I don’t think this is a super simple thing and I think there are probably a lot of specific cases where that outcome would be super frustrating for parents. If these are rural areas, it’s possible someone lives 5 minutes from a religious school and 45 minutes from the next closest school of any kind. At that point even if they prefer a non-religious education for their kids, the logistics alone might be an issue. I mean, I doubt they have a school bus available for the 45 minute commute.
That shouldn’t happen and that’s where any money should go.
4 Likes
I agree in theory, but in a rural state it seems reasonable that there can be edge cases.
If there is sufficient demand for a religious school then there should also be a public school.
Y’all missed the most fucked up ruling of this release.
https://twitter.com/SCOTUSblog/status/1539247357816184839
Basically insurers are required to cover stuff for End Stage Renal Disease patients (ESRD) as they would for other things. This is usually dialysis.
How do we get around that?
The problem is that this is true and it’s also true that Federalist Society goons will use the edge case as evidence that’s OK to overturn the whole principle idea the next time the principle idea that they want to overturn comes up.
1 Like
The days of the mega payments to davita or other dialysis centers are long, long gone. People with medicare will also frequently have private insurance on top of it.
Just look to see who is in the majority.
I’m also having a hard time getting rustled about this SC dialysis decision.
This seems like the inevitable conclusion of how Medicare is set up. If Medicare covers everyone with end stage renal disease (regardless of age), then of course insurers are going to take advantage of that.
This seems like something that could be addressed by congress if there was a desire to do so. The existing law is (as dissenters note) highly exploitable.
Also seems like everyone with ESRD will still get dialysis will still get it, but cost can get shifted to Medicare, but I doubt if anyone with ESRD really gives a shit that the end result of the law is that they still get dialysis, but more tax dollars are spent.
It is not even clear to me that people without ESRD who need dialysis for a short period of time would be affected. It sounds like the ruling means that the dialysis provider just has to take the shitty reimbursement that the insurer is willing to give and they still get their dialysis too.
Only people who get fucked are dialysis providers. Not sure how rustled I should be about that. I suppose that could have some secondary effects that reduce access to dialysis. Maybe.
I didn’t actually read the decision, so I could be wrong about above. I’m sure I’ll get around to it at some point.
You shit over enough dialysis providers and there won’t be dialysis.
Yeah, as I mentioned, that could be a consequence.
I’m not sure this is a lock though. There are constantly cuts to reimbursements for all sorts of medical services. The targets of the cuts always say, “Well if you cut payments, then we’ll go out of business and can’t provide the service.” That doesn’t always happen. I’m sure it happens sometimes. Will it happen here to a significant extent? I don’t know for sure. Perhaps.
It happens all the time. Being a medicaid patient with some sort of medical condition that requires specialist care is a nightmare because of it.
America does more dialysis than any other country IIRC. Very few other places do dialysis on 80 year olds. This is a values decision… and it’s for the worse imo ftmp.
That’s not untrue, but that’s a bit different. Lots of docs don’t take Medicaid because there are tons of higher reimbursing patients that they could take care of instead.
But in this case, ESRD is kind of single payer. So it’s not like if you refuse Medicare, you can still have a bunch of other higher paying patients ESRD patients This ruling seems to reduce those other higher paying patients dramatically.
Wasn’t there some kind of thing where big dialysis was actively discouraging or lobbying to prevent treatments that would get people off of dialysis? Seems like a 60 minutes or similar piece maybe 10-15 years ago…
Here is an article from a quick google. Bottom line is that the incentives don’t line up well with either cost control or patient care (but great for the two companies profits).
If you have end stage renal disease, you’re pretty much not getting off dialysis unless you get a transplant. Or you die.
I didn’t read Dan’s link, but can you give some cliffs on how a dialysis company can help someone get a transplant?
I’d have just assumed that’s the nephrologist’s job. I can see issues if the nephrologist has an ownership stake in the dialysis center, but how often is that the case with people who get their dialysis at DaVita?
The link has more to do with getting people to switch to private insurance which pays up like 17x and also the for profits have a much higher complication risk, they end up buying the device makers and other things.
Now that the transplant list has been brought up, I believe the old thing I saw was about that. That they would keep on the dialysis and discourage transplants.
I’d love to hear the sales pitch on that. How do you sell people on voluntarily choosing to drag their ass down to the dialysis center for three half-days a week for the privilege of probably dying sooner?
I assume they would be lying their asses off, but presumably anyone with ESRD has a nephrologist, who could help them make a non-idiotic decision.
I’m almost 3 months into a new job at one of the two “Big Dialysis” providers.
Obviously I don’t make market setting decisions about how much to get reimbursed, or anti competitive practices between Davita and Fresenius,
So I’m just gonna say that we have way more candidates for chairs than chairs available, it’s limited terribly by staffing, and just about all our patients are two weeks away from death without the treatments we provide.
I (somewhat proudly) don’t understand the economics and incentives that makes this all work, because I know what I cost. But I take some satisfaction in giving these people the dignity and quality of life that wouldn’t have existed even just a few decades ago.
10 Likes