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

    Originally posted by leswp1 View Post
    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!
    Minnesota Hockey

    Comment


    • 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.
      CCT '77 & '78
      4 kids
      5 grandsons (BCA 7/09, CJA 5/14, JDL 8/14, JFL 6/16, PJL 7/18)
      1 granddaughter (EML 4/18)

      ”Any society that would give up a little liberty to gain a little security will deserve neither and lose both.”
      - Benjamin Franklin

      Banned from the St. Lawrence University Facebook page - March 2016 (But I got better).

      I want to live forever. So far, so good.

      Comment


      • 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/

        Comment


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

          Originally posted by Bill View Post
          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.

          Comment


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

            If PPACA is to be repealed, here's some ideas:

            Comment


            • 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 ?
              Last edited by FreshFish; 10-16-2012, 08:57 AM.
              "Hope is a good thing; maybe the best of things."

              "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

              "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

              "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

              Comment


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

                Originally posted by FreshFish View Post
                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.

                Comment


                • 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.
                  "Hope is a good thing; maybe the best of things."

                  "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                  "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                  "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                  Comment


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

                    Originally posted by FreshFish View Post
                    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¢
                    Take the shortest distance to the puck and arrive in ill humor

                    Comment


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

                      Originally posted by DrDemento View Post
                      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.
                      "Hope is a good thing; maybe the best of things."

                      "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                      "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                      "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                      Comment


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

                        Originally posted by FreshFish View Post
                        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.

                        Comment


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

                          Originally posted by FreshFish View Post
                          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.
                          This is an over simplification but here goes-I have always felt that so much abuse of the medical system could be eliminated by simply charging a token fee-let's say $2 every time someone used their coverage. Call it a copayment or whatever. I had patients that would ask for the moon in treatment-simply because (and they told me so) it cost them nothing. Often times asking by name for incredibly expensive drugs-when less expensive ones were perfectly adequate-simply because it cost them zero. Of course this does not address the myriad of other problems and abuses and inequalities. But I could not agree with you more-when people pay nothing for a service(medical or otherwise)-then they think it costs nothing. They do not know or do not care that it costs everyone.
                          Take the shortest distance to the puck and arrive in ill humor

                          Comment


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

                            Originally posted by leswp1 View Post
                            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.
                            Thanks for the kind words. We do seem to agree pretty often. I guess we have had a lot of similar experiences in the health care industry. What i find particularly upsetting is using all sorts of statistics to compare US medical care with that of other countries. It is totally ludicrous-we have a distictly different population than these same countries. We have 310+ million people with a great percentage of immigrants. How can this be compared with a country like Canada who has a population 1/10th the size (and access to medical care across the border since 75% or more of their population lives within driving distance of the US). Or Australia which has a similarly small population and restrictive immigration policy. Life expectancy, neonatal mortality-these are often the stats used to compare-are also suspect since it is very difficult to compare, using those statistics, homogenous societies like Japan with unrestriced heterogenous populations more like a melting pot in the US. This may be hard to swallow for many-but the best way to decrease medical costs in this country is to stop rewarding the increase in population. Having less children, allowing less immigration, both politically untenable-would go a long way towards decreasing the amount of money needed to care for the population.
                            Take the shortest distance to the puck and arrive in ill humor

                            Comment


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

                              Originally posted by DrDemento View Post
                              Thanks for the kind words. We do seem to agree pretty often. I guess we have had a lot of similar experiences in the health care industry. What i find particularly upsetting is using all sorts of statistics to compare US medical care with that of other countries. It is totally ludicrous-we have a distictly different population than these same countries. We have 310+ million people with a great percentage of immigrants. How can this be compared with a country like Canada who has a population 1/10th the size (and access to medical care across the border since 75% or more of their population lives within driving distance of the US). Or Australia which has a similarly small population and restrictive immigration policy. Life expectancy, neonatal mortality-these are often the stats used to compare-are also suspect since it is very difficult to compare, using those statistics, homogenous societies like Japan with unrestriced heterogenous populations more like a melting pot in the US. This may be hard to swallow for many-but the best way to decrease medical costs in this country is to stop rewarding the increase in population. Having less children, allowing less immigration, both politically untenable-would go a long way towards decreasing the amount of money needed to care for the population.
                              Agree again and agree with the co-pay thing.

                              One of our biggest problems is we are schizophrenic in what we want.
                              We don't want to pay for prevention.
                              We don't want to pay for people to have basic insurance.
                              We don't want to make people pay to get insurance if they don't want to.
                              We don't want to deny care to people who don't pay.
                              We don't want to take responsibility for the fallout when they cost the medical system huge cash.
                              We can't understand why people don't pay in when there is no consequence.
                              We don't allow consequence- you cannot ethically deny care.
                              We don't want to pay for people to prevent pregnancy.
                              We don't want to pay for the kid when it comes out.
                              We want to get medical care for little or no cost.
                              We want medicine to be a free market to regulate itself.
                              We want to decrease cost of care
                              We have an increasing population who will be sick.
                              We won't pay for home care
                              We will pay for nursing home treatment at huge cost.
                              We expect families to help out their relatives
                              Most families are now scattered.
                              We want the community to help but only voluntarily.
                              We want medicine to be cheaper
                              We don't want to impede the pharm companies from making profits for the investors.

                              As a society we are very unrealistic and if someone actually talks about how our expectations are schizoid it is political suicide. No one can propose a compromise because that would mean admitting we can't achieve everything we want and there is no absolutely right choice.
                              Last edited by leswp1; 10-16-2012, 08:27 PM.

                              Comment


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

                                Originally posted by leswp1 View Post
                                Agree again and agree with the co-pay thing.

                                One of our biggest problems is we are schizophrenic in what we want.
                                We don't want to pay for prevention.
                                We don't want to pay for people to have basic insurance.
                                We don't want to make people pay to get insurance if they don't want to.
                                We don't want to deny care to people who don't pay.
                                We don't want to take responsibility for the fallout when they cost the medical system huge cash.
                                We can't understand why people don't pay in when there is no consequence.
                                We don't allow consequence- you cannot ethically deny care.
                                We don't want to pay for people to prevent pregnancy.
                                We don't want to pay for the kid when it comes out.
                                We want to get medical care for little or no cost.
                                We want medicine to be a free market to regulate itself.
                                We want to decrease cost of care
                                We have an increasing population who will be sick.
                                We won't pay for home care
                                We will pay for nursing home treatment at huge cost.
                                We expect families to help out their relatives
                                Most families are now scattered.
                                We want the community to help but only voluntarily.
                                We want medicine to be cheaper
                                We don't want to impede the pharm companies from making profits for the investors.

                                As a society we are very unrealistic and if someone actually talks about how our expectations are schizoid it is political suicide. No one can propose a compromise because that would mean admitting we can't achieve everything we want and there is no absolutely right choice.
                                Virtually none of what you listed is ever reported on-and if it was-the public would just not understand or even care. We have produced a population that is all give me, take care of me, but don't charge me and don't make me pay for it. I am not exactly sure when medical care became a right and not a privilege. Medical care generates a lot of cost and of course a lot of income. But now everyone wants a piece of that medical pie. You have medical doctors, osteopathic doctors, nurse practitioners, physicians assistants, homeopathic practitioners, nutritionists, chiropractors, etc. And everyone wants to earn a living. Some treatments administered by all of these groups are based on some solid science or detailed clinical trials. Some are not. But so many are now covered by insurance or government payment-that costs are out of control. Decisions about medical care are increasingly being made by non medical personnel. In a previous post FreshFish highlighted a brief note about the AMA. What he posted is absolute truth. The AMA does not represent practicing physicians. Only about 15-20% of doctors belong and a great percentage of those that do are not the ones seeing patients and providing care. Many push paper around, review medical articles, and are not out in the medical world tending to patients. When i first entered practice most doctors belonged to the AMA. Now, I honestly do not know a single doctor who pays dues. But i see the AMA used politically as support all the time. If they wanted the truth, however, they should ask those of us who have actually been taking care of patients and especially those who have been doing it for a long time who have a perspective of how things have changed. Just my medical 2¢
                                Take the shortest distance to the puck and arrive in ill humor

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