09:58 AM
Robert- Your story is painfull to read and should not have happened. Despite the horrible process, I sincerely hope that the outcome was alright. Your story is far too typical of stories that I am intimately familiar with. It is a perfect example of why shange is so necessary. Despite what you have been fear mongered into believing, parts of Obamacare are designed directly to address the root cause of your story. It eliminates the patient being caught in the middle while everyone trys to shedule/bill whatever they can independently of the patient experience. Thank you for sharing your story. I hope that, through it, others may be helped to see that our system is broken. Although Obamacare is far from perfect, it is a step in the right direction.
Diogenes October 15, 2012 at 10:18 AM
As Ken points out, global reimbursement was designed to eliminate billing - a la carte style - for procedures. For instance: Need a radical hysterectomy? The surgeon says: OK. I can take care of that, but to do it I'll need: -To do a physical before the surgery; and -see you back in the office after the surgery to make sure you are OK. Oh, and by the way, the surgery consists of roughly 3 distinct parts: -Open you up; -Remove the parts that are causing the problem; and -Close you back up. If there were no global system, the surgeon could bill for all of that seperately... And then schedule a few extra follow-up visits because your incision was not fully healing well (and he wanted to make sure he covered his boat payment). What the global system does not do is cover The Hospitals billing. Therefore, The Hopsital could be the cause of a problem (ie. infection) and the surgeon is stuck dealing with that problem without additional reimbursement, for as long as it takes. Obamacare actually addresses that by lumping together the reimbursement for the Hospital and the Surgeon. IF THE PATIENT LOSES, THEY BOTH LOSE! Regarding "MEANINGFUL USE" - do you really believe that we should be operating in the year 2012 with paper record? Isn't it frustrating when you go from one physician to another and they have not communicated about you and your health problem? Meaningful use sets a standard for what an EHR should address. The opposite is "meaningless."
Diogenes October 15, 2012 at 10:22 AM
Couldn't agree more that tort refrom SHOULD have been part of Obamacare. Defensive medicine is expensive medicine. I also like "torte reform." :)
Dr. Robin Appleby October 15, 2012 at 10:36 AM
Locoguy/Diogenes/Ken/Doc My heart really goes out to you (and the others involved). Your situation is so far past a nightmare, I dont know how you survive it. The stories I am hearing are just heartbreaking... After many years of loving, compassionate service....you all deserve so much better. Best wishes, Robin
Linda Taylor October 15, 2012 at 11:15 AM
Been using EMR/EHR for 6 years..there is good and bad..it's only as good as the info that is put in to it! As far as MEANINGFUL USE goes..let me explain..these are questions you are REQUIRED to answer for the government. Many have LITTLE to do with medicine. Do you find THAT intrusion necessary? BTW you guys/ladies are brilliant. Would love to have a roundtable discussion some day!
Ryen November 07, 2013 at 07:14 AM
HERE you have it! The U.S. government has just passed a new law called: "The affordable boat act" declaring that every citizen MUST purchase a new boat, by April 2014. These "affordable" boats will cost an average of $54,000-$155,000 each. This does not include taxes, trailers, towing fees, licensing and registration fees, fuel, docking and storage fees, maintenance or repair costs. This law has been passed, because until now, typically only wealthy and financially responsible people have been able to purchase boats. This new laws ensures that every American can now have an "affordable" boat of their own, because everyone is "entitled" to a new boat. If you purchase your boat before the end of the year, you will receive 4 "free" life jackets; not including monthly usage fees. In order to make sure everyone purchases an affordable boat, the costs of owning a boat will increase on average of 250-400% per year. This way, wealthy people will pay more for something that other people don't want or can't afford to maintain. But to be fair, people who can’t afford to maintain their boat will be regularly fined and children (under the age of 26) can use their parents boats to party on until they turn 27; then must purchase their own boat. If you already have a boat, you can keep yours (just kidding; no you can't! ;). If you don't want or don't need a boat, you are required to buy one anyhow. If you refuse to buy one or can’t afford one, you will be regularly fined $800 until you purchase one or face imprisonment. Failure to use the boat will also result in fines. People living in the desert; ghettos; inner cities or areas with no access to lakes are not exempt. Age, motion sickness, experience, knowledge nor lack of desire are unacceptable excuses for not using your boat. A government review board (that doesn't know the difference between the port, starboard or stern of a boat) will decide everything, including; when, where, how often and for what purposes you can use your boat along with how many people can ride your boat and determine if one is too old or healthy enough to be able to use their boat. They will also decide if your boat has out lived its usefulness or if you must purchase specific accessories,(like a $500 compass) or a newer and more expensive boat. Those that can afford yachts will be required to do so...it’s only fair. The government will also decide the name for each boat. Failure to comply with these rules will result in fines and possible imprisonment. Those not legally allowed to drive a boat or be on the water will be provided a boat by the government--guaranteed. Government officials are exempt from this new law. If they want a boat, they and their families can obtain boats free, at the expense of tax payers. Unions, bankers and mega companies with large political affiliations ($$$) are also exempt. If the government can force you to buy health care, they can force you to buy a boat....or ANYTHING else.. Yeah...it's that stupid...


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