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The Sad Case of the Patient Protection and Affordable Care Act

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  • leswp1
    replied
    Re: The Sad Case of the Patient Protection and Affordable Care Act

    Originally posted by Rover View Post
    I'll defer to les and co on this one, but hasn't a shortage of primary care physicians been a problem for like the last 20 years, as in long before Romneycare/Obamacare?
    This isn't news. It isn't even old news. Specialists get paid sig more and have way less responsibility in the current system. The primary care people are getting more and more responsibility and no renumeration to go with it. Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

    Until they start paying the primary practice for all the things they think we should do this will persist. Why does an ENT's med asst get paid 250 to irrigate and ear and we get 80$? Our reimbursement for care is not as high as the specialist. Top that with all the punishments the insurance companies heap on us if the patient is non-compliant and we practically pay to take care of the pt. See various rants in this and previous threads

    Leave a comment:


  • Rover
    replied
    Originally posted by FreshFish View Post
    http://gma.yahoo.com/doc-shortage-co...ws-health.html (from that hotbed of conservative values, ABC News):




    Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?
    I'll defer to les and co on this one, but hasn't a shortage of primary care physicians been a problem for like the last 20 years, as in long before Romneycare/Obamacare?

    Leave a comment:


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

    http://gma.yahoo.com/doc-shortage-co...ws-health.html (from that hotbed of conservative values, ABC News):

    The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, a new study found.

    The predictions also reflect the passage of the Affordable Care Act -- a change that will expand health insurance coverage to an additional 38 million Americans.

    "The health care consumer that values the relationship with a personal physician, particularly in areas already struggling with access to primary care physicians should be aware of potential access challenges that they may face in the future if the production of primary care physicians does not increase," said Dr. Andrew Bazemore, director of the Robert Graham Center for Policy Studies in Primary Care and co-author of the study published Monday in the Annals of Family Medicine.

    .....

    The problem does not appear to be one of too few doctors in general; in fact, in 2011 a total of 17,364 new doctors emerged from the country's medical schools, according to the Association of American Medical Colleges (AAMC). Too few of these doctors, however, choose primary care as a career -- an issue that may be worsening. [emphasis added]

    ....

    It's pretty tough to convince medical students to go into primary care," said Dr. Lee Green, chair of Family Medicine at the University of Alberta, who was not involved with the study.

    Green added that he believes this is because currently primary care specialties are not well paid, well treated or respected as compared to subspecialists.

    ....

    Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians. [emphasis added]

    Dr. Randy Wexler of The John Glenn Institute of Public Service and Policy said he has concerns that this trend could be reflected nationwide.

    "Who is going to care for these people?" he said. "We are going to have problems just like Massachusetts. [They] are struggling with access problems; it takes one year to get into a primary care physician. Coverage does not equal access." [emphasis added]

    Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?

    Leave a comment:


  • leswp1
    replied
    Re: The Sad Case of the Patient Protection and Affordable Care Act

    Originally posted by huskyfan View Post
    did I post this already? it might not have gone through.

    why are health related companies - hospitals, medical device companies, pharms, etc - cutting their work forces? wont ObamaCare be being millions into the system? more demand should equal more supply. what am I not getting about?
    Mass saw a decrease in pharma because they were no longer able to bring people out to dinner/lunch etc or give freebees (no pens, paper, any little gadgets). The pharma reps I talked to said they were allowed to give out medically connected paraphenalia but the companies weren't willing to spend money on that. They don't sample name brands that are generic and right now there aren't a ton of meds coming out. Insurance companies are dictating what we can write for so the rep can talk til they are blue in the face and it won't change what we can access for the pt. Ergo- less pharma reps.

    Leave a comment:


  • Rover
    replied
    Originally posted by goldy_331 View Post
    Sorry, I went off a Boston Globe article as I assumed they would know what is in Romneycare. I guess they were wrong.
    Hell even I don't listen to the Globe.

    Leave a comment:


  • goldy_331
    replied
    Re: The Sad Case of the Patient Protection and Affordable Care Act

    Originally posted by Rover View Post
    Ummm...this is Massachusetts. Yes on both counts.
    Sorry, I went off a Boston Globe article as I assumed they would know what is in Romneycare. I guess they were wrong.

    Leave a comment:


  • Rover
    replied
    Originally posted by goldy_331 View Post
    Does Romneycare violate religious freedom by mandating coverage for abortions and all forms of contraception? I don't believe so (not an expert, so correct me if I'm wrong).
    Ummm...this is Massachusetts. Yes on both counts.

    Leave a comment:


  • Rover
    replied
    Originally posted by FreshFish View Post
    Wrong. Very, very wrong. very very very very wrong.

    Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

    is there a medical devices tax in Romneycare?

    -- um, no.

    Does Romneycare take money from Medicare?

    -- um, no.

    Was the Romneycare mandate found unconstitutional?

    -- um, no.

    (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


    Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

    -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")
    All of this is irrelevant BS. Does each have a mandate? Yes. Do they require businesses to cover their full time employees? Yes. Have businesses started fleeing the state? No. Are employers dropping coverage onto the state? No. Has the state gone bankrupt? No.

    Now, those lovely states of Mississippi, Alabama, West Virginia, and Kentucky all don't have universal health insurance. Funny, but wouldn't one expect those to all have better economies than Mass?

    Leave a comment:


  • goldy_331
    replied
    Re: The Sad Case of the Patient Protection and Affordable Care Act

    Originally posted by FreshFish View Post
    Wrong. Very, very wrong. very very very very wrong.

    Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

    is there a medical devices tax in Romneycare?

    -- um, no.

    Does Romneycare take money from Medicare?

    -- um, no.

    Was the Romneycare mandate found unconstitutional?

    -- um, no.

    (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


    Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

    -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")
    Does Romneycare violate religious freedom by mandating coverage for abortions and all forms of contraception? I don't believe so (not an expert, so correct me if I'm wrong).

    Leave a comment:


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

    Originally posted by Rover View Post
    Romneycare = Obamacare.
    Wrong. Very, very wrong. very very very very wrong.

    Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

    is there a medical devices tax in Romneycare?

    -- um, no.

    Does Romneycare take money from Medicare?

    -- um, no.

    Was the Romneycare mandate found unconstitutional?

    -- um, no.

    (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


    Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

    -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")

    Leave a comment:


  • Rover
    replied
    Originally posted by FreshFish View Post
    Gee, so our talented well-intentioned amateurs had no idea that unintended consequences might apply?

    For those who know what PV=nrT means, they'll understand immediately.

    Basically, there are interdependent variables; if you fix two numbers the third number is forced by the laws of nature. (this is about gas, not the political kind nor the biological kind, the physical kind). Out of Pressure, Volume, and Temperature, you can fix two of the three but the third is forced by nature.

    In PPACA, they tried to fix all three of the comparable variables by statute. It is bound to fail. it is a mathematical necessity that it must fail. it is like King Canute ordering the tide to stop rising. you cannot override nature by law no matter how well-intentioned your purpose.
    I've got a better equation for you Fishy! Try this one on for size:

    Romneycare = Obamacare.

    What this mathematical formula proves is that the consequences for a 1/50th representation of the whole is a good harbinger for how a countrywide rollout might take place. The better part is that we also have a six year track record to study.

    So, back to the subject of jobs. In the state of Mass, according to right wing theory, 1) unemployment should be above the national average, 2) businesses would be cutting full time employment and hiring part timers in their place, and 3) state would be overburdened by all these people on the public plan.

    Care to guess at the actual results?

    Leave a comment:


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

    Originally posted by FreshFish View Post
    Price rationing. Obama"care" is not about improving the quality of care it is about creating mass production lines. There is nothing in the law about "care;" the law is all about (attempts at) cost control.


    Obama"care" is not bringing any new money into the system; it is merely shifting around existing funds. Cut from Medicare to apply it toward PPACA for example.



    there actually is a "medical devices tax" making it more expensive to acquire equipment. backwards from what a rational person would want.
    Really starting to like your postings more and more.

    Leave a comment:


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

    Originally posted by geezer View Post
    The most obvious outcome to all this will be that the new normal will be working two or more part-time jobs (obviously with no benefits) to make up for the lost full time opportunities. We can all agree it sucks.

    Gee, so our talented well-intentioned amateurs had no idea that unintended consequences might apply?

    For those who know what PV=nrT means, they'll understand immediately.

    Basically, there are interdependent variables; if you fix two numbers the third number is forced by the laws of nature. (this is about gas, not the political kind nor the biological kind, the physical kind). Out of Pressure, Volume, and Temperature, you can fix two of the three but the third is forced by nature.

    In PPACA, they tried to fix all three of the comparable variables by statute. It is bound to fail. it is a mathematical necessity that it must fail. it is like King Canute ordering the tide to stop rising. you cannot override nature by law no matter how well-intentioned your purpose.

    Leave a comment:


  • Rover
    replied
    Originally posted by geezer View Post
    You're right of course, about the value and right of public protest and the crappiness of Papa John's etc. But just for the record, McDonald's is going gangbusters over in China. So you never know.
    Do the Chinese like pizza? I never thought about that but I wonder...

    Leave a comment:


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

    Originally posted by Rover View Post
    What Papa Scrooge doesn't seem to realize is that his is not the only pizza joint in the country. That and his product isn't that great. He can launch a public campaign against his employees and then watch as his business bleeds away to his rivals. That's the beauty of public exposure of these idiots. Unlike most Republicans, he can't just move his operations over to China.
    You're right of course, about the value and right of public protest and the crappiness of Papa John's etc. But just for the record, McDonald's is going gangbusters over in China. So you never know.

    Leave a comment:

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