The PPACA Thread Part III - Let's have a healthy debate!

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Well, here we go.

WASHINGTON — House Republicans on Tuesday will unveil a proposed budget for 2016 that partly privatizes Medicare, turns Medicaid into block grants to the states, repeals the Affordable Care Act and reaches balance in 10 years, challenging Republicans in Congress to make good on their promises to deeply cut federal spending.

Under congressional rules, a budget cannot be filibustered in the Senate, so Republicans would bear most of the responsibility if they failed to pass one.

http://www.nytimes.com/2015/03/17/us...773522000&_r=0

We can now be rid of Obamacare. The Republicans are in charge now.

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I'm brilliant AND I went to a name college, so there's that.

Where a physician went to medical school makes a small difference(if any at all). But where he did his residency and what he did during that residency makes a world of difference since that is his real training for what he does. I have friends who went to the most prestigious medical schools who have hands of stone when they perform surgery and i would not let them slice a turkey for dinner. And i have friends who went to lesser known schools and trained at more modest residencies but are like Rembrandt with a scalpel. You know which of these i would choose if I need someone to carve into me.

BTW-I cannot tell a good plumber from a bad one or a good lawyer from a bad one. But give me 5 minutes talking to a physician and I pretty much can tell you where he graduated in his class and whether he knows what he is doing. But i suppose all of us in different occupatins can do the same with what we do.

[Priceless]

I'm brilliant AND I went to a name college, so there's that.

Humble too.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Rover: I do not represent the entire medical community at all. But I do represent someone who has practiced medicine for 45years and is board certified in 3 separate specialties. I am fortunate enough to be semi retired at this stage. I am fairly sure i have not made any direct comments about whether I am for or against any law including the ACA. What I am against, is anyone, and i do mean anyone, practicing medicine and making medical decisions that affect patients lives, who is not qualified to do so. When you take your car in for service, you want a mechanic who knows what he is doing to fix it. When you have electrical work in house performed, i would hope you opt for a certified electrician. I merely expect medicine to be practiced the same way. Your body and your life is just too precious to be treated by anyone who is not adequately trained and experienced. Bad advice is worse than no advice. Bad medicine is worse than no medicine. The last time i looked, there have been prosecutions for practicing medicine without a license. Yet for some odd reason, we have allowed medical decisions that deal with saving lives to be made by insurance companies, governments, and non physicians. For those who do not mind, let them seek and take medical advice and treatment from whoever they want and if they think cheapest is the answer, then so be it. As for me, i still practice the best medicine I have been trained for, I fight for my patient's rights to the absolute best care by the best people possible. And you can bet before i or my wife go for any medical attention for ourselves, I look up credentials and experience. And wherever possible(at least for important indications) we take brand name medications rather than generics).
please do not take this wrong since I have followed much of your postings for some time. You make some very valid points, but so do many others on this thread. I am just one of those old time physicians(I am not simply as the government would prefer to call me, a provider) who believes that the first tenet in medicine is do no harm. If you are not going to make a situation better, at least do nothing to make it worse. I also strongly believe that the most important phrase in medicine is the phrase " I don't know."

Appreciate the feedback. Sorry you got dragged into this but unfortunately Flaggy was trying to make you the poster boy for anti-ACA expertise when as best I can tell that's a job you didn't sign up for.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Humble too.

Not to mention good looking. That's why I'm called "The Total Package".

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Appreciate the feedback. Sorry you got dragged into this but unfortunately Flaggy was trying to make you the poster boy for anti-ACA expertise when as best I can tell that's a job you didn't sign up for.

I do have feelings about the ACA but first of all, at over 2000 pages it is far too complicated for me to understand fully. And secondly, how is it at all possible to make any judgements after such a short time. Medicare was passed as legislation almost 50+ years ago and even now it is hard to understand the benefits it has provided versus the problems it has caused.

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Not to mention good looking. That's why I'm called "The Total Package".

The total package is marrying a rich girl who can cook. Anything else you can get elsewhere (best advice i ever got from my dad).

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

other posters have offered anecdotes of doctors they know doing the same? If so, this is totally rock-solid evidence

Anecdotal evidence is true and also inconclusive, it merely provides several data points where thousands of data points really are needed to draw reliable conclusions.

I have posted anecdotal evidence of doctors who have closed their private practice because they did not want to deal with the reporting mandates required under PPACA. They remain active in the field of medicine, they just stopped seeing patients as primary care physicians. I also know of several practices that have affiliated with hospital groups because of the administrative requirements of PPACA, it is just too burdensome for the individual private practice to comply compared to outsourcing the administration to one central source. And of course, as DrD has said in a related context, once you remove primary-care physicians from direct responsibility for patient care, you get reduced quality outcomes, almost by necessity, since the criteria by which decisions are evaluated become diluted: it once was, "is the patient's condition improving, or at least stabilized?" to "is this the most practical cost-benefit outcome? or do we merely recommend palliative care only because, while improvements are clearly possible, they cost more than what we want to pay."

Also, while anecdotal, the number of primary-care physicians who are limiting the number of Medicaid / Medicare patients they will accept is also pretty well documented. As are the high deductibles required for a PPACA-exchange policy, and the restrictive provider networks.

After awhile, the accumulation of anecdotal evidence becomes more meaningful. How and when is debatable, I grant you; but you cannot merely dismiss it out of hand simply because it doesn't conform to what you want to believe is true.

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The total package is marrying a rich girl who can cook. Anything else you can get elsewhere (best advice i ever got from my dad).

Your dad is a very very very smart man. Wish mine was the same.

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

cont'd

PPACA has some good parts do it, and it has some awful parts to it. One cannot really speak about it as a monolithic entity, you really need to parse out what's good from what is terrible.

The concept of insurance exchanges is promising, if you really allowed for unfettered innovation. The lack of variety and the overload of mandates makes the execution of the concept really bad.

The concept of combining a prohibition against pre-existing conditions with open enrollment windows can work well. The way PPACA implemented that concept was totally bass-ackwards.

etc.

The promoters of the law limit their praises to its objectives, the opponents limit their objections to its consequences. How can anyone have a meaningful conversation that way?

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Your dad is a very very very smart man. Wish mine was the same.

Scooby: I was just too young to appreciate much of what he used to say. He also advised me(jokingly) to never get married and never have children. he said doing that means you can take your last dime and put it into the pay phone to call the undertaker. He was one of those super intelligent guy who was well read (3-4 newspapers per day) but the family did not have the money for any sort of college education having him and his 4 bothers. With all my education, I never beat him at Scrabble, never answered more questions correctly on Jeopardy, and he could finish the NY Times Sunday Crossword puzzle in pen within 45 minutes.
I do not think he was all that unusual though. I think that generation (he was born 1914) just was very special in ways that we do not approach.

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

One of the sillier tropes in this country today is the hyperventilating and posturing over where the average person went to college. I work with a couple of software developers who attended two years of community college, and they write code that is just as good, or better than the work of some people with a 4-year CS/CpE degree from a flashy 'brand name' school. In fact, I find they are far more practical and receptive to the realities of writing industrial-strength code than the folks who were steeped in 4-5 years of academic theory.

Meanwhile, you get some schools where the students are getting worthless majors that they can't use, end up partying for four years, and get stuck with huge bills they complain about not being able to pay.

[joecct]

The total package is marrying a rich girl who can cook. Anything else you can get elsewhere (best advice i ever got from my dad).

The Maine mantra is to marry a nymphomaniac whose father owns a liquor store.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

but you cannot merely dismiss it out of hand simply because it doesn't conform to what you want to believe is true.

That knock on your door is from the Irony Police. You're about to be charged with Felony Hypocricy!

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

cont'd

PPACA has some good parts do it, and it has some awful parts to it. One cannot really speak about it as a monolithic entity, you really need to parse out what's good from what is terrible.

The concept of insurance exchanges is promising, if you really allowed for unfettered innovation. The lack of variety and the overload of mandates makes the execution of the concept really bad.

The concept of combining a prohibition against pre-existing conditions with open enrollment windows can work well. The way PPACA implemented that concept was totally bass-ackwards.

etc.

The promoters of the law limit their praises to its objectives, the opponents limit their objections to its consequences. How can anyone have a meaningful conversation that way?

And when you point out something reasonable and not what you heard on the Glen Beck show we can have that conversation. Or you guys can remain a laughingstock. Either way works for me.