The Sad Case of the Patient Protection and Affordable Care Act

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Mrs. Les,

Does your office not deal with any Medicaid or Medicare patients? I've heard that, no matter how difficult insurance companies may be, they are even worse (the bureaucrats, not the patients)!

Sort of like dealing with the IRS...many of the people who "work" there don't even know what they are talking about (I can't find it now but I read somewhere that over 1/4 of the answers given by IRS personnel were incorrect! )


Also, at least once a week I read about a Medicare or Medicaid fraud ring being busted somewhere....every dollar of fraud takes at least a dollar away from patients and providers.

DrDemento- awesome post! At some point people will realize it is about the money and not health care.

FF The gov't plans seem less serendipity than the private insurance. I know you want to connect the problems mu practice experiences with the gov't intrusions but I don't agree. I find it sig easier to deal with the gov't plans than the private insurances. I could tell stories all day about plans excluding things arbitrarily not because of evidence based medicine but because the HR dept of that company decided to exclude it (my favorite was excluding cardiac echograms but covering all other imaging). This was occuring way before the Bill went thru. I may be wrong but I think this is in direct response to the aging population. The burden on the system will go up by default. Even the most efficient system cannot decrease the number of patients who will have increasing med needs as they get older.

Yes there is fraud. Not sure what that has to do with anything. That applies to all insurances as far as I know.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

FF-I have been in the practice of medicine in several specialties for over 40 years. Please read Leswp1 posts carefully. Although i don't always agree with everything she says-she is mostly right on the money. I am now semi retired-by choice. I saw the handwriting on the wall years ago. Once the US government and the insurance companies were allowed to pay for most medical care-it was a natural progresin for them to want to decide what they would pay for and how much. I am old enough to remember the days when medicine was practiced without the interference or influence of Medicare. So much has changed over the past 40 years it is diffiuclt to recognize the field as being the same. I became a physician for a number of reasons-but none of them were financial. I am sure i could have made a very comfortable living doing most anything. I loved what i did and especially loved the autonomy. I made my own decisions. I had no one telling me what to do, what to charge, who to see. As time went on, it became obvious that I was starting to merely practice cookbook medicine-I had to do test A before proceeding to therapy B. And if i skipped test A-I or the patient was not reimbursed for step B. I got extremely tired of arguing on the phone for hours per day with some young snot who was popping gum in my ear telling me how to diagnose and treat my patients. After all-I had 4 years of medical school, a rotating internship year, a year of internal medicine residency, 3 years of dermatology residency, a year of plastic surgery and 35+ years of experiential practice. My decisions were no longer my own and no longer based on my experience and training-they were simply decisions being made based on the bottom line-what cost the least regardless of what was best for my patients.
I have my own thoughts about government and insurance company influence and interference in medical practice. If it can be shown to my satisfaction that they were truly interested in the BEST medicine for the patients, then it would make sense to me. But my experience has been that the only interest is in providing the CHEAPEST medical care (even if it is provided by totally inadequately trained personnel). I can guarantee you that every Senator and Congressman never has to put up with the same medical care that they want the rest of us to experience. They can see the top specialist in any field, at any time, for any reason and have whatever testing they need or want. [emphasis added] I have tried in vain to understand Obamacare. I have read the entire legislation. It is my own opinion but i find it to be an intrusive abomination (and remember-I am semi retired and it hardly affects me as a practitioner-but certainly affects me as a consumer since I am a patient also). The most telling statement ever was Ms Pelosi saying they had to vote and rush to pass the thing so they could finally read it and figure out what was in it. Just my 2¢

Thanks very much for your perspective. It reflects the same feelings and attitudes my soon-to-be-former physician related, and the experiences of most of the medical professionals I deal with in my work. It seemed to me that Obamacare was more a vanity project than any kind of serious effort to address the problems we face.

I think it is also revealing that Mrs. Les' practice is in MA, the home of RomneyCare, and it appears many of her frustrations are more acute in MA than in other states.

As many others have pointed out, there is always rationing, and if you try to cap costs then some other form of rationing applies....PV=nRT, so to speak...or to put it colloquially, there is no free lunch.

For decades, the root of the problem has been that the person who receives the care doesn't see the bill. If someone else is paying for what I get, then inevitably there will be a misallocation of scarce resources.

I'd love to listen and learn over a tasty cold beverage sometime. There is a direct correlation over time between the number of government mandates and the cost pressure on insurance companies. My auto insurance company is tremendously responsive because they are allowed to set rates based on experience, and so because of price competition they have to give good service or you just go elsewhere. Many people I've talked to have the same experience with auto and home insurance: you have a claim, they pay it promptly, because it's all built into their pricing up front and there is no pressure to cut corners. If they had the same number of mandates and restrictions as health insurers, we'd talk about them the same way too.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Mrs. Les,

Does your office not deal with any Medicaid or Medicare patients? I've heard that, no matter how difficult insurance companies may be, they are even worse (the bureaucrats, not the patients)!

Sort of like dealing with the IRS...many of the people who "work" there don't even know what they are talking about (I can't find it now but I read somewhere that over 1/4 of the answers given by IRS personnel were incorrect! )


Also, at least once a week I read about a Medicare or Medicaid fraud ring being busted somewhere....every dollar of fraud takes at least a dollar away from patients and providers.

FF-I have been in the practice of medicine in several specialties for over 40 years. Please read Leswp1 posts carefully. Although i don't always agree with everything she says-she is mostly right on the money. I am now semi retired-by choice. I saw the handwriting on the wall years ago. Once the US government and the insurance companies were allowed to pay for most medical care-it was a natural progresin for them to want to decide what they would pay for and how much. I am old enough to remember the days when medicine was practiced without the interference or influence of Medicare. So much has changed over the past 40 years it is diffiuclt to recognize the field as being the same. I became a physician for a number of reasons-but none of them were financial. I am sure i could have made a very comfortable living doing most anything. I loved what i did and especially loved the autonomy. I made my own decisions. I had no one telling me what to do, what to charge, who to see. As time went on, it became obvious that I was starting to merely practice cookbook medicine-I had to do test A before proceeding to therapy B. And if i skipped test A-I or the patient was not reimbursed for step B. I got extremely tired of arguing on the phone for hours per day with some young snot who was popping gum in my ear telling me how to diagnose and treat my patients. After all-I had 4 years of medical school, a rotating internship year, a year of internal medicine residency, 3 years of dermatology residency, a year of plastic surgery and 35+ years of experiential practice. My decisions were no longer my own and no longer based on my experience and training-they were simply decisions being made based on the bottom line-what cost the least regardless of what was best for my patients.
I have my own thoughts about government and insurance company influence and interference in medical practice. If it can be shown to my satisfaction that they were truly interested in the BEST medicine for the patients, then it would make sense to me. But my experience has been that the only interest is in providing the CHEAPEST medical care (even if it is provided by totally inadequately trained personnel). I can guarantee you that every Senator and Congressman never has to put up with the same medical care that they want the rest of us to experience. They can see the top specialist in any field, at any time, for any reason and have whatever testing they need or want. I have tried in vain to understand Obamacare. I have read the entire legislation. It is my own opinion but i find it to be an intrusive abomination (and remember-I am semi retired and it hardly affects me as a practitioner-but certainly affects me as a consumer since I am a patient also). The most telling statement ever was Ms Pelosi saying they had to vote and rush to pass the thing so they could finally read it and figure out what was in it. Just my 2¢

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Mrs. Les,

Does your office not deal with any Medicaid or Medicare patients? I've heard that, no matter how difficult insurance companies may be, they are even worse (the bureaucrats, not the patients)!

Sort of like dealing with the IRS...many of the people who "work" there don't even know what they are talking about (I can't find it now but I read somewhere that over 1/4 of the answers given by IRS personnel were incorrect! )


Also, at least once a week I read about a Medicare or Medicaid fraud ring being busted somewhere....every dollar of fraud takes at least a dollar away from patients and providers.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Why Doctors Hate ObamaCare, by Dr. Marc K. Siegel, a professor of medicine at NYU Langone Medical Center:


Under ObamaCare, we’re being asked to provide the same high-tech service with more restrictions and regulations to more patients and to be paid less for doing so


kind of weird how in the bolded quote, "their" opposition yet "our" permission ?

I don't know if this guy actually practices but our issue is with the insurance companies and their restrictions and regulations. Before the Bill the insurance companies would dock us for patients not getting preventitive care measures like physicals, mammograms, pap smears, etc. They weren't covered and the patients didn't do them because of cost. The Bill at least gives a chance to get compliance.

Specialists don't like the Bill is because they won't be reimbursed at a higher rate than Primary Care folks get for the same service. The example that stuck out for me in the article was the cardiologist who would be getting 280$ v double that for an EKG read. Well- the Primary care person always got the 280$. If my office irrigates an an ear I get way less than the ENT for the same service and the MA/nurse is the one doing the procedure, not the provider. If I dx an ear infection, pbuemonia or see someone for a follow up of blood pressure for a routine/easy visit I will get reimbursed significantly less than the provider of a specialty office even if I provide the same service. Why do they get 250$ to see an ear infection when I get $80? Sure they have more training but there is no reason for the pt to go there unless the problem is complex. In our current climate people see specialists inappropriately and the system pays out big bucks (waste of $$)

There is no money in Primary Care and huge responsibility. This pressure for primary care being responsible started with the insurance companies, not the Bill. That is just a continuation. One of the things the Bill does is tries to put the focus off of specialists for mundane things and use them to deal with more complex issues. Of course the Primary care folks are completely overloaded so even if theoretically this is something most in the medical community would agree to in principle our system is not ready for that yet. Unfortunately most of the negotiating bodies for reimbursement fee schedules are laden with specialists. If you have one rep from every discipline the Primaries are outnumbered before they start. It would be an act of God for the specialists to vote less reimbursement for themselves.

If you look at medical economics analysis the thing that is decreasing the productivity is EMR usage not the Bill. Electronic med records are sig curtailing the amt of pts people can see. Many specialists were seeing huge amts of pts (some >40 a day). There is no way you can document that many on an EMR no matter how fast you are.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Why Doctors Hate ObamaCare, by Dr. Marc K. Siegel, a professor of medicine at NYU Langone Medical Center:

...

there comes a point where we doctors can no longer afford to stay in practice. We rely on an unfettered environment to provide creative health-care solutions. This is why survey after survey (most recently one by The Physician’s Foundation) show that ObamaCare is highly unpopular among physicians.

Under ObamaCare, we’re being asked to provide the same high-tech service with more restrictions and regulations to more patients and to be paid less for doing so

...

ObamaCare probably means fewer doctors, too. In the Physicians Foundation Survey of 13,000-plus physicians, more than half plan on cutting back on patients, switching to cash only or quitting over the next three years — thanks largely to the president’s “reform.” Indeed, 60 percent say they’ll retire if they can.

Doctors don’t see their opposition to ObamaCare as political, but rather a justified response to being manipulated without our permission. We may be a special interest group, but many doctors don’t feel that the American Medical Association, which supported ObamaCare, truly represents our interests. That’s why only 15 percent of practicing physicians are AMA members. [emphasis added]

...

kind of weird how in the bolded quote, "their" opposition yet "our" permission ?

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

If PPACA is to be repealed, here's some ideas:

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Darden restaurants cutting back on full time employees (converting them to part time) due to Obamacare:

http://libertyblitzkrieg.com/2012/10...-to-obamacare/

And when their quality goes to shiat, they'll either close up shop or start offering it again to attract quality waiters.

[Bill]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Darden restaurants cutting back on full time employees (converting them to part time) due to Obamacare:

http://libertyblitzkrieg.com/2012/10...-to-obamacare/

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The only system I'd seriously look @ in Europe is France. They seem to be a merging of public / private. Also, their tort costs are almost non existent. The rest with the government pretty much involved 99% in the health business is something I'd steer away from.

[brookyone]

Re: The Sad Case of the Patient Protection and Affordable Care Act

This. It is easy for a healthy, young person to make assumptions regarding availability of care. I guess if you aren't exposed or don't know anyone who has a chronic illness you might not realize care is rationed in this country. If you are working poor you don't get any. If you are a step above that and not rich the insurance companies ration it. The difference is they can make arbitrary limits. What I read from your statement is as long as you are well off enough to get care screw everyone else no matter what the need. If I had a penny for all the people who were so righteous until they had to deal with all the costs I could retire now.

...and subsequently, THIS!

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

And look at how bankrupt those countries are. But I tell you what, if you want to go to Europe, I'll buy you the one-way ticket, contingent you never come back here and try to ruin our system again. Sure we might have to pay in a monetary sense, but at least it isn't rationed.

Seriously, for someone who supports laissez faire capitalism to its utmost extreme, you don't understand that everything is rationed?

You'd just rather have it rationed based on ability to pay rather than some other metric.

This. It is easy for a healthy, young person to make assumptions regarding availability of care. I guess if you aren't exposed or don't know anyone who has a chronic illness you might not realize care is rationed in this country. If you are working poor you don't get any. If you are a step above that and not rich the insurance companies ration it. The difference is they can make arbitrary limits. What I read from your statement is as long as you are well off enough to get care screw everyone else no matter what the need. If I had a penny for all the people who were so righteous until they had to deal with all the costs I could retire now.

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Seriously, for someone who supports laissez faire capitalism to its utmost extreme, you don't understand that everything is rationed?

You'd just rather have it rationed based on ability to pay rather than some other metric.

Exactly. Republican economics. Except taxes. Taxes is not based on ability to pay.

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Sure we might have to pay in a monetary sense, but at least it isn't rationed.

Seriously, for someone who supports laissez faire capitalism to its utmost extreme, you don't understand that everything is rationed?

You'd just rather have it rationed based on ability to pay rather than some other metric.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

All of Europe what? Don't call yourself a dentist yet. If I had a choice to practice here or in Europe I would go there in a minute. At least my patients could get rudimentary coverage and the option to get supplemental insurance if they are well off enough. Here I get to spend my time trying to figure out how to help people get the most basic care for chronic diseases, have patients who just don't come because they can't afford it, don't take meds because they can't afford them and listen to well meaning but ignorant people slam the initiatives that would help fix the system while claiming people on assistance are all slugs and should pull up their bootstraps. I also get to be continually baffled by the fact that people do not see that pretending our system is really OK is costing us enough money to care for the country 3 times over.

If I had a choice to be a patient, the US would not be close to my first choice unless I was very well off or lived near somewhere like the Mayo (with those awful 'death panels' and patient care panels). Most of the local hospitals are seriously understaffed, the insurance companies arbitrarily decide what to cover or not, if you are a patient you need to be very knowledgeable or have a lot of luck to get stuff done right during anything but a simple admission. If you are in a 3rd world counrty they tell you you need your family to help you or you pay extra. Here they don't make allowances for your family to live in (in most places) but don't have the staff to watch over everything like they used to.

Capitalism and free enterprise is not a good working model for healthcare. When the bottom line is profitability v outcome not everyone choses the moral/ethical choice. Insurance companies are constantly pitting hospitals/ practices against each other, practices and hospitals are in competition with each other. In our area the hospital is trying to take over all the private practices. Mine is a hold out. They are doing everything to make it difficult enough that my boss will pack it in. Where is the motivation to work as a cohesive system? Since the goal is to be the last one standing there is no motivation for them to work to make things smoother.

Bottom line- the patient is lost in the shuffle but the $ report gets to look like something positive happened.

Meeting with someone this AM in the grand plan to get out. Hopefully it is the beginning of the answer.

And look at how bankrupt those countries are. But I tell you what, if you want to go to Europe, I'll buy you the one-way ticket, contingent you never come back here and try to ruin our system again. Sure we might have to pay in a monetary sense, but at least it isn't rationed.