The Sad Case of the Patient Protection and Affordable Care Act

[FlagDUDE08]

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

http://gma.yahoo.com/doc-shortage-could-cause-healthcare-crash-172501425--abc-news-health.html (from that hotbed of conservative values, ABC News):




Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?

ABC is the provider of news for CNY Talk Radio, the alternative station (i.e. not the wallbanger or golfer).

 

[joecct]

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

Fish-Most of my cohorts have indeed retired or are considering it precisely for that reason. Jenny and I are losing all our personal physicians-and honestly we no longer have a primary care physician at all. If we did not have the medical training ourselves, we would not know who to see for anything.

My son's insurance would not pay an ER claim because he did not have (could not find) a primary care physician.

Guess we're headed to concierge (for the more well off) or clinics. Stinks?

 

[unofan]

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

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

The problem there is a shortage of doctors, which is itself primarily a result of the shortage of medical schools (which, unlike law schools, are generally not money makers for universities) and available spots within said schools.

Or are you really arguing that having more people covered by insurance/health coverage is a bad thing because more people will then seek medical services?

 

[leswp1]

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

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

Hello- Reality is we have had a large aging population of people that have not been able to get care and are now visible because they can afford to get care. To act like the law created need is silly. 'adding all these people' is what should happen. In just about every other civilized country all these people would have been in the system to begin with.

The problem is we have a system that is not focused on prevention and does not financially reward the people we now are relying on to handle the overall management of the patient. No one thought to listen to the medical people who were saying there are not enough providers to manage the volume. People continued to go into the more lucrative specialties. We have some parts of the system saying there won't be enough MDs and trying to ramp up NPs and PAs to fill this gap with initatiives to do so. Another part is actively trying to exclude PAs and NPs from the system all together and barring that trying to put in place rules that will be so restrictive it will drive us out of the system (the practices won't be reimbursed at a level that makes it worth their while if they hire us).

We continue to tolerate a system that is driven by profit with CEOs that make the gross product of several small countries no matter what their performance. We continue to tolerate unqualified people making decisions to deny treatment and testing and think that is OK as long as the gov't isn't in control of the criteria.

MDs were retiring in large numbers before this bill. Numbers of hospitals were also decreasing. The system has been breaking for a long time. Demand for resources has been increasing with our aging population. Instead of looking at how to decrease cost in a reasonable way we let the 'market' drive our thought process. The market does not have a medical degree and is not motivted to decrease their profits. Lobbyist for the pharma companies have no reason to want to decrease medication cost. Insurance companies do not want to put out for prevention.

 

[huskyfan]

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

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

 

[leswp1]

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

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

In Mass the board that determines reimbursement has 2 primary care MDs and 26 specialists on it. You probably do not need a road map.

 

[FlagDUDE08]

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

You know what really irks me about all of these arguments... people can point the fingers at physicians requiring unnecessary tests, or pharmaceuticals overcharging for meds, or insurance companies not providing services, yet no one has the balls to go after the sheeple that can't take care of themselves. If you screw up, that doesn't mean I am to pay for you. Pay for your own stupidity, DAMMIT!

 

[DrDemento]

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

You know what really irks me about all of these arguments... people can point the fingers at physicians requiring unnecessary tests, or pharmaceuticals overcharging for meds, or insurance companies not providing services, yet no one has the balls to go after the sheeple that can't take care of themselves. If you screw up, that doesn't mean I am to pay for you. Pay for your own stupidity, DAMMIT!

Just an incredibly sensible thought. And of course will be totally ignored by the powers that be.

 

[DrDemento]

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

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

The other side of the coin is to pare down the payments for the procedures that specialists perform. That has happened-ophthalmologists get paid far less for cataract surgery now than they did years ago. But the problem is that there seem to always be newer more expensive procedures developed-or variations of old ones that are reimbursed differently and the beat goes on.

 

[FlagDUDE08]

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

Just an incredibly sensible thought. And of course will be totally ignored by the powers that be.

I dunno, the messiah dictator might take it seriously. After all, he doesn't have to please anyone any longer.

 

[FreshFish]

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

'adding all these people' is what should happen. In just about every other civilized country all these people would have been in the system to begin with..

Which to a sensible person means you actually have a plan for how to integrate them, no?

The problem is we have a system that is not focused on prevention

yes, very much so, yet look at what happens when we try to introduce some incentives.

The carrot: our health insurance plan gives people $100 every six months if they go to they gym three times a week. that works pretty well.

the stick: people who engage in unhealthy habits should pay more. It's common practice for smokers to have higher rates than non-smokers, for example, yet try to have the obese pay a higher premium or lose weight and listen to the outrage! in CT the governor wanted to implement a plan by which people who work for the state actually take the prescription drugs for 4 common conditions or else pay more for their health coverage and it was a huge controversy. (the conditions were high cholesterol, high blood pressure, COPD, and diabetes). It's my understanding that all of these conditions are well-controlled with medication; physicians who presumably have on-going contact with their patients prescribe them, yet people resist taking them anyway? Why shouldn't they pay more when they don't?

 

[FreshFish]

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

Or are you really arguing that having more people covered by insurance/health coverage is a bad thing because more people will then seek medical services?

I'm saying that a comprehensive, considered, thoughtful approach that solicited input from all affected parties would have been far preferable to this cobbled-together mess of half-baked ideas we are now stuck with. We had people who literally did not know what they were doing, read a few magazine articles, and then impose restrictions with huge unintended consequences while leaving no remedial mechanism in place to mitigate those consequences.

The original post that started this thread is just as valid as ever: no matter what you think we should have done, the specific details of this particular law leave you very dissatisfied.

 

[Rover]

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

Sounds like Fishy and Flaggy are advocating a single payer system!

In reality, this is exactly why universal health care is needed. Far from the stupid notion that the solution to the doctor shortage is keeping more people uninsured, the first step is actually getting everyone insured. Once that happens you can go after costs and patient care. For example, as there is a big difference in how doctors are paid based on whether they're in general practice or specialists, this is something that clearly the market has failed at, so the gubmint as the biggest payer of medical expenses can start throwing its weight around to rectify. Another example is both preventative wellness and steps to charge irresponsible people more (as in smokers, who should be paying 10 grand, not 100 bucks extra). In a system where you can choose to blow off health insurance, these people make out like bandits. When everyone gets insurance, they get to pay their fare share.

 

[huskyfan]

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

a question for our in resident medical specialists.

my doc tells me he gets (numbers are rough - I cant remember exactly) 80 cents on the dollar from Blue Cross, 45 from TriCare (military coverage) and 20 cents from medicare. do doctors screen their patients by what insurance coverage they have? do patients with better insurance get better, quicker service?

as an aside, wow, this system is really broken.

 

[FreshFish]

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

do patients with better insurance get better, quicker service?

If any part of the TV show Royal Pains is accurate, super-wealthy people who completely self-insure get the best service of all.

Even before PPACA there were trends going in that direction: physician groups that offered subscription service. You pay a flat fee upfront, you get all the service you need throughout the year. Of course, that would not cover hospitalization, and so people who subscribed to that service still needed some insurance coverage, which pre-PPACA you could still find with a high deductible (which generally was met by the subscription fee).

One of the next laws to be passed in this arena could very well be one that makes it illegal to purchase health care services outside of the exchanges. Sigh. Like the story about the little Dutch boy and the leaking dike, you soon start to run out of enough fingers to plug every hole while you leave a contorted mess behind.

 

[FreshFish]

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

Sounds like Fishy and Flaggy are advocating a single payer system!

Do you lialways bop in and unload your bombast without paying any attention to the ongoing thoughtful conversations among the regulars?


The Federal Government Employees Insurance Program (see joecct he knows much more than I do) has had a single-payor system for a long time. You get a premium budget and then you get to pick which insurance company to spend that budget on.

Paul Ryan also proposed a single-payor system for Medicare, in case you weren't paying attention: seniors would get a premium budget and a list of insurance companies, including existing Medicare if desired, to pick which one to spend that budget on.

We were having a related conversation last night at dinner. There were people from different states, and we were comparing cable television service. Universally, everyone noticed that, as soon as competition was introduced to an area, the incumbent's service magically became much better and their pricing increases magically slowed, just like that.

Single-payor plus multiple provider could work very well. You need the threat of taking your business elsewhere to keep a service provider honest. Once you allow a monopolist to have unrestrained pricing power, you inevitably get inferior service and higher costs. that's just how life is.

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset. Makes no sense at all to a logical mind. I guess you are programmed so that your rampant cheerfleading exclusively for one side impairs your ability to think clearly outside of a partisan box??

 

[FlagDUDE08]

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

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset.

Careful, you use a term like "government monopoly", and they'll mistaken you for me!

Also, I'm still trying to find where I petitioned for a single payer system...

 

[Rover]

Do you lialways bop in and unload your bombast without paying any attention to the ongoing thoughtful conversations among the regulars?


The Federal Government Employees Insurance Program (see joecct he knows much more than I do) has had a single-payor system for a long time. You get a premium budget and then you get to pick which insurance company to spend that budget on.

Paul Ryan also proposed a single-payor system for Medicare, in case you weren't paying attention: seniors would get a premium budget and a list of insurance companies, including existing Medicare if desired, to pick which one to spend that budget on.

We were having a related conversation last night at dinner. There were people from different states, and we were comparing cable television service. Universally, everyone noticed that, as soon as competition was introduced to an area, the incumbent's service magically became much better and their pricing increases magically slowed, just like that.

Single-payor plus multiple provider could work very well. You need the threat of taking your business elsewhere to keep a service provider honest. Once you allow a monopolist to have unrestrained pricing power, you inevitably get inferior service and higher costs. that's just how life is.

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset. Makes no sense at all to a logical mind. I guess you are programmed so that your rampant cheerfleading exclusively for one side impairs your ability to think clearly outside of a partisan box??

Fishy, the next thoughful conversation that you're part of will be the first one. You seem butthurt over the fact that your party got humiliated and your ideology is going the way of the dinosaur. Neither of these are my fault, so kindly drop the anger.

The idea behind single payer, which I'm open to, is that as the government is technically a non-profit entity they can operate cheaper, and can achieve some economies of scale. Show me a proposal and I can get behind it. Ryan's plan was stupid, and has been thoroughly rejected by the American people. His block grant was fixed while healthcare costs will rise by some amount over time, thus reaming those people who coincidentally don't vote Republican while asking for no changes out of the people currently bankrupting the system. Willfully omitting key points like that destroys your credibility. Just ask Paul Ryan...

 

[DrDemento]

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

a question for our in resident medical specialists.

my doc tells me he gets (numbers are rough - I cant remember exactly) 80 cents on the dollar from Blue Cross, 45 from TriCare (military coverage) and 20 cents from medicare. do doctors screen their patients by what insurance coverage they have? do patients with better insurance get better, quicker service?

as an aside, wow, this system is really broken.

My office never asked anyone about insurance ever before an appointment was made. But that was years and years ago. We just did not care what coverage a patient had-we adapted to whatever situation the patient was in and if they truly had nothing-they paid nothing. One of the reasons i closed the office and just do consulting work was exactly what you indicate-coverage can determine care. I cannot abide by that. I did not go into medicine to be employed by an insurance company or the government. But from what I have seen-and remember, Jenny and I are patients also-every office asks as their first question what insurance do you have? We are not even asked what the problem is or is it emergent. Just how will you be covered for payment. I never thought I would ever say this-but I am glad we are no longer practicing in an office environment.

 

[DrDemento]

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

Which to a sensible person means you actually have a plan for how to integrate them, no?



yes, very much so, yet look at what happens when we try to introduce some incentives.

The carrot: our health insurance plan gives people $100 every six months if they go to they gym three times a week. that works pretty well.

the stick: people who engage in unhealthy habits should pay more. It's common practice for smokers to have higher rates than non-smokers, for example, yet try to have the obese pay a higher premium or lose weight and listen to the outrage! in CT the governor wanted to implement a plan by which people who work for the state actually take the prescription drugs for 4 common conditions or else pay more for their health coverage and it was a huge controversy. (the conditions were high cholesterol, high blood pressure, COPD, and diabetes). It's my understanding that all of these conditions are well-controlled with medication; physicians who presumably have on-going contact with their patients prescribe them, yet people resist taking them anyway? Why shouldn't they pay more when they don't?

FF: I normally agree with you for the most part. But on the point of forcing people to take medications or else they would pay more for coverage. If you force a patient to take a medication-for example Lipitor or another statin-and they get rhabomyolysis and are incapacitated or die from protein overload shutting down their kidneys (and trust me it does happen and we have seen it)-who gets sued and for how much and who pays? After all, perhaps the doctor felt it really wasn't indicated but had to give the medication because it was mandated by someone.