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View Diary: Ezra Klein's Best Ever: The #1 Way to Cut Health Costs & Save Lives (128 comments)

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  •  Seems like this would be great for medicaid, too (29+ / 0-)

    where there is a population less educated and unable to
    follow thru on doctor's orders. A weekly visit would teach people what the doctor orders really meant and how to follow thru. There really should be some cost savings in that.

    I think it was Howard Dean in Vermont who instituted a nurse visit to every home that had a newborn, and it really cut down on child abuse, which saved the state more than the cost of the visiting nurse.

    There would have to be a huge investment in nurse's training to provide enough nurses, which would be good for employment.

    Today's problems are yesterday's solutions. Don Beck

    by Sherri in TX on Mon Apr 29, 2013 at 03:08:26 PM PDT

    [ Parent ]

    •  You just nailed it--this has been implemented in (3+ / 0-)
      Recommended by:
      YucatanMan, Gary Norton, Sunspots

      the RN home visit program you mentioned, but it only applies to low-income folks.  And they are receiving the care at no cost to them, at all (from what I've read).

      And, I believe that the program is optional, not mandatory.  [Certainly it is optional in some states.]

      That program is so much a 'health-care' program, as it is a social service-type program (even though an RN may  dispense minimal medical advice/care, as well).

      If you're familiar with the program (I am only through policy papers), these 'visits' are primarily geared toward providing social service advocacy, not rendering medical care.

      Anyway, how many well-educated folks are going to welcome the intrusion of a 'mandatory' home health care worker or nurse visit?

      My guess--not that many.

      Even folks that would go along with a particular treatment plan, might object to  'having no choice in the matter,' when it comes to the treatment they receive.

      And many folks may not agree to 'mandatory' [weekly or otherwise] doctors or nurses appointments--at one's home or at a practitioner's office.

      After all, Medicare beneficiaries (other than maybe dual-eligibles) are 'paying customers.'

      Now, if the nurses' housecalls are strictly optional--fine.

      But I don't believe that in this medical care model, it is up to the discretion of the patient.  [Let me know is I've misunderstood Klein or the study, LOL!  I'm sure someone will.  ;-)]

      Much of the objection to the ACA (from both the right AND the left) is the 'mandate.'

      If Medicare becomes 'managed care,' they can keep it.  

      Just like another commenter, I've know too many folks greatly harmed by that form of 'non-care,' including two members of our extended family--both deceased.


      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


      by musiccitymollie on Mon Apr 29, 2013 at 04:34:52 PM PDT

      [ Parent ]

      •  My sense is that people with chronic or disabling (2+ / 0-)
        Recommended by:
        mamamedusa, Gary Norton

        Conditions would welcome anything that works.  This make so much sense.  If i am healthy there would be no need to send someone out.  My regular appointment with my doc would suffice.  I am healthy so no intervention required.  I am sick then send someone for one on one help..I would welcome it.

        •  timethief, I would absolutely 'welcome' housecalls (0+ / 0-)

          or home visits IF done at the beheast of the Medicare beneficiary.

          Believe that I said that above.  

          'Now, if the nurses' housecalls are strictly optional--fine.'
          Who wouldn't?

          Believe me, if I did, and this service is done at the beheast of, and at the convenience of the Medicare beneficiary (IOW, it is 'their call'), I WOULD LOVE THIS SERVICE!

          But, I'm under the impression that this is not offered 'as an option,' but 'as a condition' of insuring the beneficiary.

          Anyway, I did ask for clarification above, in case I've misconstrued the managed care model that Klein describes above.

          And so far, no one has replied that I 'misinterpreted' the suggested managed care model.

          I hope that I did, 'cause I would love this model if the 'home visits' are 'optional services,' at the sole discretion of the Medicare beneficiary (whether or not to participate).   ;-)


          "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


          by musiccitymollie on Tue Apr 30, 2013 at 08:50:54 AM PDT

          [ Parent ]

    •  There are two parts as I see it (4+ / 0-)

      One is helping people to do what the doctor prescribed, and knowing that somebody is coming by to check would help with that. The other is a trained eye checking for any worsening of their condition.

      People don't always call the doctor because they don't always realize they should. Especially if they're on a medication with side effects that seem like some minor thing or aren't thinking clearly. Having somebody who's aware of the possible side effects and/or who sees them regularly and will spot a worsening condition early is crucial.

      Remember, many older people aren't near family and may not have a lot of friends nearby.

      •  Your two points are great if the Medicare (0+ / 0-)

        beneficiary "wants" this service.  

        If this is strictly 'an option,' I would be at the front of the line to sign up, LOL!

        Otherwise, I can't imagine it.

        We are offered 'coaching' by our 'consumer-driven' health, and have been for 4-5 years.  And it's not even mandatory, but we've not participated in it, and don't feel the need to do so, at this time.

        But this service is offered to us, to use or not, at our sole discretion.

        Now this is a model that I could wholeheartedly embrace!


        "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


        by musiccitymollie on Tue Apr 30, 2013 at 09:03:23 AM PDT

        [ Parent ]

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