Affordable Care Act (ACA) - Obamacare

[Dr JIM]

There's no such thing as a "free lunch" why of course there is DT!

We call them ENTITLEMENTS in the US!

Ya see someone changed the constitution from the RIGHT (via government "intervention") to PURSUE happiness to the RIGHT to HAVE IT!

Yea baby!

 

[DTdr2]

Sure Dr. Jim

"The Further A Society Drifts From THE TRUTH The More It Will Hate Those Who Speak It".​

~ George Orwell ~

 

[cxxpxxc10]

There are no words I can use to express my hatred for this man. He's nothing but a socialist pig with nothing good to offer this Country other than a "public icon" figure. That in itself however is disturbing enough to me. How anyone could ever vote a president or political figure into office using such shallow reasoning such as the color of his skin is absolutely outrageous and beyond reckless.

That aside, i know he isn't technically a socialist but he sure is headed in that direction and has seemed to be since day one. In the most basic sense, just to make my point i will use an analogy for communism vs socialism. In a communist nation, everyone has nothing and is given an equal amount of goods so the ratio is 1:1 more or less. In a socialist society, lets say someone has "3" things and another person has "1". In an attempt to even out the seemingly problematic socioeconomic gap increase; 1 thing will be taken from the person with 3, and given to the person who has 1. Therefore they both have 2. Now we have never truly been a capitalist nation but who the hell thinks this mentality is okay?

As far as Obamacare goes, I have never been more opposed or hostile towards any other reform. Because of this douche bag, the privatized industry in healthcare is slowly diminishing. I understand that we were number 17 or so on the list of top medical care for developed nations, but when a person from another area of the world needed emergency surgery, they came here. Because of this forced, pitiful attempt to nationalize healthcare the salary of doctor's will be and has already almost been cut in half. The increase in HMOs PPOs and free clinics have changed a physician or surgeon's pay to a fixed salary with a required amount of patients to see a day - whereas before they were paid through insurance or out of the patients pocket. Now most physicians will see a mix a both types of patient's, private and public; but i cannot wait to see the pride and motivation doctor's once had from their career and title crumble into what would be comparable to a cashier's attitude at a supermarket during peak business hours.

I could continue on but I think my point is clear. I am sorry if I offended any of you with my opinion but seeing it first hand I can't tell you how much I hate this man.

 

[idmd]

but i cannot wait to see the pride and motivation doctor's once had from their career and title crumble into what would be comparable to a cashier's attitude at a supermarket during peak business hours.

This is already well on it's way and has been for a while! The children of physicians made up the largest single parent profession in my dental school class. I was shocked to learn 1/3 of all the kids in my class had a parent who was a physician and that while some causally pushed their kids to not become physicians and significant number of parent forbid their children. Long hours, constantly reduced pay, insurance bullshit, loss of autonomy, etc, etc, etc.

As soon as medicine let managed care in they were doomed...this is something the dental world watched and while managed care has made some inroads into the profession the ADA and other organization work tirelessly to not let us end up like physicians. On top of that we are not forced to take Medicare or Medicaid which would instantly double my workload, quadruple my headaches and at a certain point if I had enough of these patients severely lower my income.

 

[cxxpxxc10]

This is already well on it's way and has been for a while! The children of physicians made up the largest single parent profession in my dental school class. I was shocked to learn 1/3 of all the kids in my class had a parent who was a physician and that while some causally pushed their kids to not become physicians and significant number of parent forbid their children. Long hours, constantly reduced pay, insurance bullshit, loss of autonomy, etc, etc, etc.

As soon as medicine let managed care in they were doomed...this is something the dental world watched and while managed care has made some inroads into the profession the ADA and other organization work tirelessly to not let us end up like physicians. On top of that we are not forced to take Medicare or Medicaid which would instantly double my workload, quadruple my headaches and at a certain point if I had enough of these patients severely lower my income.

Amen to that. My parents are both doctors, my uncle is a urologist and the other a ENT. I've been watching it on the decline for years now. Had my dad not decided to become a medical examiner and have a private practice doing autopsies and expert work rather than only sticking to his government salery, hed be in just as much of a loss as every other MD in the country.

 

[zkt]

Some of you people seem to think that the weak should perish.
Are you closet Darwinians?
By that reasoning why dont I simply ban you and end your time here?
How does it feel when your survivial is at stake?

 

[Dr JIM]

Oh no Z not the weak.

What you think I have no compassion, the LAZY should rot in their rocking chair however, IMO.

If you want a reliable means of distinguishing between the two, stay ONE NIGHT in any county or university based Emergency Department.

Regards
Jim

 

[Dr JIM]

Private Physicians ARE NOT forced to accept Medicare or Medicaid patients, hospitals are.

So IF you want to practice "hospital medicine" of any form, your required to "be on call" for your particular speciality on a proportionate basis.

The key to "AHC" is what level of reimbursement the private sector physicians be GUARANTEED, because IF it's on par with existing CMS funding NOTHING WILL CHANGE.

WHY because most DOCs don't and can't accept the 10-20% "monetary reward" as compared to privately insured patients!

Understand this, these "underfunded" patients are currently overloading the existing county, community and university based primary care facilities whom CAN AFFORD to see them because of ADDITIONAL financial incentives allocated by the Feds, local and county taxing authorities.

These incentive FUNDS are NOT given to the private sector!

IMO, we will have more people "with insurance" yet with few physicians willing to accept it.

Next step by "socialists", forcing ALL DOCs to take these patients as qualifying mechanisms for licensure, board exams, or hospital privileges etc!

 

[idmd]

Private Physicians ARE NOT forced to accept Medicare or Medicaid patients, hospitals are.

Forced by the government or forced by the market....does it really matter? I don't know a single private primary care physician who doesn't accept Medicare and most accept Medicaid. Some do this for altruistic reasons but most do it because they need patients....if everyone else accepts it in town then they need to too.

My point was in dentistry most don't accept Medicaid or any government-based "insurance" and we are fairing much better than medicine. This trend in medicine will continue IMO.....sucks to be a physician.

 

[Dr JIM]

According to 2110 data released by CMS this year only 40% of non-hospital based doctors are considered "participating" . That is to say they have agreed to accept payment from CMS as "payment in full" and thereby waive any deductible.

This definitely is my experience working in both community, university and private hospitals.

Ya see the problem is and has been for a prolonged period, patient access to OFFICE or out of hospital primary care.

Why is that? Well rest assured its not because of the 20% uninsured rate we keep hearing about (although it's a contributor) Nope it's because most doctors will no longer accept 10-20% payment on the dollar from federal programs such Medicaid or Medicare.

 

[Dr JIM]

Hey Idster my intention is NOT to be confrontational with you mate but, if you believe it "sucks to be a physician" because of reimbursement issues or because I've exposed a few of the not so salient difficulties many doctors confront a regular basis I adamantly disagree.

I love my profession, patients, practice and the challenges they all pose and if I had to do it all over again YOU BET I WOULD!

However what often makes the practice of medicine difficult is extraneous bullshit such as GOVERNMENT "intervention" (some of which is definitely needed but the process is always a pain in the ass and the OUTOME ALWAYS has some unintended and UNWANTED consequences).

Shit DENTAL INSURANCE is an absolute farce excluding "preventative care" damn near every plan is limited to ONE THOUSAND BUCKs annually, for restorative care.

One grand is the cost for one emergency department triage note, lol!

Oh no, separate of government "funded" health insurance the reimbursement is actually quite good, which is exactly why after most physicians have become "established" they DROP CMS directed plans. (FYI for those that don't know CMS is the abbreviation for the Committee of Medicare/Medicaid Services).

Idster this was the point I've been trying to make mate. To reiterate IF the AHC plans provide physician reimbursement on par with either of the existing CMS plans enacting "Obamacare" will make very little difference, because very few private sector doctors are going to place "AHC" welcome mats in their foyer.

To put it another way, for each PRIVATELY INSURED patient a physician sees (with an identical complaint) they will have to evaluate FOUR to FIVE times that number to receive the same level of funding. YEP!

Now it's a NO BRAINER which patients any reasonable person (and that includes most docs, I think) will try to fill their offices with!

Regards
jim

 

[zkt]

Why is it so hard to see that the middle men, the insurance comparies, are sucking so much money out of the system and are the real problem?
Single payer would have been the better way to go but the impact on the economy might have been disasterous. All those insurance reps and execs out of work would have forced the republicans to refund unemployment. lol

 

[zkt]

Oh no Z not the weak.
What you think I have no compassion, the LAZY should rot in their rocking chair however, IMO.
If you want a reliable means of distinguishing between the two, stay ONE NIGHT in any county or university based Emergency Department.
Regards
Jim

Do you really think that everyone is playing on a level field here in the USA ?
The system is stacked in favor of some and to the detriment of many.
Those alcoholics, other druggies and general losers you see in the ER at 4am might have chosen a different path under more favorable circumstances.
Are we to blame the man or are we to fault the society that made the bad choices so easy for many of us?
Laying the blame on any group of people is simply racism.
Understanding that we are all in this together is a step toward the path of enlightment.

 

[Gape Van Damme]

Do you really think that everyone is playing on a level field here in the USA ?
The system is stacked in favor of some and to the detriment of many.
Those alcoholics, other druggies and general losers you see in the ER at 4am might have chosen a different path under more favorable circumstances.
Are we to blame the man or are we to fault the society that made the bad choices so easy for many of us?

Absolutely. I'm sure I'll get flamed for this, but wealth inequality is inherently tied to inequality in general. Poverty rates in schools are directly related to lower standardized test scores in said schools.

Social mobility in America is a lie. The overwhelming majority of wealth in the US is concentrated in the top 10%, with the top 1% owning over half of the nation's wealth.

As far as universal healthcare is concerned, it's a VERY basic philosophical argument. Either healthcare is a basic human right that everyone should enjoy, or it is not. If it is not, that is fine, but in my opinion, anyone who takes this stance has to make a persuasive argument that while healthcare isn't a human right, protection of their property is. For example, in all Capitalist nations we say that physical inequality (i.e. I am bigger than you) may not be used as a means for gain (I can't take what you have simply because I am physically am more powerful than you... we call that robbery). Yet, Capitalist nations have no problem protecting wealth inequality, when the same corollary can be made about the effects of wealth inequality as one can make about physical inequality (i.e. I am richer than you, therefore, I can afford a longer life, better education; access to good lawyers means that even the rule of law isn't applied the same to me).

The entire game is a joke.

 

[idmd]

Social mobility in America is a lie. The overwhelming majority of wealth in the US is concentrated in the top 10%, with the top 1% owning over half of the nation's wealth.

Not only is it a lie....that top 1% has rigged the game making it almost impossible for the average person to get ahead. I have a cousin who is CFO of a major upper scale retail chain at the age of 44. I spent Thanksgiving dinner last year listening to him laugh at how stupid the American people are for buying ANY of his shit and how he just went to India to secure cheaper labor/materials to sell clothing that is literally a 2000% markup. Guess what he got for outsourcing US jobs.....an $8 MILLION dollar bonus which he used to buy a $4M house on Long Island (his summer house) which is now being renovated for an additional $2M.

My wife has an uncle who is a retired senior VP for Morgan Stanley who currently owns his own investment company - guy was a regular on Squawk Box - all of his kids are on Wall Street and they all own $5M+ houses in Darien, CT and they all have the IQ of guppy. They ALL laugh at how the system is rigged because they know THEY are the ones who rig it.

We have people starving and these 35 year olds who do nothing more than syphon off other people's money are literally kings of this country and they will NEVER let the average American get ahead because to do so would mean they would have do give some of what they have up....it ain't gonna happen any time soon!

 

[nuncaquite]

As far as universal healthcare is concerned, it's a VERY basic philosophical argument. Either healthcare is a basic human right that everyone should enjoy, or it is not. If it is not, that is fine, but in my opinion, anyone who takes this stance has to make a persuasive argument that while healthcare isn't a human right, protection of their property is. For example, in all Capitalist nations we say that physical inequality (i.e. I am bigger than you) may not be used as a means for gain (I can't take what you have simply because I am physically am more powerful than you... we call that robbery). Yet, Capitalist nations have no problem protecting wealth inequality, when the same corollary can be made about the effects of wealth inequality as one can make about physical inequality (i.e. I am richer than you, therefore, I can afford a longer life, better education; access to good lawyers means that even the rule of law isn't applied the same to me).The entire game is a joke.

Ill take a stab at (a part of) the philosophical argument.
Governments, tribes, social organizations, and such, were formed to guarantee protection of self and property. If a person has no protection they can not pursue making a living and supporting themselves and family. Thats a social responsibility....... Caring for ones health, on the other hand, is a personal responsibility. If as a society we were to honestly come together and chose to make healthcare a social protection. Well thats something else completely different. Charitable organizations do lots of this. The aca is not an honest attempt for the betterment of society.

 

[DTdr2]

The goal is single-payer health care, and it looks like it may happen sooner rather than later.

The open enrollment period for Obamacare coverage is slated to last for six months. If the first week's total were an indication of how many Americans will sign up during that time through the Obama administration's website, its final tally would reach a paltry 1.32 million.

Healthcare.gov provides enrollment services for Americans in 36 states; the remaining 14 states and the District of Columbia, which operate enrollment programs in their own exchanges, represent 33.7 per cent of the U.S. population, according to census projections.

If the state-run exchanges were to have a similar response rate for six months, the national enrollment total would be approximately 2 million.

That number is less than 29 per cent of the 7 million the Obama administration would need, according to the nonpartisan Congressional Budget Office, in order to balance the new health insurance system's books and keep it from financial collapse.

The administration’s goal is seven million people in the first year, and at this pace the number who lost insurance is greater than those who have signed up.

 

[zkt]

"The aca is not an honest attempt for the betterment of society. "
Right: its a government plot to turn the country into a socialist state. Yes?. Is that it?
" George Carlin - "Never argue with an idiot. They will only bring you down to their level and beat you with experience"

 

[Dr JIM]

There are a several other means to achieving this goal besides what OBC derived.
These exchanges are the claw for the private sector to BECOME competitive.

That being said once health care is relegated to a single payor system kiss the absolutely most advanced HC system in the world GOOD BYE.

The single payor systems do provide PRIMARY CARE ACCESS for the populous quite well BUT what many are deficient at achieving is ensuring their diagnostic capability matches therapeutic funding.

And in many instances they DO NOT. Why because providing identical care for everyone (including couch potatoes) the elderly, the infirmed is just to damn expensive (and EVERY OTHER country knows this which is why many have criterion to qualify for certain therapeutic modalities used in the management of CHRONIC AILMENTS like dialysis, chemotherapy, organ transplants etc)

So for instance an adult with stage V leukemia would be offered palliative therapy alone because the chances for "cure" at such an advanced stage is abysmal and expensive.

Let me show you just how expensive it is;
1) Bone marrow transplant 100-200K

2) Chemo ranges between
2-50K for a single treatment and many protocols require the patient receive several

3) Radiation therapy 5-10k single therapy

4) ICU admission at least 10K PER DAY

5) out patient follow up care
about $2-300 per visit

6) Cost of OxyContin about ONE DOLLAR per pill!

Why because capitalism rather than socialism is the impetus for "progress" in this field (and country).

Why? Because technological, drug research, operative intervention, etc are otherwise prohibitively expensive and NO OTHER entity is willing to "roll those financial dice" such as TESTING new techniques, drugs or therapeutics because the cost of failure becomes prohibitive.

I've been to close to 20 countries, some 3rd world and a few deemed first tier health care systems. Understand this NONE operate a single payor system exclusively and ALL (although some are unwilling to admit it) look upon the US as the best developed HCS out there.

Good gosh folks you don't need to change the whole damn thing to improve on that which is clearly broken!

The myopic "single payor" sentiments of some are EXACTLY what many patients, HCP, industry pundits are very concerned about (because they are satisfied with the coverage they have and contend if it ain't broke why fix it) AND why so many are opposed to OBAMACARE.

Oh and ONE MORE THING why in the fuck won't the assholes who passed the AHC act sign the amendment ensuring ALL in congress MUST acquire and use the insurance acquired thru one of these exchanges?

Because they have NO INTEREST whatsoever in being a part of this "single payor system"!

For for those who believe otherwise your living in the land of OZ, IMO.

Best to you all
Jimmy

 

[zkt]

There are a several other means to achieving this goal besides what OBC derived.
These exchanges are the claw for the private sector to BECOME competitive.

That being said once health care is relegated to a single payor system kiss the absolutely most advanced HC system in the world GOOD BYE.

The single payor systems do provide PRIMARY CARE ACCESS for the populous quite well BUT what many are deficient at achieving is ensuring their diagnostic capability matches therapeutic funding.

And in many instances they DO NOT. Why because providing identical care for everyone (including couch potatoes) the elderly, the infirmed is just to damn expensive (and EVERY OTHER country knows this which is why many have criterion to qualify for certain therapeutic modalities used in the management of CHRONIC AILMENTS like dialysis, chemotherapy, organ transplants etc)

So for instance an adult with stage V leukemia would be offered palliative therapy alone because the chances for "cure" at such an advanced stage is abysmal and expensive.

Let me show you just how expensive it is;
1) Bone marrow transplant 100-200K

2) Chemo ranges between
2-50K for a single treatment and many protocols require the patient receive several

3) Radiation therapy 5-10k single therapy

4) ICU admission at least 10K PER DAY

5) out patient follow up care
about $2-300 per visit

6) Cost of OxyContin about ONE DOLLAR per pill!

Why because capitalism rather than socialism is the impetus for "progress" in this field (and country).

Why? Because technological, drug research, operative intervention, etc are otherwise prohibitively expensive and NO OTHER entity is willing to "roll those financial dice" such as TESTING new techniques, drugs or therapeutics because the cost of failure becomes prohibitive.
I've been to close to 20 countries, some 3rd world and a few deemed first tier health care systems. Understand this NONE operate a single payor system exclusively and ALL (although some are unwilling to admit it) look upon the US as the best developed HCS out there.
Good gosh folks you don't need to change the whole damn thing to improve on that which is clearly broken!
The myopic "single payor" sentiments of some are EXACTLY what many patients, HCP, industry pundits are very concerned about (because they are satisfied with the coverage they have and contend if it ain't broke why fix it) AND why so many are opposed to OBAMACARE.
Oh and ONE MORE THING why in the fuck won't the assholes who passed the AHC act sign the amendment ensuring ALL in congress MUST acquire and use the insurance acquired thru one of these exchanges?
Because they have NO INTEREST whatsoever in being a part of this "single payor system"!
For for those who believe otherwise your living in the land of OZ, IMO.
Best to you all
Jimmy

I am quite familiar with the cost of cancer treatment and pallative care after guiding a freind of some 40 years to her death after a Dx of inflammatory ER+ breast cancer. Healthy to dead in six months flat.
A onsiderable portion of medical research is devoted to prolonging the lifespan.
The issue of just how much do we spend as a society on a given individual in any given situation is another matter entirely.
The best example of a single payer system is the VA which is more cost effective than medicare and private payer. I wont bore you with refs. They are abundant.
Many seem to complain of VA medical care. Perhaps my situation is atypical since I study medicine and can relate to medical professionals on more of a peer to peer level. Patient involvement is something that the VA strongly supports. I havent experienced that in the private sector. I council a lot of people and not just here.
Case in point:
I have a Hx of atherosclerosis. Bilateral renal and carotid stenosis which has been followed with yearly doppler studies and quarterly basic blood chemistry tests. You cant do better than this. What benefit could an insurance company provide? The renal stenosis has progressed to > 60 % on one side lately. I consulted with the chief of vascular surgery and we agreed that a consult with my nephrologist and interventionist was appropriate. How much better would it get with private payer? NONE.
Again I say: the insurance companies are siphoning money off the top and giving nothing back in return other than their CEOs inflated paychecks and exorbitant bonuses investment in the stock market.
What has the capitalistic system contributed to the advance of medicine?
Seems to me that most of the research has been funded by the NIH and prestigious universities. Big Pharma funds what they can profit by.
Please enlighten me.