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

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

ScoobyDoo said:
No one is saying that's what is happening. What is happening is all the juice (money, research) is going into chronic care cause that's where the profit is. Medicine is not a good place to be assigning a profit model but that's exactly what we are and have been doing.
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The profit model is what led to the finding of the cure for Hep C. What's wrong with that? Without the profit model a huge number of medical breakthroughs would never have occurred.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

St. Clown said:
If a company comes across a cure for a disease and withholds it in favor of treating a chronic ailment, what would be the fallout once that news was divulged? It would destroy the company's reputation, and it would likely be sued by anybody currently suffering from the disease or anybody who's lost a loved one from that disease since the date the cure was discovered. And it's not a matter of IF, it's a matter of WHEN information of that discovery would be released.
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Not necessarily. That's why you don't seek FDA approval for the cure, or have Congress legislate a ban on something involved with the cure. You then have an out, and anyone who complains about it is outed as "tin foil hat".
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

WisconsinWildcard said:
This is more what I suspected. Please do not let me put any words in your mouth and correct me if I am wrong but broadly, you had a full career and probably did not lose many practice years due to bureaucracy.

My response to flag was when he broadly implied physicians are no longer practicing medicine because of the bureaucracy. I freely acknowledge that it is a problem and something that should be perpetually refined (or challenged) but I have not seen any numbers that would leave me to believe we are losing significant physician work/years over the issue. I know plenty of docs who decided to hang it up once private practice became unfeasible or the role of government peeved them too much but these are physicians near the end of their career (65+), not newly minted physicians. From the conversations I have had with my elders, they could retire whenever they wanted and this provided the catalyst, but was not the sole reason or the majority (in most cases).

I do not doubt there are young physicians who have given it up, I just believe them to be in small numbers unless I see numbers otherwise. I know there are people who have chosen not to go into medicine for that reason, but there are plenty of capable applicants to take their place in medical school. Medicine will always be in motion and I suppose you just practice until the motion is too much, you have accomplished what you set out to do, or you die. I am young and naive (relatively) but I really fear the day when I do not love what I do (it truly is a privilege).

As for residency: Derm is still near the tops for competitiveness. I think ophthalmology is as well, however I have a skewed perception since my alma mater traditionally matches really well into that so I have heard relatively few who have failed to match.

Others are plastics and neurosurgery. The past few years have had relatively competitive general surgery and OB/Gyn matches (at least going by board scores). You can basically always match into family or internal medicine somewhere.

Here is the 2015 brief match data: http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf

And the long 2014 match data: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf
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WWC: Sorry for the long delay in response but have off line for a while. Almost always find that I agree with what you post and you support your positions well. In my own case the choice to slow down and even to close the office and practice as I do now was simple. I did not choose to be a physician to take orders from anyone. When i started to see the handwriting on the wall, when 21 year old young ladies on the phone for Insurance companies and Medicare were telling me how to practice, who to see, what to charge and worse, what to prescribe, I felt it would be better for me to make some changes. I never wanted to be a Provider, i was a physician. I did my own history and physical, came up with a differential diagnosis list, prescribed and treated or performed whatever surgery was needed on anyone and everyone. Once i was being told that i could not treat someone(because they did not go through the proper channels or have the proper referral) or told I could not prescribe a certain medication because of its expense(and had to prescribe either a generic version of it or some other cheaper medication) I bristled. I would have accepted that sort of notion as advice from a fully trained physician colleague, but not from some employee of an insurer. I felt what they were doing was akin to practicing medicine without a license. Yet I was the one ultimately responsible for my patient's welfare and certainly LEGALLY the one who would be targeted if anything went amiss.
What I mentioned in a previous post is exactly how I felt. I was indeed fortunate to have practiced long enough to remove myself from that regulated and controlled environment and do mostly consultation work pro bono. I am sure years ago I probably could not have conceived of being able to do it, but I still provide medical care albeit only for those that i choose to see. But I bill no one, not Medicare (although i certainly could), not an insurance company, and most certainly not the patient. This allows me to still be an unencumbered physician who can try to provide the best care for those I tend to. I do not have to listen to anyone who tries to tell me what i can or cannot do or restrict what I suggest on the basis of their unwillingness to pay for it. I must say, it gives me a warm and fuzzy feeling. It may not work for many others, but Jenny and i have been doing this for almost 15 years now and find it truly rewarding. As far as earning a living and paying the bills? Well, that is what Wall Street and other investing is for.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

DrDemento said:
WWC: Sorry for the long delay in response but have off line for a while. Almost always find that I agree with what you post and you support your positions well. In my own case the choice to slow down and even to close the office and practice as I do now was simple. I did not choose to be a physician to take orders from anyone. When i started to see the handwriting on the wall, when 21 year old young ladies on the phone for Insurance companies and Medicare were telling me how to practice, who to see, what to charge and worse, what to prescribe, I felt it would be better for me to make some changes. I never wanted to be a Provider, i was a physician. I did my own history and physical, came up with a differential diagnosis list, prescribed and treated or performed whatever surgery was needed on anyone and everyone. Once i was being told that i could not treat someone(because they did not go through the proper channels or have the proper referral) or told I could not prescribe a certain medication because of its expense(and had to prescribe either a generic version of it or some other cheaper medication) I bristled. I would have accepted that sort of notion as advice from a fully trained physician colleague, but not from some employee of an insurer. I felt what they were doing was akin to practicing medicine without a license. Yet I was the one ultimately responsible for my patient's welfare and certainly LEGALLY the one who would be targeted if anything went amiss.
What I mentioned in a previous post is exactly how I felt. I was indeed fortunate to have practiced long enough to remove myself from that regulated and controlled environment and do mostly consultation work pro bono. I am sure years ago I probably could not have conceived of being able to do it, but I still provide medical care albeit only for those that i choose to see. But I bill no one, not Medicare (although i certainly could), not an insurance company, and most certainly not the patient. This allows me to still be an unencumbered physician who can try to provide the best care for those I tend to. I do not have to listen to anyone who tries to tell me what i can or cannot do or restrict what I suggest on the basis of their unwillingness to pay for it. I must say, it gives me a warm and fuzzy feeling. It may not work for many others, but Jenny and i have been doing this for almost 15 years now and find it truly rewarding. As far as earning a living and paying the bills? Well, that is what Wall Street and other investing is for.
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I think your posts capture very well the essence and passion of being a physician.

I can only speak for myself, and my experiences, but at this point I do not feel like I have lost much of the autonomy you describe. I have only worked for large academic centers (though I have rotated through many different settings in training) and I admit, the administrators are a presence. However, it my limited experience, I have found them to be an asset instead of a burden. Day to day, I do not have to worry about profits, dealing with insurance, etc very often. I can delegate that to others. If I have the patient's best interest in mind, and evidence to back it up, they are the supporting staff that serve as bulldogs to help navigate the system while I can focus on patient care. I have been educated on what I need to document to bill at certain levels but I feel no pressure to "bill higher" unless it is my professional opinion that the documentation is necessary and important for patient care.

Here are just some random thoughts...no reply to anything in particular. There are many things that have been lost in the profession of medicine. I would love to live in the time of home calls. I lament when colleagues disparage proper physical exam techniques because we can easily rely on imaging. I wish we could live in a system where everyone could afford the needed care. But with those losses, we have also gained much power. We can sequence a genome for ever expanding clinical application. I can avoid redundant testing because I can access hospital data from many hospitals and institutions. I can tell if I am being scammed for pain medication by looking up what other docs are prescribing things to my patient.

Your second paragraph speaks volumes about the type of physician you are, and I think, what physicians should aspire to be. Retirement is far in my future (hopefully) but when meeting with my financial adviser, he asked me what my retirement goals were. All I could really think of to say is that I want the ability to stop practicing medicine at a point but not want to.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

FlagDUDE08 said:
Not necessarily. That's why you don't seek FDA approval for the cure, or have Congress legislate a ban on something involved with the cure. You then have an out, and anyone who complains about it is outed as "tin foil hat".
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It is a very complex issue. If you can handle it, you should read the Emperor of all Maladies. There is a good case describing a cancer treatment and patients fighting to use it while the company wanted to ensure safety.

Right to try laws are tricky. I have a very nuanced position on it but a blog that provides good discussion by a physician is Respectful Insolence.
Here is Dr. Gorski's last article on it, he does a good job referencing earlier conversations.
http://scienceblogs.com/insolence/2...t-is-right-to-try-continues-to-spread-part-2/
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

So, the guy who brought the case to the Supreme Court that could take Obamacare down doesn't care about the consequences. And guess why. Cause he has his own taxpayer funded health insurance.

Hypocrite.

http://www.msnbc.com/rachel-maddow-show/why-david-kings-indifference-matters?cid=sm_fb_maddow

…Mr. King said that he was not really worried about the outcome of the case, King v. Burwell, because as a Vietnam veteran, he has access to medical care through the Department of Veterans Affairs.

If he wins, Mr. King said, “the left will blow it out of proportion and claim that eight million people will lose their health insurance.” But he said lawyers had assured him that “things are in play to take care of the problem.”
Click to expand...
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

A new CBO report finds that repealing the Affordable Care Act would cost the U.S. government $137 billion over the next decade.

“The new report is the first federal assessment since the main provisions of the law took effect in 2014. It found that repealing the health-care law would increase deficits by $353 billion over 10 years. But after taking into account economic factors, including slightly larger workforce participation that would result from repealing the law, that amount would fall to $137 billion.”

“The analysis also concluded that repealing the health-care law would increase the number of uninsured Americans by 19 million in 2016.”

http://politicalwire.com/2015/06/19/obamacare-repeal-would-cost-137-billion/
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Rover said:
A new CBO report finds that repealing the Affordable Care Act would cost the U.S. government $137 billion over the next decade.

“The new report is the first federal assessment since the main provisions of the law took effect in 2014. It found that repealing the health-care law would increase deficits by $353 billion over 10 years. But after taking into account economic factors, including slightly larger workforce participation that would result from repealing the law, that amount would fall to $137 billion.”

“The analysis also concluded that repealing the health-care law would increase the number of uninsured Americans by 19 million in 2016.”

http://politicalwire.com/2015/06/19/obamacare-repeal-would-cost-137-billion/
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It's no wonder the Republicans want to kill it.
 
Rover said:
A new CBO report finds that repealing the Affordable Care Act would cost the U.S. government $137 billion over the next decade.

“The new report is the first federal assessment since the main provisions of the law took effect in 2014. It found that repealing the health-care law would increase deficits by $353 billion over 10 years. But after taking into account economic factors, including slightly larger workforce participation that would result from repealing the law, that amount would fall to $137 billion.”

“The analysis also concluded that repealing the health-care law would increase the number of uninsured Americans by 19 million in 2016.”

http://politicalwire.com/2015/06/19/obamacare-repeal-would-cost-137-billion/
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And the War on Poverty costs how much? The War on Drugs? Overseas military commitments?

137 billion is a drop in the bucket. :)
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Every time one of those lists comes out, I find it shocking only when Minnesota isn't #1 overall. It's such a great state to live in.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Its a pretty tall order asking the Court to overturn something like this. You'd pretty much need 5 Scalia's to do so.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Rover said:
Its a pretty tall order asking the Court to overturn something like this. You'd pretty much need 5 Scalia's to do so.
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Scalias or Alitos. Scalia votes based on conservative political ideology, Alito votes based on Republican party affiliation.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Bernie's email to his supporters:

Today, because of the Supreme Court's decision to protect the modest gains made under the Affordable Care Act, it is a good day for millions of Americans who will be able to keep their access to health care.

It's also a good day for the small business owners who, before the passage of the Affordable Care Act, couldn't afford the escalating cost of providing insurance for their employees.

But while I am glad the Supreme Court upheld the law, in my view, the only long-term solution to America's health care crisis is a Medicare-for-all single-payer system.

I start my approach to health care from two very simple premises:

1. Health care must be recognized as a right, not a privilege -- every man, woman and child in our country should be able to access quality care regardless of their income.

2. We must create a national system to provide care for every single American in the most cost-effective way possible.

Tragically, the United States fails in both areas.

The health insurance lobbyists and big pharmaceutical companies make "national health care" sound scary. It's not.

In fact, a large single-payer system already exists in the United States. It's called Medicare and the people enrolled give it high marks. More importantly, it has succeeded in providing near-universal coverage to Americans over age 65 in a very cost-effective manner.

It's time to expand that program to all Americans.

If we are serious about providing high-quality, affordable care as a right for all Americans, the only solution to this crisis is a Medicare-for-all single-payer system. Add your name to our petition if you agree.

The American people understand that our current health care system is not working.

They understand that the profiteering of the pharmaceutical industry and private insurance companies causes the United States to spend more per capita on health care than any other nation, while our life expectancy, infant mortality and preventable deaths outcomes are worse than most other countries.

We should be spending our money on care and disease prevention, not paper-pushing and debt collection. But the simple truth is that our efforts to eliminate waste and profiteering are endangered by these powerful corporate interests.

A single-payer system will expand employment and lift a major financial weight off of businesses burdened by employee health expenses. And the millions of Americans stuck in jobs they don't like, they would be free to explore more productive opportunities as they desire.

I attempted to offer a single-payer amendment during the Affordable Care Act debate, but my efforts were blocked.

But our time will come.

Add your name to mine if you agree it's time for America to adopt a Medicare-for-all single-payer health care system.

I am convinced today more than ever before that universal quality health care as a right will eventually become the law of the land. It is the only way forward.
Thank you for adding your name to mine,
Bernie Sanders
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Re: The PPACA Thread Part III - Let's have a healthy debate!

Kepler said:
Bernie's email to his supporters:
Click to expand...

Interesting. I celebrated when this case passed the SCOTUS. But there is a risk of going to far.

Right now, we may not have quite as comprehensive of coverage for everyone as some other countries. But there's no place in the world I'd rather have triple bypass surgery, CKD or any other serious malady. And while I get knocking the insurance industry as a middle layer in just about every sector they're in...my opinion is that the pharma industry gets way too much flack. Medicines they make save lives...pure and simple. But they need to be prescribed correctly. Do they sell them? Sure do. But just as with defense in a court case...you need someone to make sure that an outcome is properly considered. The doctors and patients need to make the final decisions. So I'm of the opinion that we can continue to refine the ACA...but just as with invading a country, you don't know what outcomes you'll get after you rip up the current system.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Kepler said:
Bernie's email to his supporters:
Click to expand...
Bernie is 100% correct in his statement that this is a huge benefit to small businesses.

I saw a statistic one time that showed there were about 6 million employers in this country. Of those 6 million businesses (I think they called them "firms"), somewhere between 5 and 5.5 million have fewer than 20-25 employees.

The ACA didn't make health insurance more affordable for small businesses. It gave them the opportunity to discontinue health insurance altogether without leaving their employees cold. Those businesses were able to give their employees a small, one time raise and send the employees out on the exchange, and finally, after all these years, separate themselves from the giant financial mill stone that was employee health insurance. I speak from personal experience. As a business owner that offered employee health insurance, and knowing what I know now, if you let me go back in time and asked me if I would be in favor of the ACA, I would say 100%.

Now, I personally believe it's going to come at a substantial, and very difficult cost. First, all these people out on the exchange are now going to have the burden of expanding health insurance costs heaped upon them, which will ultimately result in greater and greater subsidies until we get to a point where the government has just effectively expanded medicare to everyone. Until something is actually done about the cost of health care, this is going to gut the lower to middle class. All those employees of small businesses who used to have at least a portion of their health insurance picked up by their employer can now stand in line for subsidies.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

5mn_Major said:
Interesting. I celebrated when this case passed the SCOTUS. But there is a risk of going to far.

Right now, we may not have quite as comprehensive of coverage for everyone as some other countries. But there's no place in the world I'd rather have triple bypass surgery, CKD or any other serious malady. And while I get knocking the insurance industry as a middle layer in just about every sector they're in...my opinion is that the pharma industry gets way too much flack. Medicines they make save lives...pure and simple. But they need to be prescribed correctly. Do they sell them? Sure do. But just as with defense in a court case...you need someone to make sure that an outcome is properly considered. The doctors and patients need to make the final decisions. So I'm of the opinion that we can continue to refine the ACA...but just as with invading a country, you don't know what outcomes you'll get after you rip up the current system.
Click to expand...

Bernie's campaign aides need to warn him about being the skunk at a picnic. I say again, I have no philosophical opposition to single payer. I'd just like to see a real world example IN THE US of it working, much like how the Massachusetts law foreshadowed the ACA.
 
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