The PPACA - Implementation Phase I

[St. Clown]

Re: The PPACA - Implementation Phase I

Last time I checked the ER was more expensive than the standard doctor visit. Where was it that you go to the ER where it isn't?

My point is that these people won't be able to get into a standard doctor (the Primary Care Physicians - PCPs). The crux behind Obamacare is that those not currently receiving preventative care end up in the ER where costs are most definitely higher. Well, looking at the figures, we're not gaining enough PCPs to hand the huge influx of new patients wanting services. When these PCP doctors do not exist, people will still end up in the ER. So you have families paying some $X per month for insurance they wouldn't have purchased otherwise now unable to make an appointment because doctors, PAs and LNPs will not or cannot accept new patients. So these people will still end up in the ER. Who benefits.

 

[unofan]

According to Justice Roberts, the mandate is unconstitutional...

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

There's no net social benefit in preventing people from going bankrupt due to medical bills?

This is why there's this little thing called an emergency fund.

 

[Patman]

Re: The PPACA - Implementation Phase I

Except now when they end up in urgent care or the e.r., their bills are covered.

Otherwise, your argument still seems to compel me to believe single payer is the way to go.

So basically everybody ends up in a queue for doctors that clearly don't exist? I don't see how single payer makes it better... the only thing you've done is negated a penalty (cash) and changed it with a penalty (health, ironically) applied to ALL others. So we're gone from "these people can't" to "everybody can't".

Funny how we're arguing for the moralistic "we need to provide care to everybody" which usually means "equal care to everybody"... which is naturally anti-economic and inefficient.

Ahh.... the trainwreck we call morally mandated solutions. BUT ITS MORAL!!!! Efficient, well, no... but the heart of the matter is our hearts are in the right place.

Worse, is we're seeing it fall apart in motion and people are STILL saying they can build it better.

Ladies and gentlemen when you try to take the insanely complicated and try to make it universally harmonizable... It just can't happen. It lacks adaptability. The invisible hand is still more responsive than a single data machine. Remember, I AM the one you're looking to build the machine.

edit: I KNOW my doctor hates this stuff and I KNOW she works with spanish speaking people. Fact is the burden wouldn't be better for them under single payer.

In all this is the presumption that we have the tools and knowledge to do better if given the chance. What I don't understand is why the "intelligent" never learned the term "hubris". What's really going to happen is we're going to paper over the problems so the intelligent don't end up looking stupid.

If anything, the only thing "intelligent" people know how to do is to paper their tracks and obfuscate when caught out.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

your argument still seems to compel me to believe single payer is the way to go.

Actually, that might not be such a bad idea: let's arrange it so that the patient is the payer, and then have reimbursements flow through him/her. This third-party payment from one entity to a provider without the patient even seeing how much it costs has universally been acknowledged as one of three driving factors behind the growth of healthcare costs. Give the patient a bit more financial incentive to be a better shopper, now that is indeed something upon which you and I can both agree.

Then each patient can figure out the best way to get covered among the myriad intersection of possibilities. In fact, we can make a whole growth industry out of people who become specialized in navigating the ins and outs of the healthcare maze, and will track down all the paperwork for you, in exchange for a relatively modest fee compared to how much value they provide.*

I never would have expected such imagination and vision from you! Very impressive. Thanks.




* This is already going on, in the way plans in California are setting out to help people enroll. There are organizations receiving government grants to help people enroll in insurance exchanges. Another form of corporate welfare, one of the most enduring bipartisan forms of corporate welfare.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

Just had a chance to read up on the details of this amazing announcement:

While technically the employer mandate is the law of the land, the Obama administration announced that they would suspend enforcement of that part of the law for a year.

Effective translation: go ahead and knowingly ignore the law, but only for this year, and we promise to look the other way, but only for this year.


[long-winded diatribe redacted]



If Congress had any spine, members of both parties would be saying "not so fast here. Look, if you want that part of the law to be suspended for a year, you have to ask us to pass a law to authorize it. You can't pick and choose which parts of what laws you want to enforce, and which parts you want to ignore. We'll amend the law. It is very important to us that our constituents be law-abiding citizens. You can't advise people not to comply with the law, that is a terrible precedent. No way we can just tell people to ignore the law!"


Now, part of the individual mandate is dependent upon the employer mandate. I wonder if they've yet thought through the ripple effect that suspending the latter is inevitably going to have on the former.



Anyone else remember the Keystone Kops short films?

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Just had a chance to read up on the details of this amazing announcement:

While technically the employer mandate is the law of the land, the Obama administration announced that they would suspend enforcement of that part of the law for a year.

Effective translation: go ahead and knowingly ignore the law, but only for this year, and we promise to look the other way, but only for this year.


[long-winded diatribe redacted]



If Congress had any spine, members of both parties would be saying "not so fast here. Look, if you want that part of the law to be suspended for a year, you have to ask us to pass a law to authorize it. You can't pick and choose which parts of what laws you want to enforce, and which parts you want to ignore. We'll amend the law. It is very important to us that our constituents be law-abiding citizens. You can't advise people not to comply with the law, that is a terrible precedent. No way we can just tell people to ignore the law!"


Now, part of the individual mandate is dependent upon the employer mandate. I wonder if they've yet thought through the ripple effect that suspending the latter is inevitably going to have on the former.



Anyone else remember the Keystone Kops short films?

Let him do it. Then use it as grounds for impeachment.

 

[joecct]

Re: The PPACA - Implementation Phase I

To pay the tax or pay the premium, that is the question...

http://www.boston.com/lifestyle/hea...pt-out/0AMHQuD1C5O6mBbXxOn47H/singlepage.html

 

[brookyone]

Re: The PPACA - Implementation Phase I

To pay the tax or pay the premium, that is the question...

http://www.boston.com/lifestyle/hea...pt-out/0AMHQuD1C5O6mBbXxOn47H/singlepage.html

Dan Lopez rarely gets sick and hasn’t been to a doctor in 10 years, so buying health insurance feels like a waste of money.

Even after the federal health overhaul takes full effect next year, the 24-year-old said he will probably decide to pay the $100 penalty for those who skirt the law’s requirement that all Americans purchase coverage.

‘‘I don’t feel I should pay for something I don’t use,’’ said the Milwaukee resident, who makes about $48,000 a year working two part-time jobs.

I haven't had a collision, been victimized by vandals, car thieves...haven't had my vehicle broken into, damaged...haven't filed any claim against my auto insurance in thirty years. I don't think I should have to buy auto insurance. My house hasn't burned down, been hit by a tornado or damaged in any way...haven't filed a homeowners claim ever. I don't think I should have to pay for any insurance I don't use...because I always buy insurance desperately hoping I'll have a reason to use it.

Speaking of a waste of money...responsible folks who buy health insurance covering their own care then picking up the tab for Dan when he has an accident or does need care for any reason. Wasting someone else's money on his behalf works for old Dan though I suppose.

 

[Rover]

Re: The PPACA - Implementation Phase I

Ever notice how knuckledraggers all try to hit the same theme at once? I recall back when Uncle Joe Biden crushed Weasel Paul Ryan so thoroughly in their VP debate, every right wing pundit and their accolytes were forced to hit the same theme, at the same time, which was Biden was too hard on the poor little wimp.

So, apparently "you can't see a doctor because they're all overbooked" is the dinosaur argument of the day. Problem is, you don't have to see a PCP to get treatment! What's that you say?!?!?! Its true! You can see a physician's assistant in a lot of cases, or you can go to the minute clinic at the CVS for example. But, you say, didn't you just completely obliterate the knuckledragger argument of the day?!?!? Why yes, yes I did.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

Ever notice how knuckledraggers all try to hit the same theme at once? I recall back when Uncle Joe Biden crushed Weasel Paul Ryan so thoroughly in their VP debate, every right wing pundit and their accolytes were forced to hit the same theme, at the same time, which was Biden was too hard on the poor little wimp.

So, apparently "you can't see a doctor because they're all overbooked" is the dinosaur argument of the day. Problem is, you don't have to see a PCP to get treatment! What's that you say?!?!?! Its true! You can see a physician's assistant in a lot of cases, or you can go to the minute clinic at the CVS for example. But, you say, didn't you just completely obliterate the knuckledragger argument of the day?!?!? Why yes, yes I did.

I don't know about any themes going on in the national press, I've not been paying attention to the political news lately.

And no, really, you didn't obliterate anything.

Obamacare was designed such that a person would make regular visits with his/her PCP. The reason being that the PCP is cheaper, can take care of the vast majority of mundane issues, and would create a baseline relationship between physician and patient, thus allowing for abnormalities to be caught earlier and thus cheaper care. Oh, my patient normally has blood pressure readings of 105-over-70, and today she came in with 125-over-85, well, I now know something is potentially wrong. Meanwhile another doctor with no experience with that patient would just think those numbers are borderline high and give the patient a pass.

It's the very heart of the PPACA's reasoning and planning. And now you're skirting the issue because it's become politically expedient.

 

[Rover]

I don't know about any themes going on in the national press, I've not been paying attention to the political news lately.

And no, really, you didn't obliterate anything.

Obamacare was designed such that a person would make regular visits with his/her PCP. The reason being that the PCP is cheaper, can take care of the vast majority of mundane issues, and would create a baseline relationship between physician and patient, thus allowing for abnormalities to be caught earlier and thus cheaper care. Oh, my patient normally has blood pressure readings of 105-over-70, and today she came in with 125-over-85, well, I now know something is potentially wrong. Meanwhile another doctor with no experience with that patient would just think those numbers are borderline high and give the patient a pass.

It's the very heart of the PPACA's reasoning and planning. And now you're skirting the issue because it's become politically expedient.

Wrong. While Obamacare does make it easier for you to see you PCP for regular checkups, which are generally a once a year thing, it also tries to keep people from the more expensive ER for minor problems. If you have insurance, you can simply go to either the local CVS or a physician's assistant in the same practice as your PCP and get treatment. See, the PCP most likely lets his staffers see your medical info, no?

So, once again I've obliterated a right wing talking point. BTW, its raining today and no, Obamacare didn't promise nothing but sunny days either so I just saved you all some bandwidth over your next complaint! No need to thank me.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

Wrong. While Obamacare does make it easier for you to see you PCP for regular checkups, which are generally a once a year thing, it also tries to keep people from the more expensive ER for minor problems. If you have insurance, you can simply go to either the local CVS or a physician's assistant in the same practice as your PCP and get treatment. See, the PCP most likely lets his staffers see your medical info, no?

So, once again I've obliterated a right wing talking point. BTW, its raining today and no, Obamacare didn't promise nothing but sunny days either so I just saved you all some bandwidth over your next complaint! No need to thank me.

My in-network orthopedic surgeon had no access to my records from my PCP. EMRs aren't as advanced/share-able as you seem to think.

And seeing Dr. Habib while I normally see Dr. DeWalt is hardly the same thing. And what good is having Dr. DeWalt as my PCP if I'm never able to get an appointment with the good doctor?

 

[Rover]

My in-network orthopedic surgeon had no access to my records from my PCP. EMRs aren't as advanced/share-able as you seem to think.

And seeing Dr. Habib while I normally see Dr. DeWalt is hardly the same thing. And what good is having Dr. DeWalt as my PCP if I'm never able to get an appointment with the good doctor?

It sounds like your problem is not with Obamacare but rather with your provider. If an in network doctor doesn't have access to your medical records might I suggest you take your business elsewhere if possible? Obamacare isn't meant to legislate away incompetence. I left a network and then returned 5 years later and they still had all my records.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I don't know about any themes going on in the national press, I've not been paying attention to the political news lately.

And no, really, you didn't obliterate anything.

Obamacare was designed such that a person would make regular visits with his/her PCP. The reason being that the PCP is cheaper, can take care of the vast majority of mundane issues, and would create a baseline relationship between physician and patient, thus allowing for abnormalities to be caught earlier and thus cheaper care. Oh, my patient normally has blood pressure readings of 105-over-70, and today she came in with 125-over-85, well, I now know something is potentially wrong. Meanwhile another doctor with no experience with that patient would just think those numbers are borderline high and give the patient a pass.

It's the very heart of the PPACA's reasoning and planning. And now you're skirting the issue because it's become politically expedient.

This is assuming that your PCP is still around, or doesn't start charging higher for checkup care in order to cover the cost of the administration, even if outsourced, in order to make sure that the PCP maintains compliance with PPACA. Eventually, so many patients would eventually be lost due to an inability to pay and going to the public health system (counties in NYS have these set up) that you'd end up transitioning to the system that the UK has. Would that happen right away like the they're-all-doom-and-gloom-huff-and-puffers keep spouting in their talking points about tin foil hats? Probably not, but the long term is a different story.

 

[joecct]

It sounds like your problem is not with Obamacare but rather with your provider. If an in network doctor doesn't have access to your medical records might I suggest you take your business elsewhere if possible? Obamacare isn't meant to legislate away incompetence. I left a network and then returned 5 years later and they still had all my records.

Good luck switching. Number of docs down here say "Not accepting new patients." And I know by Les there is a shortage of primary care docs.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

you don't have to see a PCP to get treatment! What's that you say?!?!?! Its true! You can see a physician's assistant in a lot of cases, or you can go to the minute clinic at the CVS for example.

or you could just go to the emergency room and we wouldn't have needed PPACA in the first place, eh?

 

[unofan]

Good luck switching. Number of docs down here say "Not accepting new patients." And I know by Les there is a shortage of primary care docs.

How is a doctor shortage the fault of the ACA? What it sounds like on here is people who formerly didn't worry about it because they had insurance while others did not (and who impliedly did not deserve care otherwise they would have had it already) are now ****ed off because more people have insurance and access to their previously exclusive medical care.

Sorry, but the solution to a shortage of doctors isn't to artificially restrict the availability to them. It's to curtail the AMA's power to restrict medical licenses. Encouraging more medical schools (which, unlike law schools, are typically money losers for universities) would be helpful too.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

How is a doctor shortage the fault of the ACA?

because of the number of doctors who decided to retire rather than deal wtih it, probably.

 

[Rover]

Good luck switching. Number of docs down here say "Not accepting new patients." And I know by Les there is a shortage of primary care docs.

Just switched this year and had zero problems doing so (I changed insurance and networks). I also live in the only state where universal care is up and running so I'm not sure what the problem is.

Health care needs to evolve in several ways. 1) If there's a need for a service, more professionals will drift towards that service, or take on more of a workload, in an effort to increase earnings. The concept is simple - if your town supports two gas stations, and one closes because the owner retires, you can now open one up across the street and make $$$ without having to charge people more than the going rate for a gallon of gas. You're filling hole in the supply of the product. 2) People need not get every aspect of medical care from a primary or the ER. In fact they may be better off finding more convenient options, which benefits everyone.