Doctors may not get paid for care if patients don’t pay their ACA premiums

[rblnr]

Whatever the so-called lawyers lobby spent was/is dwarfed by what the insurance industry spent fighting ACA -- over a half billion in the last few years.

 

[Phelonious Ponk]

Sorry to run at the mouth, but I'm on a roll here...

Here's an interesting thing that speaks to the question of "is Obamacare more efficient than what we have?" I'm no fan of the way ACA has turned out, but I'm not sure it could be worse. We have this decades-long fight in American against universal coverage. A horrible thing; another entitlement. I get it. But if you have no insurance and you get sick or hurt in America, you go to the emergency room, probably too late when the condition has become much more difficult and expensive to treat. And they treat it. And if you don't have the money to pay for the treatment out of your pocket - likely if you didn't have full-time work decent enough to offer health insurance - you won't have to pay for it.

We already have universal coverage. We've had it for decades. We've had it all the while we've fought tooth and nail agains the evils of another entitlement in the form of universal coverage. We've just had the worst, most expensive universal coverage imaginable; people without doctors, getting no treatment until they're so sick they can't ignore it any longer, seeking treatment at the ER.

Really, it's time to hang up the ideology and look at this as a pragmatic, economic problem. When we do that, we'll have a chance. We may even be able to get pragmatic enough to take on insurance and pharma. Until then, we're screwed. But ACA? God it's an ugly, screwed up, dog's breakfast of a law. But if it had nothing going for it but its requirement that 80% of insurance revenues go directly to patient care, portability and the elimination of pre-existing conditions, it'd be better than where we came from. MHO. YMMV.

Tim

 

[DaveyF]

Sorry to run at the mouth, but I'm on a roll here...

Here's an interesting thing that speaks to the question of "is Obamacare more efficient than what we have?" I'm no fan of the way ACA has turned out, but I'm not sure it could be worse. We have this decades-long fight in American against universal coverage. A horrible thing; another entitlement. I get it. But if you have no insurance and you get sick or hurt in America, you go to the emergency room, probably too late when the condition has become much more difficult and expensive to treat. And they treat it. And if you don't have the money to pay for the treatment out of your pocket - likely if you didn't have full-time work decent enough to offer health insurance - you won't have to pay for it.

We already have universal coverage. We've had it for decades. We've had it all the while we've fought tooth and nail agains the evils of another entitlement in the form of universal coverage. We've just had the worst, most expensive universal coverage imaginable; people without doctors, getting no treatment until they're so sick they can't ignore it any longer, seeking treatment at the ER.

Really, it's time to hang up the ideology and look at this as a pragmatic, economic problem. When we do that, we'll have a chance. We may even be able to get pragmatic enough to take on insurance and pharma. Until then, we're screwed. But ACA? God it's an ugly, screwed up, dog's breakfast of a law. But if it had nothing going for it but its requirement that 80% of insurance revenues go directly to patient care, portability and the elimination of pre-existing conditions, it'd be better than where we came from. MHO. YMMV.

Tim

+1000

 

[ddk]

But if it had nothing going for it but its requirement that 80% of insurance revenues go directly to patient care, portability and the elimination of pre-existing conditions, it'd be better than where we came from. MHO. YMMV.

Tim

You talk as if the money comes from outer space, your mileage will vary if you had to pay for it! You're robbing Peter to pay Paul. So in your better scenario Peter and his family get fucked, and they have no say in it! And you're saying to hell with them.

david

 

[Vapor1]

I remember this well enough. In fact, I've been pretty close to it recently, when self-employed and minimally insured (very high deductibles). It was OK back in the day, when I was a kid, when health care was hospitalization. But there are two big problems with it, one old, one fairly new:

1) it is absolutely anti-preventative and would force American medicine even further away from prevention, healthcare, and toward disease and injury treatment, health problem resolution. I know of no respectable data that says treatment is less expensive than prevention. None. This is the hard way.

Our current system already puts very little emphasis on prevention, that's a straw man argument. And no matter what the patient still must decide to seek out the preventative measures, insurance or not. At least until Homeland Security starts dragging people into screening clinics.

All insurance does is drive costs up because the patient never sees the true cost, so 'shopping' never comes into the equation. Also doctors stand to make far more money pushing synthesized pills, and since the patient doesn't care the cost, they agree. Without insurance covering every scratch or sniffle, doctors would encourage natural and homeopathic cures that can often be just as effective without side-effects. But I suppose that's the true reason it won't happen, too much special interest influence.

2) Medicine doesn't work this way anymore...you know, where you don't need insurance until something catastrophic happens. Medicine is about short-term hospital visits, out-patient procedures and therapies and drugs, lots of pharmacological therapies. Contemporary medicine could easily bankrupt families without a major catastrophic event.

It's just not the kind of coverage our current system requires and it doesn't point toward the future we need to be heading to.

Now it's chicken or the egg, of course it doesn't work that way anymore because it's all about getting people in and out the doors as often as possible to incur more costs. But it sure didn't work that way in the past, and even in some pockets of rural America there are still pay as you go doctors. The one my parents had been seeing for 40+ years recently retired, now they drive 2 hours each way to see another. Of course the way it typically works could bankrupt people quickly, but that's exactly the point. It's not working and all we're doing is facilitating costs to continue spiraling out of control. The only solution is to reign it in by taking away the blank check that is all-encompassing insurance coverage.

Entitlements are huge, but their solutions are not. Medicare and Social Security could be fixed tomorrow; Reagan extended SS for a generation with a bit of ink, back in the 80s. What we lack is not the ability, but the political will to do so. Healthcare? Makes entitlements look like chump change because you don't just have to get around politicians' unrealistic ideological expectations, you have to get past the pharma and insurance lobbies, and they are deep in the financial genetic code of DC.

Tim

The financial genetic code of DC is rob Peter to pay Paul, then lie to the public. We're now at 26% all Federal tax revenues being used to service interest on outstanding debt! Sorry, but the game is over ... it's just a matter of time now. Our solution thus far has been for the CBO to pump out bogus numbers based on unattainable GDP growth projections, and to sell "cuts" as only growing Federal spending at 4.9% instead of 5%.

 

[DaveyF]

You talk as if the money comes from outer space, your mileage will vary if you had to pay for it! You're robbing Peter to pay Paul. So in your better scenario Peter and his family get fucked, and they have no say in it! And you're saying to hell with them.

david

David from Utah, you seem to have a very short memory or maybe a simply confused memory, LOL. You have been paying for health care for ever; only in the past, IF god forbid you had an existing condition... well you got to pay one hell of a lot more!! I think it is you who maybe is from outer space, particularly IF you preferred the health care system that was in place before....

 

[jazdoc]

So much to unpack, so little time....

it is absolutely anti-preventative and would force American medicine even further away from prevention, healthcare, and toward disease and injury treatment, health problem resolution. I know of no respectable data that says treatment is less expensive than prevention. None. This is the hard way.

Absolutely untrue. Who says so? A short list includes:
The CBO:http://www.cbo.gov/publication/20967
The New England Journal of Medicine:http://www.nejm.org/doi/full/10.1056/NEJMp0708558
Cardiologists:http://circ.ahajournals.org/content/118/5/576.full

Doesn't mean we shouldn't do it, but it is misleading to sell preventative medicine as a cost saver.

Healthcare? Makes entitlements look like chump change because you don't just have to get around politicians' unrealistic ideological expectations, you have to get past the pharma and insurance lobbies, and they are deep in the financial genetic code of DC.

Healthcare and interest on the debt are the biggest drivers of spending in the coming years and will make our current budget crisis seem like a budgetary walk in the park. Sure you can blame politicians for telling us what we want to hear: that everyone can somehow be a net importer of Federal dollars. But we choose to close our eyes and believe this nonsense. Hell, it's not really our problem, we are going to stick to the next generation. In the immortal words of Pogo: "we have met the enemy and he is us".

Tort reform? That's a laugh to those of us who do this every day, unless you're talking about either expanding, not restricting, an individual's ability to seek proper redress or removing the neanderthals masquerading as U.S. Supreme Court justices who hold a majority of the Court.

I'm a radiologist, so I sit at the nexus of defensive medicine. Come sit through a 10 hour shift covering the ED with me and then tell me what you think about defensive medicine. I'm willing to wager a helluva bottle of scotch that tort reform would save more to the system than the cost of free riders (which the Feds stipulated at <$50 Billion during their arguments before the Supreme Court). The US has by far the most lawyers per capita and the highest legal expenses of any country but I don't hear anyone in Washington clamoring for the Affordable Legal Act. I personally love Richard Rafal's idea of the 'Legal DRG'

"Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine's Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I'm surprised lawyers don't tack shipping and handling onto their bills." http://online.wsj.com/news/articles/SB10001424052970204731804574387021307651050


A central tenant of medicine is 'first do no harm'. Yes, the current system is inefficient with perverse incentives. But simply layering on another layer of perverse and contradictory incentives will only worsen the problem. And complaining about the current system without examining how we got here is like treating a cancer patient's fever with aspirin and expecting a cure.

 

[jap]

 

[ddk]

David from Utah, you seem to have a very short memory or maybe a simply confused memory, LOL. You have been paying for health care for ever; only in the past, IF god forbid you had an existing condition... well you got to pay one hell of a lot more!! I think it is you who maybe is from outer space, particularly IF you preferred the health care system that was in place before....

Davey from La Jolla, you seem to suffer from liberal reality syndrome. I was never forced to buy health insurance nor were my choices limited by good for nothing politicians, up to now it was my choice, not yours or anyone else's to dictate. I know that liberals have a hard time with facts but aside from losing a number of doctors and forced liquidation of some 3rd party providers nothing has changed in the actual healthcare system only the government has imposed a new progressive tax in the form of forced health insurance. That's all we got.

 

[DaveyF]

Davey from La Jolla, you seem to suffer from liberal reality syndrome. I was never forced to buy health insurance nor were my choices limited by good for nothing politicians, up to now it was my choice, not yours or anyone else's to dictate. I know that liberals have a hard time with facts but aside from losing a number of doctors and forced liquidation of some 3rd party providers nothing has changed in the actual healthcare system only the government has imposed a new progressive tax in the form of forced health insurance. That's all we got.

David from Utah, I don't suffer from right wing extremism or "liberal reality syndrome". In the past, you were not forced to buy health insurance, instead you had a choice...you could buy health insurance, assuming that you could afford it and were not priced out because you were hampered, due to no fault of your own, by a pre-existing condition or...you could do without insurance and go 'BK' once the big bill hit you after a little surgery. Clearly, you were never "fortunate" enough to find yourself in this untenable position. Does this sound like a "liberal" position to you, LOL.

 

[ddk]

David from Utah, I don't suffer from right wing extremism or "liberal reality syndrome". In the past, you were not forced to buy health insurance, instead you had a choice...you could buy health insurance, assuming that you could afford it and were not priced out because you were hampered, due to no fault of your own, by a pre-existing condition or...you could do without insurance and go 'BK' once the big bill hit you after a little surgery. Clearly, you were never "fortunate" enough to find yourself in this untenable position. Does this sound like a "liberal" position to you, LOL.

Davey from La Jolla, what are you arguing? Is it or is it not a progressive tax?
david

 

[DaveyF]

Davey from La Jolla, what are you arguing? Is it or is it not a progressive tax?
david

You are asking me if public health care insurance is a progressive tax?......

 

[ddk]

You are asking me if public health care insurance is a progressive tax?......

I'm asking if you realize that ACA is a progressive tax or not?

 

[Ron Party]

jazdoc, you are equating tort reform with med mal reform. med mal is, of course, just a portion.

as an aside, i appreciate the CYA aspect of practicing in the health care field but, please, your condescending attitude toward me is not well taken. i could easily give you countless examples of individuals and their families who've been screwed over by physicians but the current system, which has through the years already been *reformed* (read: curtailed, restricted by courts in every state, the worst offender being the highest court in the land), has allowed the wrongs to go uncompensated. indeed, those physicians should have had their licenses revoked.

let's call a spade a spade. it's about the money. it's always about the money. those who advocate for tort *reform* are, for the most part, those who have the money and, not only do they want to keep it, they want even more of it. you talk about saving money to the system? whose system? if you're on the outside looking in, or if you can't afford to play, it's not your system, it belongs to someone else.

 

[Phelonious Ponk]

You talk as if the money comes from outer space, your mileage will vary if you had to pay for it! You're robbing Peter to pay Paul. So in your better scenario Peter and his family get fucked, and they have no say in it! And you're saying to hell with them.

david

I think I'm talking exactly the opposite. Ignoring the fact that we already have bad, expensive universal coverage, pretending that money comes from outer space is the delusion. And I do have to pay for it. And so does Peter, so does Paul. They pay for it in the most expensive -- and not the best -- healthcare system in the world. See it pragmatically, address it pragmatically, get the BS ideology - both liberal and conservative - out of the way and we have a chance of bringing costs down significantly for both Peter and Paul, and they should be down. Statins are a lot less expensive than bi-pass surgery. Short hospital stays followed by outpatient physical therapy are a lot less expensive than long convalescence. Medicine has moved toward better, less expensive treatments. But at the same time it has moved toward commercialization -- The fact that my dad can get an MRI at a half-dozen different places within 15 miles of his home on a couple of hours notice, that every one of those hospitals/clinics is supporting those expensive machines, that doctors are prescribing scans to help those hospitals support those expensive machines? Hotel lobbies that look like 5-star hotels? The things that have been created by medicine becoming all about profit, marginalizing more difficult care and competing for the high-margin business as if hospitals were resorts, clinics were spas? These are the things that are robbing Peter and Paul. These things, and the runaway costs of insurance and drugs, are the things we can do without. Pragmatism.

Oh and jazzdoc, I'm aware of how big entitlements are. That was not the point. The point was that SS and medicare could be fixed with the political will and not a lot of pain. It's more an ideological than a financial battle. Healthcare? It's ideological, financial and pushing a big stone up Capitol hill because insurance and pharma are among the biggest lobbies in town. And you think an insurance system in which the financially vulnerable are aware of the costs of doctor visits and negotiating the cost of a check-up down from $150 to $100 is going to control costs and be preventative at once? $100 is going to motivate them to all that preventative care? I'm guessing it has been a long, long time since you've been anything anyone would call financially vulnerable. And no one will negotiate costs on the way to the hospital or the ER. That's just not understanding human nature. I get the free-market thing and trying to apply it to medicine. I just don't think it applies well, and I don't think thats just because of, or even mostly because of, awareness of costs.

Some of it might be. Some of those ideas might help. But we're not talking about them, because DC, even ACA, is protecting its big benefactors - pharma and insurance - instead of looking at it as a pragmatic, economic problem.

Tim

 

[Whatmore]

Rome is burning, guys.
You have a great country, don't mess it up

 

[Steve Williams]

well good morning everyone

Strong feelings once again abound on everything BUT what the thread subject is about. Let's get it back on topic otherwise IMO the thread has run its course

 

[ddk]

Rome is burning, guys.
You have a great country, don't mess it up

The flames must be very high already for you to see it from there, unfortunately people in the center of it don't see it until it's gone...

 

[ddk]

Tim, this is about ACA, an intrusive progressive tax rolled up with other taxes hidden in a malicious piece of legislature, disguised in the fog of healthcare, taking over the liberties of 300 million people, passed in complete secrecy. All your arguments are assumptions and hypothesis about healthcare which has nothing to do with the sleight of hand that they pulled here. There are still many other destructive hidden regulations like the one mentioned above that will continue to come to light.

 

[Steve Williams]

Thanks gents.......