Affordable Care Act--what will it mean for us as consumers?

[MrsC]

Very good points Kris. I thought it was interesting about all the coverage about the luxurious and expensive Lindo Wing when Kate Middleton was giving birth--I looked it up. It's crap compared to the average private hospital experience (in Texas at least). Steak and lobster dinner anyone? (Yes, I'm dead serious) Obviously a wee bit over the top.

I definitely think it will be a hard thing to get used to. We do have a lot of luxury in our system--honestly I could care less about some of it, but I'm going to be honest, I really don't want to give birth in a room with other women or share one in recovery. (If that becomes the norm, then sign me up for a homebirth or birthing center ASAP!)

Sorry, that's my only reference point for care right now

Mine too!

I completely agree about things being over the top. We did a tour of our hospitals "birthing pavilion" last week: 20 private suites, one labor nurse per person, spa tubs, the list goes on. Two OB's and two midwives on call per night, they run two different services, even though the rooms are less than half full most days. It just seemed excessive and costs a fortune and we're all paying for it. The community hospital DH worked at just got a huge grant from NY state to convert to all private rooms. They also have a patient population that's 60% Medicaid, made a huge loss last year and laid off a lot of staff. Skewed priorities maybe?

Some of my friends gave birth in Ireland recently, both private and public patients and were very happy with it. As a public patient, you have the same amount of prenatal appointments, same standard tests and ultrasounds as we do here. For 2K to 3K (doctor and hospital costs) you can go private and get the same as above plus as many ultrasounds as you want and a private or semi-private (two-person) room. Everyone, whether public or private, has a midwife and consultant (attending OB) there for labor and delivery who work together....I would love to have this here. I have never heard of women sharing a room for the birth. Chances are you will have to share one for recovery but I could live with that for 24-48 hours.

Having worked in Ireland, as well as the VA system, community and university hospitals here, DH still favors a system similar the Irish or VA one, both as a physician and patient. Everyone hears the horror stories about wait lists etc. in a public system but those stories exist everywhere. I have had family members/friends in Ireland with a whole range of health problems some very serious and their outcomes have never been compromised due to a lack of access to healthcare.
For me, the ACA is not the answer, though I give Obama 'some' credit for not kicking the can down the road again and at least trying something. I'd rather be at the mercy of government healthcare than some corporation (insurance/pharmaceutical company) any day. Sure, countries with public healthcare are broke right now but so are we, just for different reasons.

[v-girl]

I have to have c-sections. I would not be okay sharing a room for recovery and my 4-5 day hospital stay.

I keep hearing about congress being exempt from this. How is that possible (or fair)?

[HouseofWool]

Mine too!

I completely agree about things being over the top. We did a tour of our hospitals "birthing pavilion" last week: 20 private suites, one labor nurse per person, spa tubs, the list goes on. Two OB's and two midwives on call per night, they run two different services, even though the rooms are less than half full most days. It just seemed excessive and costs a fortune and we're all paying for it. The community hospital DH worked at just got a huge grant from NY state to convert to all private rooms. They also have a patient population that's 60% Medicaid, made a huge loss last year and laid off a lot of staff. Skewed priorities maybe?

Some of my friends gave birth in Ireland recently, both private and public patients and were very happy with it. As a public patient, you have the same amount of prenatal appointments, same standard tests and ultrasounds as we do here. For 2K to 3K (doctor and hospital costs) you can go private and get the same as above plus as many ultrasounds as you want and a private or semi-private (two-person) room. Everyone, whether public or private, has a midwife and consultant (attending OB) there for labor and delivery who work together....I would love to have this here. I have never heard of women sharing a room for the birth. Chances are you will have to share one for recovery but I could live with that for 24-48 hours.

Having worked in Ireland, as well as the VA system, community and university hospitals here, DH still favors a system similar the Irish or VA one, both as a physician and patient. Everyone hears the horror stories about wait lists etc. in a public system but those stories exist everywhere. I have had family members/friends in Ireland with a whole range of health problems some very serious and their outcomes have never been compromised due to a lack of access to healthcare.
For me, the ACA is not the answer, though I give Obama 'some' credit for not kicking the can down the road again and at least trying something. I'd rather be at the mercy of government healthcare than some corporation (insurance/pharmaceutical company) any day. Sure, countries with public healthcare are broke right now but so are we, just for different reasons.

In the UK/Ireland, do babies room with mom or are they in a nursery? I cannot fathom rooming with two babies in the same room. I would check out AMA from lack of sleep.

[poky]

I keep hearing about congress being exempt from this. How is that possible (or fair)?

http://www.forbes.com/sites/rickunga...rom-obamacare/

[MrsC]

They're still big on looking after baby in the nursery and allowing Mom time to recover. My one friend had a c-section and was in a private room, private hospital. Baby spent several hours a day in the nursery.

[SoonerTexan]

Interesting. I consider allowing rooming in to be one of the signs the hospital is a little more progressive, at least here. I guess it's just a logistical issue

[MrsC]

Interesting. I consider allowing rooming in to be one of the signs the hospital is a little more progressive, at least here. I guess it's just a logistical issue

It is a space issue there but also they way things have always been done. I considered rooming in to be more progressive too but I'm reading a book called 'Touchpoints', by a U.S pediatrician who says it may not be a good idea for all parents. His theory is that some first-time parents are ready to take on full responsibility for the baby right after birth, while others need a little time to adjust. The latter may need some bonding time, then a little break and so on, so that they are not overwhelmed while also trying to recover physically. According to his research, beyond that first period of skin to skin contact, it does not negatively impact infant/parent bonding for them to have periods of separation. He also believes that the hospital stay is too short these days to allow adequate physical recovery for the mother and time to adapt with a good support system at hand. Basically, parents should be given the option of rooming in or using the nursery depending on their own comfort level. It struck me because when we had our L & D tour, there was no mention of a nursery. The midwife said that rooming in was expected and nothing more. My first thought at the time was that if Mom wanted a break and time to recharge, would this policy make her feel like a failure right from the start?

Sorry, this is kind of off topic but I found it very interesting that this was the opinion of a pediatrician and his co-author, who is a child psychiatrist. Very good book BTW.

[ladymoreta]

I also thought it would have been nice to have a nursery available after delivery. I liked having my baby with me most of the time, but a nap before going home would have been luxurious. They took DD for about 2 hours overnight the second night, but they didn't have a nursery. They just wheeled the babies into the nurse's lounge.

[Pollyanna]

Ahhh, Dr. Brazelton! He wrote Touchpoints. Love him! I used to watch his show followed by Penelope Leach nearly 20 years ago. I don't find rooming in to be progressive I find it to be nice for those that can handle it but it puts a lot of pressure on new moms that may not have help. After this last delivery I wouldn't have been able to care for baby if dh wasn't with me 24/7 (and this was #6). But I would have had no trouble asking for the nurse to take baby to the nursery, I would have felt like a failure if it was my first or second. And you don't even want to know of some of the sad stories that happen when mama is exhausted and keeps baby with her.

[SoonerTexan]

Mandatory nursery stays are what bother me. And yes, there are quite a few hospitals in this area that still do them. Rooming in usually isn't forced here.

[PrincessFiona]

What do you guys here about bundling? DH and I were talking about this tonight. From what he understands, there will be one charge given to a patient who is admitted (say with pneumonia). That is all the hospital will get regardless of the procedures and consults the pat. needs. If the patient is there for pneumonia, for example, the hospital might stop making money after the 2nd full day. By day 3, the patient would cost money. Along that same line, if the patient is discharged after 2 days and returns to the hospital 5 days later because their diabetes is acting up, the charges might not be covered. It will be seen as lack of competence the first time around even if it is a different issue. The goal is to save money, of course, but it sounds like it is possibly at the expense of the patient care.

They had a meeting at the hospital about this at the end of last week (again) and there is generally speaking a sense of alarm. No one will want the high needs patients.

Kris

[SoonerTexan]

My sister said she saw similar situations last year. One guy was readmitted over and over over the course of a few weeks because he had severe diabetes and was noncompliant, but Medicare (maybe? Don't hold me to that) required the hospital admit him at their own expense.

I was talking with DH about all this the other night and asked him if he thought it would help Parkland (funded by Dallas County taxpayers and a few other sources. $400 of our property taxes go there). He looked at me and said, "uh no. A huge percentage of our patients are illegal immigrants or homeless."

So how do they fit into the picture? I'm assuming an illegal immigrant can't get this new insurance, or can they? I have no idea.

[Sheherezade]

Bundling has been the subject of concern for DHs hospitals for the last two years. They've made all kinds of changes to make up for the inevitable losses and the "quality" committees he's on locally and nationally are all trying to set realistic terms. Yeah - my DH takes on lots of sicker than sick cancer patients and they have complications. If the fee collected is stable across all patients being treated for generic "cancer", there is a concern that hospitals will turn away or at least avoid the harder cases.

[GrayMatterWife]

My sister said she saw similar situations last year. One guy was readmitted over and over over the course of a few weeks because he had severe diabetes and was noncompliant, but Medicare (maybe? Don't hold me to that) required the hospital admit him at their own expense.

I was talking with DH about all this the other night and asked him if he thought it would help Parkland (funded by Dallas County taxpayers and a few other sources. $400 of our property taxes go there). He looked at me and said, "uh no. A huge percentage of our patients are illegal immigrants or homeless."

So how do they fit into the picture? I'm assuming an illegal immigrant can't get this new insurance, or can they? I have no idea.

Nothing will help Parkland. They are just beyond help. My DH was stunned when he got to WashU (and Emory, too). In his first year of residency, he remarked: "No wonder Parkland is such a mess. They have no idea how to bill and collect. They have no idea how to run a hospital."

[SoonerTexan]

Update on this--my mom & siblings plan is being cancelled this year. Their new options are double the premium and takes away the family deductible (so now an $8k individual deductible for $1200 premium a month). My aunt with the pregnant daughter in the hospital (blood clot) is in the same boat. My cousin is currently on Medicaid.