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The PPACA Implementation Phase II - Love it or Lose it!

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Re: The PPACA Implementation Phase II - Love it or Lose it!

My religion is against paying taxes. Guess I'm home free.


You've said previously that your tax-free disability benefits combined with whatever other income you have leave you paying little to no taxes anyway. Guess you are in heaven, eh? :rolleyes:
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

While "having to" change your doctor is fairly commonplace, being able to find a new one is definitely getting harder than it was. There are more doctors retiring than are being added as new ones; and provider networks are becoming more restricted than before. There are documented stories about counties in Florida that have 19 OB-GYN total for 295,000 people, presumably half of which are women. Toss out the youngest and oldest, you still have 19 OB-GYN for, say, 100,000 women, or about 5,000 women per OB-GYN. That's 100 per week or 20 per day if each is seen only once a year. If a visit is 30 minutes long, that's a 10 hour day with no breaks of any kind to do anything else except see patients....and of course the law mandates other new obligations upon doctors beyond patient care.

Tweak the numbers a little if you will, you are still looking at a big mismatch between how many people want to see doctors and how much time is available within which to be seen, especially if follow-up care is needed. More and more care by necessity will come from nurse practitioners and physician assistants, there just aren't enough doctors to handle the increased demand with restricted supply.

My new doctor isn't taking new patients and hasn't been for awhile, the only reason she agreed to accept me was that my previous doctor had been part of the same practice as hers and he retired from seeing patients (he still works part-time teaching). He didn't want to retire either, he told me at our last visit (end of last year) that he loved the practice of medicine and enjoyed seeing patients, he was reluctantly leaving patient care because he wasn't willing to put up with the new rules and regulations being forced upon him against his better professional judgment. Those were his words, not mine.

Provider networks are getting smaller at the same time more people are looking for practitioners. I've read about several small towns who will be left with no doctors whatsoever because the sole practitioner in town is unwilling to comply with the new provider mandates.

When people bring these facts out, the typical response is that PPACA was meant or intended to blah blah blah and how could anyone criticize it based on such noble ambitions? well, if it doesn't work in practice, that's empirical data. Sensible people adjust their behavior when they get data telling them that something is going wrong. Idealogues insist that we must keep doing the same thing, only harder and more of it. The two sides are talking past each other entirely and neither one is hearing what the other is saying. It's a situation in which both are "right" because they are talking about two different things entirely.

That was all happening before Obamacare. And as usual the legislature is not into solving the real problem, they're only (and only the left) interested in taking over for a private sector that refuses to step up.
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

When people bring these facts out, the typical response is that PPACA was meant or intended to blah blah blah and how could anyone criticize it based on such noble ambitions? well, if it doesn't work in practice, that's empirical data. Sensible people adjust their behavior when they get data telling them that something is going wrong. Idealogues insist that we must keep doing the same thing, only harder and more of it. The two sides are talking past each other entirely and neither one is hearing what the other is saying. It's a situation in which both are "right" because they are talking about two different things entirely.

I have no idea what the short terms affects will be. But I can tell you that new companies are springing up all over the place to take advantage of the changes. You'll see much more custom healthcare...and with these changes technology will enable healthcare in the home and on the go (rather than in the hospital). From what I can tell these changes will not make healthcare cheaper...but for about the same price we should have much more flexibility and availability in the delivery of healthcare.
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

That was all happening before Obamacare. And as usual the legislature is not into solving the real problem, they're only (and only the left) interested in taking over for a private sector that refuses to step up.

So if Congress passed a law to allow machine guns and that was shown to increase the incidence of school shootings, you'd be okay with that since school shootings were happening before the law anyway?
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

So if Congress passed a law to allow machine guns and that was shown to increase the incidence of school shootings, you'd be okay with that since school shootings were happening before the law anyway?

Under the Constitution machine guns are legal. So, bring them on.
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

That was all happening before Obamacare. And as usual the legislature is not into solving the real problem, they're only (and only the left) interested in taking over for a private sector that refuses to step up.


Exactly. Where was all this whining before the ACA got passed? There's been a doctor shortage for years. The free market will presumably solve the problem as either 1) more people enter the profession to fill the demand, or 2) people seek out substitutes for having a PCP (CVS minute clinics for example). What the ACA has done, or put in a better way, will do is cause more people to get insurance, which will no doubt add demand onto the healthcare system on one end (primary care doctors) but lessen it on another (ER visits). So yes, the market will have to adjust, much like it has to given that the population of the United States continues to grow.
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

I have no idea what the short terms affects will be. But I can tell you that new companies are springing up all over the place to take advantage of the changes. You'll see much more custom healthcare...and with these changes technology will enable healthcare in the home and on the go (rather than in the hospital). From what I can tell these changes will not make healthcare cheaper...but for about the same price we should have much more flexibility and availability in the delivery of healthcare.

Very good point, agree with you totally: these changes will be great for those people who can afford to step outside the "insurance" world entirely. The shift toward "concierge" doctors is well underway: either doctors will not deal with insurance companies directly at all (you see the doctor, you pay the doctor and file the forms yourself and wait for the insurance check), OR, what is becoming increasingly popular already, you pay the doctor a flat fee every year for all the services you might need that year, and you only maintain insurance for hospitalization coverage and perhaps prescription drug coverage.

Another unintended consequence: the idea was supposed to be that everyone would get access to healthcare no matter what their income level, and the result will be that we will wind up with two separate healthcare systems entirely, one for those who can afford to pay privately, and another for everyone else.

I wonder how soon it will be until a law is proposed making "concierge" medicine illegal?
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

Very good point, agree with you totally: these changes will be great for those people who can afford to step outside the "insurance" world entirely. The shift toward "concierge" doctors is well underway: either doctors will not deal with insurance companies directly at all (you see the doctor, you pay the doctor and file the forms yourself and wait for the insurance check), OR, what is becoming increasingly popular already, you pay the doctor a flat fee every year for all the services you might need that year, and you only maintain insurance for hospitalization coverage and perhaps prescription drug coverage.

Another unintended consequence: the idea was supposed to be that everyone would get access to healthcare no matter what their income level, and the result will be that we will wind up with two separate healthcare systems entirely, one for those who can afford to pay privately, and another for everyone else.

I wonder how soon it will be until a law is proposed making "concierge" medicine illegal?

I know that Australia has a dual-tract health system, the govt paid program and then another for those willing to pay for the premium care. Like you note, that's probably going to be made illegal here because it isn't "fair".
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

You've said previously that your tax-free disability benefits combined with whatever other income you have leave you paying little to no taxes anyway. Guess you are in heaven, eh? :rolleyes:

The first 38% of my disability payments are taxable income. 100% of my Social Security is taxable income.
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

Under the Constitution machine guns are legal. So, bring them on.

For Christmas, I asked Santa for a couple of MOABs and a nuclear device. I hope he delivers!
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

Very good point, agree with you totally: these changes will be great for those people who can afford to step outside the "insurance" world entirely. The shift toward "concierge" doctors is well underway: either doctors will not deal with insurance companies directly at all (you see the doctor, you pay the doctor and file the forms yourself and wait for the insurance check), OR, what is becoming increasingly popular already, you pay the doctor a flat fee every year for all the services you might need that year, and you only maintain insurance for hospitalization coverage and perhaps prescription drug coverage.

Another unintended consequence: the idea was supposed to be that everyone would get access to healthcare no matter what their income level, and the result will be that we will wind up with two separate healthcare systems entirely, one for those who can afford to pay privately, and another for everyone else.

I wonder how soon it will be until a law is proposed making "concierge" medicine illegal?

The desire to make everybody equal until it kills them would quite ironic if it weren't a governance strategy
 
Re: The PPACA Implementation Phase II - Love it or Lose it!

A sobering thought from Peggy Noonan:

There are also the words this year that were most conspicuous by their absence. They're the words we don't use when we talk about health care. Actually we don't talk much about health care, we talk about health insurance. Fox News's Jim Pinkerton says the absent words in the ongoing debate are "medicine," "research" and "cure." Do you want to make a dent in future health-care costs? Cure Alzheimers. That's where the cost will be as the health of the baby boomers falters. Insurance isn't the key. It was never the key. It's a product. Cure and care are the words of the future. [emphasis added]

The entire structure of PPACA is focused on the wrong thing!
 
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