Obamacare is going to kill you. Or one of your kids. Or one of your parents. Someone in your family is going to die from Obamacare. You can bet on it. You can bet your life on it.
There are many things in medicine that are in a state of flux because of Obamacare. Obamacare is the name given to the most inappropriately termed “Affordable Care Act.” There is nothing about Obamacare that makes care affordable. Obamacare has made care much more unaffordable. What it has done is make healthcare appear to be affordable because of subsidized premiums. The problem is that liberals – and especially democrat voters- do not comprehend that coverage is not the same thing as care. People are forgoing medical care because they cannot afford the large deductibles needed to keep premiums at even marginally affordable rates. Deductibles are especially high for seniors:
Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.
But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.
Hospital emergency room utilization is up, not down as they promised. That means a strong possibility of delay should you ever be the one wheeled in.
Obamacare is not reducing costs as promised either. The notion that millions could be added to the rolls of health care and pre-existing condition restrictions done away with and see costs lowered was absurd.
Those who do seek care are discovering that it isn’t a simple matter to even obtain it. Rural hospitals are dying because of Obamacare:
Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state’s closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.
As they close, patients will see lengthened transport times for critical care:
Peanut and cotton farmer Buren “Bill” Jones, 52, died of a heart attack a month after Stewart-Webster closed. His family had to wait about 15 minutes for an ambulance to take him to a hospital 22 miles away, where doctors couldn’t revive him. The closed hospital was 9 miles from his house, a distance his wife or daughter — who performed CPR on him at home — might have driven.
The requirement for electronic records comes at a significant and sometimes, fatal cost:
But the $1 million or more it was going to cost to change over to electronic records was one of the last straws for Randy Stigleman, former owner of Stewart-Webster. Efforts to sell the hospital never panned out.
The anger residents feel toward Stigleman is palpable here in Richland. He appeared to shut the hospital down suddenly — giving them only a week’s notice. But Stigleman says he just couldn’t put any more money into the hospital.
And there’s one more unpleasant surprise you have coming. Ever see those websites that post all of your personal data and then demand you pay to have it removed? You’re going to see more of that- only this time with your personal medical records. Credit card companies and businesses are frequently hacked now as it is. Now that your private records have to go online they’ll be easy prey.
Insurers have already cut reimbursement rates for providers. This is leading to many clinicians questioning whether they would continue to see Obamacare patients. It’s hard to run a practice at a loss.
Things are even worse for Medicare and Medicaid. Doctors are looking at a big cut in Medicaid reimbursement:
Andy Pasternak, a family doctor in Reno, saw more than 100 new Medicaid patients last year after the state expanded the insurance program for the poor under the Affordable Care Act.
But he won’t be taking any new ones this year. That’s because the law’s two-year pay raise for primary care doctors like him who see Medicaid patients expired Wednesday, resulting in fee reductions of 43% on average across the country, according to the non-partisan Urban Institute.
“I don’t want to do this,” Pasternak said about his refusal to see additional Medicaid patients. But now that the temporary pay raise is gone, he and other Nevada doctors will see their fees drop from $75 on average to less than $50 for routine office visits.
“We will lose money when they come to the office,” he said.
The temporary raise in rates was another one of those mirages democrats threw into the air to mesmerize the public. Medicaid has been greatly expanded and democrats trumpet that (along with adding in dental coverage) as a measure of Obamacare success.
Americans are looking at higher deductibles and reduced access to care. Obama’s response to the increases in insurance rates is to obtain a lower degree of coverage to remain near the same premium. In many cases that will mean dropping from a silver to a bronze plan, and individual deductibles could run as high as $6000 and $12,000 for a family.
The solution that you’re likely to see addressing the expected shortage of doctors is the increased dependence on physician’s assistants and nurse practitioners, which leads me to why I wrote this post in the first place.
Never in one’s life does a day go instantly darker as it does when your child calls you and says
“Dad, I have cancer.”
My son (who was in his late 20s’s) made that call to me a few years ago. He usually calls his Mom to talk and I get the report on things. When he calls me, I know something’s up. I was sitting at my desk in my office when he called. Upon hearing his words I experienced an absolute emotional shock and to my surprise, tunnel vision. My first words to him were “I’ll get you through this.” He was diagnosed with non-Hodgkins lymphoma and actually made the self-diagnosis, finding a positive supraclavicular lymph node.
Months before he’d mentioned to me that he had an enlarged and hardened axillary lymph node. That instantly sets off alarms in my head and I begged him to see a physician ASAP. His insurance coverage had him seeing a PA (physician’s assistant) who suggested he might have cat scratch fever based on a chest x-ray and CBC. You want to believe this represents the truth but it bothered me and never stopped bothering me and the PA insisted it was nothing. Some months later he called when he found the second node.
We saw an oncologist and then my wife and I took him up to Dana Farber in Boston to see Arnold Freedman, the top lymphoma doc in the world. I remember Dr. Freedman rubbing his hands together and saying to my son “You had a 7 cm mass under your arm and they thought it was nothing.”
If you’re a doctor you know exactly what he was saying.
The chemo regimen that Dr. Freedman recommended was the same as the one the local oncologist recommended and we felt comfortable with it. My son underwent seven chemo sessions lasting as long as nine hours. I sat together with him for six of those sessions, canceling out my days so I could. It may sound odd, but really I enjoyed the time we shared.
He’s been cancer free for several years now and for that I am eternally grateful. We would have taken him anywhere on Earth to do whatever it took. Fortunately the answer was nearby. I could not be more proud of how he shouldered the treatment.
Since then, Obamacare has excluded many of the premier cancer treatment centers from it’s coverages. That means Obama’s kids, Pelosi’s kids and grandkids and Gruber’s kids will get the very best of treatments should they require it, but yours likely won’t.
If you’re tempted to think doctors are paid too much, imagine for a moment what you would pay to save the life of your child. Imagine what you’d think if your child’s life hangs on a cheaper doctor substitute. Health care costs what it costs because people want to live. They want their kids to live. Health care costs what it costs because people need and use health care. The only way around it is high deductibles, rationing and lower cost treatments. As we’ve seen recently, liberals mean all those things for you and not for them.
My son had the benefit of having the right Dad and for Dad having one of the best internist-diagnosticians around as a close friend. PA’s and NP’s are stopgap measures, but they aren’t doctors. Someone you know is going to die because of that. You can bet your life on it.
DrJohn has been a health care professional for more than 30 years. In addition to clinical practice he has done extensive research and has published widely with over 70 original articles and abstracts in the peer-reviewed literature. DrJohn is well known in his field and has lectured on every continent except for Antarctica. He has been married to the same wonderful lady for over 30 years and has three kids- two sons, both of whom are attorneys and one daughter on her way into the field of education.
DrJohn was brought up with the concept that one can do well if one is prepared to work hard but nothing in life is guaranteed.
Except for liberals being foolish.
John, it’s a new year. Why don’t you stop with the constant bull regarding Affordable Health Care? The ACA is wildly popular in Kentucky, Delaware, Arkansas, Georgia and states that embraced it early on. Wildly popular. Seventy percent of Americans who’ve taken advantage of the exchanges rate their coverage as excellent or good.
http://www.gallup.com/poll/179396/newly-insured-exchanges-give-coverage-good-marks.aspx
Sure. It’s great until you get sick.
“Health care costs what it costs because people need and use health care. The only way around it is high deductibles, rationing and lower cost treatments.”
It doesn’t have to be that way. Health care costs do not HAVE to keep going up and up, ever faster, infinitely and forever. Like LASIK eye surgery and elective plastic surgery that is not covered by insurance if it were subject to the normal demands of the marketplace, cutting edge treatments would get more cheaper, more efficient and more available. As it is, people can’t “shop around” because–among other things–they aren’t even ALLOWED to know how much their treatment actually costs unless they’re in the concierge market.
The healthcare market shares with the educational system in that it is just too “sacred” to be left to the whims of cruel, filthy, unholy capitalism. Therefore, it is so monstrously distorted by state intervention and regulation and subsidies and price controls that nature isn’t allowed to work.
@Gary Miller: Tell me Gary, what exactly are they happy with?
@Doramin: What do you propose to do about new technologies? They’re going to cost a lot of money in the beginning and that’s always the way it is.
The costs of many cancer treatments are so astonishingly high that most people would be happy to be left with personal, out-of-pocket responsibility for only $5,000 or $10,000. There were 12 new anti-cancer drugs approved during 2012. Of those, 11 cost over $100,000 for a single year of treatment. That’s just for the medication itself. Treatment for the various complications that can arise during chemotherapy—tumor lysis syndrome, serious infections resulting from a depressed immune system, etc—can commonly add ICU care costs at a rate of over $4,000 per day. Throw in 10 days over a year, and you’re now up to $140,000. That would be in addition to the costs of all regular medications and medical care that a person already required.
The fact that an insured person can’t come up with the $5,000 or $10,000 deductible left unpaid isn’t going to result in a denial of medical treatment. You’ve just got a $5,000 or $10,000 debt problem rather than a $100,000 or $140,000 debt problem—or the possibility that you wouldn’t have had access to the care you need at all. The Affordable Care Act alleviates those last two disastrous scenarios. If the first scenario worries you, you can always choose to pay more to get lower deductibles, provided you’re financially able and wish to. You really shouldn’t be choosing a catastrophic plan to begin with, if you’re trying to avoid very high deductibles. That’s as true now as it was before Obamacare.
What I find odd about this entire line of argument is that people were formerly complaining about the elimination of a type of inexpensive individual policy that kept premiums low by having far worse coverage holes than anything that exists under new Affordable Care Act requirements. Not only were there high deductibles; there were also lifetime coverage limits, exclusions for preexisting conditions, and the possibility of cancellation of long-standing coverage based on newly discovered technical problems that existed at the time of the initial application.
@Gary Miller: if you read the law, there are death panels. No they are not called that, but they will help those with congenital or terminal diseases whether they should end their lives. Remember the town hall meeting where obama couldn’t understand why a woman had surgery conducted on her 95 year old mother? He thought a pain pill would be the most she should have gotten. Abortion is not only condoned but encouraged. This will help to keep the health costs down since less babies will beborn. People will begin to have their health care restricted. This is the only way that it can be sustained. The youth who obama thought would sustain the system, which is actually socialism since their money will be used for others is not going to happen. Look at the UK. IN 2012 about 130,000 elderly died because they either could not get care in time orthey were denied. This will be the United States.
Regardless this is not about health care. It is about control of the American people. See saul alinsky’s first rule to a state of socialism.
My late mom never lived to see ObamaCare, or even Obama, but she was an NP for many years.
She’d had 4 children and they gave her a huge extended family.
As a way to prevent MD visits most of us would call her first.
She dispensed advice up to a point.
But she usually ended the call with a warning that seeing a doctor and getting this-or-that test was vital.
Yes, NP and PA visits will cost Americans their lives.
It should not be an end-point visit for hardly any health issue.
I supervise 4 NPs in an inpatient ICU. They are 4 of the best NPs I have ever worked with in almost 2 decades of practicing medicine. The key point is that though they handle patients semiautonimously, I still see their patients and we discuss the care plan every day during rounds. NPs and PAs are physician EXTENDERS, not physicians. Within that that framework, NPs and PAs are extremely valuable. But in an outpatient setting without proper physician oversight, NPs and PAs are being expected to practice medicine beyond the scope of their skills. Obamacare, with the inherent cost limiting paradigm, skews the working partnership between physicians and NP/PAs such that stories like these will become more common.
Insurance does not equate to medical care, no matter the intensity of the wishful thinking of the left. Actual medical care is a finite resource that requires years of investment to produce. A single primary care physician takes 11 years minimum to develop after high school, with specialists taking a minimum of 14 years or more. A single physician can only see so many patients in a day. A primary care doc who sees 4 patients an hour, starting at 8 AM, taking an hour for lunch and continuing until 5 PM can see at most 32 patients a day. If any of those patients has a problem that requires more than 15 minutes slows down the entire process. This doesn’t take into account the time it takes to ask all the mandatory questions the government requires at an appointment, (frequently having nothing to do with the patient’s reason for wanting to see the doctor) nor computer data entry, prescription writing, lab orders and acquisition of lab samples. When you add in time taken up having to debate insurance company payment denials for treatment, government data requirements, state certification of continuing education, mandatory medical conferences – then having to pay personnel and overhead expenses – is it any wonder there is a physician shortage?
The American Medical Association supported the passage of ACA
Dr J the cost of healthcare in the US has gone up but why wouldn’t it ? Inflation, a growing population, aging baby boomers and many other factors affect the cost. However as you seem to have forgotten to mention the RATE OF INCREASE has been low in fact historically low. I think that this is important to mention, apparently you did not.
Dr J would you refuse service to a long time patient because of a fee reduction caused by the ACA? Fortunately many new doctors are no longer primarily motivated by income. Perhaps this is gender effected back in 1970 only 10% of doctors in the USA were women now it is heading for 40% especially as the old generation that was 90% male fades away
@Nanny: The problem isn’t the fact that it is NP or PA — the problem is that they will be monitored by the Feds — and will be more concerned with looking over their shoulders than whether some patient should be referred for a test or physician evaluation!
@Pete:
Not to worry — they will be imported from the third world by the thousands!
It will take decades to get over the damage this idiot Obama has done to our great country
@bike mike: I agree with you to a certain point; however, you are probably young enough to see the retransformation, many of us won’t live that long. The medical situation will implode soon enough; the arrogance, incompetence, and corruption of the Obama appointees like Gruber have made the meltdown inevitable. Unfortunately, the stagnation of the economy represents six years of prosperity that are lost, with two more that are set-up to help America sit in the quagmire of lost prosperity. This is wealth creation that can never be recovered, wealth that was stolen from the American people through incompetence and corruption. Now, to insure the success of banks and to feather his own nest, your wealth or deposits will now insure the bank against failure, like the stock investors of GM, your investment becomes the first line of defense against incompetence, questionable investments, and nepotism, but don’t threat, bankers and Obama, our elites, will reinsured by every dollar you run through the banks at less than 1% interest. Yes, healthcare and the economy will take decades to be corrected or maybe the corruption and incompetence will be so interwoven into the systems, they will never be corrected.
@john:
I did not argue otherwise
Recessions will do that.
No and I bet Pete would not either.
Few of us were. If money was the motivation, becoming a lawyer or a hedge fund trader was the best direction. Then again, why would someone spend 10-15 years in school beyond high school for little more than minimum wage? Why invest a huge part of your life to learning how to save lives when all will get you is the place between the hard place and the rock? On the one hand patients want you to do all you can for them and on the other lawyers troll and are ready to sue anyone for having a bad hair day. I don’t know that you comprehend the eternal sword of Damocles hanging over your head every minute of every day and then having Nancy Pelosi cutting your income. Notice how Congress never cuts its own income? I’ve got colleagues who are stressed out badly- GI and neurosurgeons alike.
This is a good thing. It serves women very well especially if they choose to make medicine a part time profession.
@Pete:
Pete, for the longest time I have been trying to get people to understand that coverage isn’t care. A poll purporting to canvas whether someone is “happy with the cost of healthcare” is ridiculous if it doesn’t survey those who have actually needed care. The poll referred to above is entirely mistitled. The reality is that what was polled was satisfaction with the cost of coverage, not with the cost of healthcare.
@Doramin:
Doramin
If a person is not entitled to enjoy the fruits of his or her labor, what’s the point? Do you or do you not want the best? The US has- or maybe had- the best medicine in the world. Nowhere are cancer survival rates better overall. Without a doubt I suspect your attitude toward capitalism in medicine would change were someone very close to you find him or herself in dire need but honestly, I hope you never do find that situation. It’s brutal.
“‘You had a 7 cm mass under your arm and they thought it was nothing.’
If you’re a doctor you know exactly what he was saying. ”
Hell, I’m not a doctor and I know exactly what he was saying!
Although, thirty years ago, I was an Army medic. Not a Presidential corpse-man, either.
Just how much knowledge does one need to be a PA these days, anyhow? (Note, I said “knowledge”, not “education”. Two different things.)
“Hospital emergency room utilization is up, ”
Our local hospitals have solved the problem of parents crowding the emergency rooms with non-emergencies…
They’ve re-named their outpatient clinics “Emergency Rooms”.
The emergency rooms are now “Trauma Centers”.
Anyone who comes to the emergency room with a genuine emergency gets zipped over to the trauma center.
As far as government health care goes, I have a local sawbones on retainer. I give him a small payment each month, and he take care of everything that one doctor can. Saves me money, saves him paperwork, and there are no records outside of his paper files.
That is a growing trend in many areas of the nation where self-sufficiency is a desired trait.
And before anyone points out the obvious, there is the concept of “legal” and the concept of “right”. Sometimes they even mean the same thing!
@john: #10
“Dr J would you refuse service to a long time patient because of a fee reduction caused by the ACA?”
It is difficult to provide service to a long time patient if you have left public practice, retired early, or moved to another country.
I now know four doctors who have done just that. One retired early, two have moved to New Zealand where they are doing well, and one has left public practice to work for a large company as their in-house doctor, treating employees only.
It is a fine thing to be motivated by altruism, but that only works if you are able to care and provide for yourself and your family, as well as pay off a mountain of loans, malpractice insurance, and other bills.
When you compare a doctor’s income to his bills and taxes, it is not unusual for a doctor’s real personal income to be less than 25% of his paper income.
I won’t even get into comparing the time they spend providing care to the time they spend on paperwork and mandates. Or the amount they spend paying someone else to spend time on paperwork and mandates.
@Petercat:
If this persists, we’ll see a bifurcated system as exists now in England; a private sector for those who can afford it and the public sector for everyone else.
And eventually it’ll go bust as is happening in England now.
@john: #10
The AMA, really? That is a mere ~17% of the Physicians {~217,000 including medical student members} in the US; what did the other 83% of the 1.2 million doctors think about it?
http://truecostofhealthcare.org/summary
It’s a large site, but I recommend that anyone who wants to know why healthcare in the US is not affordable become familiar with it. It is done by a doctor in search of those answers and lays out several causes.
1. Government legislating for insurers to get more money.
2. Costs hidden from the payers via third party (insurers)
3. Costs often hidden from the doctors themselves.
4. Hospitals playing the insurance games to get paid.
There are more, but it boils down to capitalism has been completely removed from the medical industry via government legislation. Therefore, doctors, hospitals and manufacturers no longer compete on costs, efficiency, accuracy, or customer satisfaction. This is a microcosm of what happens in any collectivist controlled economy. The ACA makes this WORSE. Pricing for hospital procedures have been decoupled from their cost or value and this leads to the elimination of competition in the market. Since those are driving the increase in medical costs, we are still not fixing anything. Adding a layer of obfuscation by involving the government, actually exacerbates the problem, even when not accounting for government corruption.
Here’s proof that capitalism CAN still work in the US medical industry and is perfect validation of the first link.
http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi
Dr. John, glad to hear of your son’s recovery and I certainly hope he lives a long healthy life.
Wlth 4 children of my own, I well understand how you’d fight relentlessly as I know that I and my wife of 30 years would travel to the ends of the earth as well.
But I’m missing the connection in how ACA, changes from ACA, or changes not associated with ACA plays a role. Now all this shortage of doctors and socialized medicine and European transformation and death panel crap has been debunked time and time again so arguing those points are redunantly senseless. This leaves us to your argument of 6k deductibles and such.
The ability to aquire quality medical care is contengent on one’s resources. ACA provides those resourses to over 10 million people that otherwise couldn’t get it. I’m sure most of these millions of people would fight to the end for their love ones as well. Most people can reach that 6k figure be it through loans, familly, chucrh, charitable facilities, fund raisers, community, mortgaging or selling their home, cars, or valuables and so on. Without coverage at all it’s beyond their reach so they’re faced with the conservative alternative which is to just go home and die.
@Ronald+J.+Ward: OK Ronnie, you sell your home and car. Where are you going to live? How are you going to get to work? Or do you even have a job?
@harp1034:
Your argument makes no sense on any level. I’d live in a tent or a cardboard box to protect the life of my immediate family. I’d concede my job if necessary. Family and God first my friend. Or do you disagree? You seem to present a tone that the unemployed should be exempt from healthcare, or something. Again, you make no sense.
the person you talked about first had a pre existing condition and without the aca they would not have insurance.6000 deductible is high but its less then paying the whole thing which most people could not afford so they would file bankruptcy and the hospital would be left holding the bag for their care
This entire article is predicated on bad math.
The first claim is that high deductibles are necessary for low premiums semicolon that’s true, however it has nothing to do with Obamacare. That has always been true, just simple math. Prior to Obamacare you still could buy high deductible low premium policies, and then you would have the same problem as the lady in the first instance.
The rest of the article suffers from similar issues; for example the claim about ER’s quotes an article in Breitbart that doesn’t actually say what is claimed here; it says about half of the ER’s say there are getting more business. Half get more, half get less, it’s a wash! No numbers are shown but the citation does not prove the proposition, say the least.
Sifu is mistaken.
Hospitals have played Insurance games for as long as there was insurance. Prior to Obamacare, hospitals still shopping around to try to get insurance to pay as much as possible, and ensures work hard to avoid making payments. The worst that can be said about Obamacare in that regard is that it hasn’t fix the problem enough; it has made progress however
@john:
Your ignorance of the practice of medicine shows clearly in your post. The AMA has been a leftwing shill parading in a labcoat for almost 2 decades, which is the reason less than 20 % of practicing physicians are members. The vast majority of AMA funding comes from the mandatory need to purchase theit CPT/ICD coding references every year. If a physician doesn’t have the most current coding guides, he or she cannot get paid. I know leftists think doctors should work without getting paid, but the people that feel that way don’t ever seem to put their money where their mouths are.
@steve:
What you neglect in your praise of obamacare is that over 80% of obamacare enrollees require taxpayer subsidies to pay the monthly premiums. How on earth are these people supposed to pay the $6000/yr deductible? And while it is true that employer provided insurance had dedeuctibles, they were generally in the $1500-$2500/ year range. In what alternate universe is an obamacare plan better, especially if you cannot find a physician who will accept obamacare reimbursement rates?
@Ronald+J.+Ward:
Please….Gruber’s 2009 briefing notes to Obama, in which he admits the only way obamacare saves money is to deny care, debunk your mythical debunking of the IPAB being a de facto death panel.
There is no point “debating” with people who think that Gruber wrote a note saying the only way Obamacare saves money is by denying care. That’s just silly AND it’s not relevant to the claim that Obamacare will kill someone in your family OMG OMG OMG!!!!
If you want to meet people whose lives were saved by Obamacare, see
https://www.facebook.com/ObamacareSavedMyLife
@Pete: @Pete: As mentioned above, all of this has been haggled endlessly so you death panelist, birthers, and flat earthers can continue to beat your stupid drum all you like. It just doesn’t hold water to anyone other than you low percenters that are convinced the sun revolves around the earth.
Aside from that, you’re nonsensical distraction from my argument is simply that, which is to be expected as it’s understood that this is your role.
@Ronald J. Ward:
Hearing an AGW fanatic call anyone a “flat earther” and “low info” is hysterical. Denying Gruber’s statements about denial of care is delusional.
Tell you what, RJW… when you spend a month treating obamacare patients, then you might have a smidgeon of credibility on the subject. Until then your bloviations are as useful as micturating into the wind.
@Ronald+J.+Ward:
You missed the premise. Obamacare will eventually drive out real doctors in favor of PA’s and NP’s acting solo. That will kill people. Also, it will reduce the nation’s cost of health care.
@Pete: When I “spend a month treating obamacare patients”?
Let’s digest that for a moment.
When I “spend a month treating obamacare patients”?
?
What if I spent a month treating people who purchased their insurance through the Affordable Care Act exchange which could be most any of the big boy carriers? Would that be okay? What if I spent a month treating patients who have identical policies from identical providers who just didn’t happen to go through the ACA or if you prefer, Obamacare exchange? I mean, do “obamacare patients” give you warts or such? Do you honestly have an iota of a clue as to what the hell you’re talking about or do you simply assume that everyone is profoundly ignorant?
@DrJohn: I go to a nurse practitioner and have so for years. I’ve always been referred to doctors for most anything beyond the initial screening. I not seeing supportive evidence of that changing.
How that’s a bad thing flew over my head.
@Pete //*Denying Gruber’s statements about denial of care is delusional.*//
— and yet, you don’t link to those statements. Wonder why?
And I don’ t mean linking to a meme, or a snippet pulled out of a speech. I mean the full thing when Mr. Gruber says that the only way Obamacare can save money is by denying care.
And by “only” you mean “only” right? So money saved from the 80/20 rule will result in denial of care? So money saved from letting customers do an apples-to-apples comparison of policies on an exchange … a reform that free marketers should applaud … and then choosing a bronze plan if they want, or a silver plan, or a gold plan from whatever carriers offer plans in their state … will result in denial of care?
Buyers having information on their purchases will result in denial of care?
Yeah. Show us where Gruber said that … and then show us where (even if he did say that lol) it would be true.
Or don’t. You hate Obama, we all get that, and you don’t have any factual basis for it. Rage keeps you warm, and it would be rude to deny you that pleasure.
@Ronald J. Ward:
Not yet, but if this trend continues you will.
Depends on whether it’s your child who dies or someone else’s. People dying because they can’t meet the deductible or die because a non-doctor failed to properly diagnose them makes health care cheaper because they die early. You and I disagree as to whether that’s a bad thing.
@drjohn: This trend you fear was a work in progress long before ACA. Ironically, many on the right advocate tort reform which would actually amplify the very trend you speak of, jacklegs replacing higher paid professionals as there’d be no repercussions of these failed diagnostics. But I digress.
If there’s one thing that never changes in any industry it would be the that fact that everything changes and accordingly, industry professionals adapt. Again, these changes are not a product of ACA.
Your argument seems to ignore the shambles our overpriced and underperforming health system has been in for years while blaming ACA for it’s evry shortcomings.
@Ronald J. Ward:
Sorry, I forgot with whom I was dealing. Let me lower the level of cognitive discourse so you can understand, since you are nothing but an obnoxious leftist troll.
First – go to medical school and get into a primary care residency. Take all the loans you need, estimated at $250,000 or more, just for medical school. You cannot work while in med school.
Second – Go into a primary care residency for three years minimum. You will make maybe $40-50,000/year average during this time while learning about your field. Your medical school debt will continue to be waiting on you, as most residents are not paying on their medical school loans while in residency.
Third – Once you finish your residency in a primary care field, unless you join a group practice or hospital, in which you will be lucky to start out at $150,000 per year as a primary care doctor fresh out of residency, you will have to take out MORE loans to open up your office clinic, buy equipment, computers, hire admin and nursing staff, disposable medical equipment (tongue blades, ear speculums, etc – those aren’t free) and copy machines. Then let’s not forget the software and regulatory books for coding so you can meet all the government-mandated record-keeping requirements. And of course the state medical licensing fees, DEA certification fees, and state medicare ID certification fees. These take weeks to months to get approved. You cannot be paid for services until you have all these. Oh – and let’s not forget that you have to get malpractice insurance.
Fourth – You have to see patients, the vast majority of whom expect to have to pay nothing nor do anything except show you an insurance card (if you are lucky) or demand that you look up their insurance number for them, file all their insurance paperwork for them….and then deal with the repeated delays and denial of payment from third party payers. Now, anyone with any experience actually practicing medicine…unlike obnoxious trolls like you…knows that medicare/medicaid pays roughly 11-15% of billed charges, while private insurers (at least prior to obamacare) pay roughly 50-65% of billed charges. Private insurance companies pay much more quickly than medicare/medicaid plans, at rates that are essentially making up the shortfall for the below cost reimbursement rates of medicare/medicaid. You blather on about obamacare plans run by private insurance companies, yet you miss the point entirely of why there is such a discrepancy between payment rates from medicare/medicaid plans run by a private insurance company versus the private insurance plans run by the same insurance company. That would be due to GOVERNMENT SETTING OF PAYMENT RATES. If you had a reasonable brain in your head, you would have caught that the dems passed a 2 year temporary increase in primary care physician reimbursement rates to tempt doctors into taking more medicaid patients while obamacare was increasing enrollment into medicaid plans. This bait-and-switch temporary increase just ended on 1 January, leaving these primary care physicians facing a 43% cut in payment rates for medicaid patients – regardless of whether a specific patient was covered by a private insurance company running a medicaid plan, or not.
Why is this relevant? Obamacare rates of payment are LOWER than medicaid reimbursement rates, even in deep blue leftist states like California. Now, if you are capable of remembering all those overhead, malpractice insurance, medical school loan payments, admin/nursing salaries costs I mentioned in number 3 above – and we haven’t even discussed the coverage of the physicians’ living expenses yet, just his medical operating expenses – then if you had the cognitive ability of a drunken amoeba, and some component of integrity, you might start to glimpse why obamacare is such a miserable failure. There is no ability to “make up it in volume” if every time you see a patient it costs you more to treat them than you receive in payment. I know that is a difficult concept for a leftist to comprehend, since you think raising taxes and giving more money to people who don’t earn it improves an economy. But just because you don’t have the mental acuity to understand it doesn’t mean that it isn’t reality.
So – you can keep acting like an idiot with your “What, obamacare patients have warts?” ignorance all you want. Since you are being deliberately obtuse – or you actually ARE that stupid – let me spell it out in the simplest terms possible for your tiny leftist brain:
I dare ya ta wurk as uh dokter fer uh munth. Ya can onny see obamahcare peeps. See if ya can pay yer bilz.
That should suffice to meet the level of intellectual discourse you demonstrate in your posts.
@rewinn:
Here’s your link, troll:
http://dailycaller.com/2014/12/30/obama-adviser-jonathan-gruber-in-2009-obamacare-will-not-be-affordable/
Here’s the quote:
What you collectivist jackasses believe is that YOU have the right to determine what everyone else is entitled to, as well as believing you have the right to forcibly confiscate from people against their wills to pay for what you leftist asshats arbitrarily decide is “fair”. And you believe you are doing nothing wrong when you lie through your damned teeth about your intentions:
And to prove that they didn’t know how to control costs…also from Gruber’s podcast: (same as previous link)
So for someone who proclaims his former seminarian status, it seems awfully bizarre for you to be denying that Gruber clearly stated that denial of care was the only way to control costs, and that you are defending him – and Obama – for knowingly lying to the American people in order to get this socialist nightmare passed.
Who would you want making your medical treatment decisions? Your physician? Or a deceitful government bureaucrat like Gruber?
Your false concern for the uninsured is despicable. Your denial of facts, while also despicable, is the typical behavior of a leftist.
@rewinn:
Here’s the link to Gruber’s policy paper from 2009: https://www.maxwell.syr.edu/uploadedFiles/cpr/events/cpr_lectures/pb41.pdf
Some interesting tidbits:
From page 8 – discussing his thoughts on the individual mandate:
So, Gruber admits to some understanding of the problem totalitarian/collectivist policies have in the real world – but instead of recognizing the inherent flaw in his leftist ideology, he doubles down on the concept of collectivist punishment of EVERYONE rather than allowing for the existence of personal liberty. Very telling…. Even more telling of the rapacious tax-addicted mindset of the leftist bureaucrat, from pages 12-13:
So rather than compliment the employer on providing a benefit to the employee for orthodontia, the leftist bureaucrat is more concerned that the government isn’t getting a tax payment!
And the pathetic little rat KNOWS this is not what the American people want, so he admits in his own policy paper that the best tactic is to try to deceive Americans about a method to raise taxes! (Page 13)
So it isn’t “the evil insurance companies” that are raising the cost of health insurance…it is the evil leftists who are foisting an unwanted government mandate of increased government control over medical care – while writing the laws to make the insurance companies look like the villains. This entire obamacare law is completely indefensible.
Oh—and here is where we get to the quote you deny existed, troll, on pages 14-15:
So you can read the rest for yourself. The key point being Gruber clearly DID write this policy paper – and he presented these positions to Obama. The ONLY thing the left admits will cut costs is DENIAL OF TREATMENT.
Hope that helps you come to a better understanding, troll.
@rewinn:
Oh, and when you read to the end of that policy paper, you can see that what we conservatives have been warning about the entire time – which you leftists shrieked histrionic denials over – was that obamacare was a dishonest attempt to push the US towards socialist healthcare. Gruber admits as much, page 19:
It is all about control, never has it been about actually improving access to care. In his position paper, Gruber claims that this is not going to be like England, where above a certain age you cannot get an organ transplant. But that is more leftist deception, whether intended or self-directed. He already admits that denial of care is the only way to control costs when the government is controlling health care. He admits that political reality prohibits raising rates on all Americans’ payroll taxes (he cites 15%) to pay for everyone to have medicare – so the left has chosen the path of the slow-boiling frog to force us to their dream of collectivist, government-controlled medical care in this country.
But yeah…don’t believe the words from the leftists themselves. It is just “rich, greedy, selfish” doctors that are the cause of medical care costing so much.
@Pete: Aside from all the blathering insults, I do have the mental capacity to understand the reality that The Affordable Care Act doesn’t replace private insurance. Nor does Obamacare. It’s the private insurance carriers that negotiate reimbursement rates with doctors in their network, not ACA and not Obamacare.
I understand you dispise Obama with your every fiber as well as anything associated with him but it would improve your snake oil sales pitch if you’d make your silly attack spews at least somewhat consistent with reality.
@Ronald+J.+Ward:
Poseur sanctimony is the typical leftist dodge tactic to avoid reality, RJW, especially when I am simply responding to your original tone. Considering the numerous lies the dems used to cram obamacare down the nation’s throat, it is the height of irony for any leftist to call pointing out the blatant deceit of obamacare a snake oil salesman.
And incidentally, such posturing as your exhibit does nothing to refute what I posted.
@Pete: Okay, that’s much better. At least you have an excused for your failed argument, your invention of reality, and your assigning blame to The Affordable Care act that doesn’t exist.
It’s all fair games because, well, Dems do it too. And I did nothing to refute your fairy tale because, well, you say so and accordingly, so there!
You win because Dems are no better and a splash of Pixie dust, typical of today’s so called conservatives.
I’m certainly not dodging your argument by any stretch as I’m actually addressing it head on. If I’m wrong, explain precisely how ACA replaces private insurance, who negotiates insurance payouts to doctors, and exactly how ACA is the culprit.
@Ronald J. Ward:
Dodging yet again, while claiming not to be dodging…and even better, despite presenting Gruber’s own words in his 2009 position paper, and describing the manner in which doctors have to battle the effects of government regulation of medical care payments…and you laughably accuse me of making up reality.
In answer to your typically disingenuous question, consider Gruber’s comments regarding not worrying about containing costs until you first force everyone into mandated coverage. The reality which you leftists vehemently deny is that obamacare is a trojan horse designed to destroy private medical insurance so you can emotionally manipulate people into accepting the complete government takeover of health care.
First, you lie about the alleged benefits and decreased costs that will result from obamacare.
Second, you have the CBO put out bogus long term cost numbers from the forced implementation of obamacare.
Next, you demonize the insurance industry for the resulting negative impacts of obamacare, when the insurance companies are only doing what the deceitful law forces them to do. Increased premiums, rising at a faster rate than before obamacare are happening because of government regulations that arbitrarily declared prior insurance “inadequate”, for idiotic things like not covering breast exams for men; mandatory coverage for drug and alcohol rehab even for people who do not drink or abuse drugs, to name a few. Then you add in how medicare/medicaid/obamacare plans have physician payment rates decided on by bureaucrats, with denial of payment for treatments these same bureaucrats deem “unworthy”. (An example is the refusal of medicaid to pay for neonatal hearing screens, which still have to be performed on every infant born). In order for a doctor or hospital to be able to keep its doors open, private insurance has to pay more to offset the loss a provider has from caring for the government set underpayment. Gruber specifically comments on the tactic under obamacare of adding additional taxes onto employer provided insurance plans, specifically to hide from Americans the tax payroll tax increase (he estimates 15%) that would be required to try to finance the dreamed of national health care system.
The underlying goal of obamacare is to make private insurance so expensive that it cannot be sustained, setting up the aforementioned scenario of the complete government takeover of medical care. The insurance companies that run the medicare/medicaid/obamacare plans pay the rates set by the government. When doctors refuse to accept patients with such plans because they lose money on each patient they see, obamacare supporters point accusatory fingers at the doctors and insurance companies for being “greedy”, rather than acknowledging the deliberately flawed government payment rates.
Hospitals with majority medicaid covered patients are closing around the country at an accelerating rate, because they cannot meet their operating expenses with the low government determined payment rates. This is not the fault of insurance companies, as they are bound by what they can pay for medicaid (and obamacare) claims by the government. Rather than admit this government-caused problem, leftists are working, though plans for taxes on employer provided insurance and constant “doctors are just too greedy” rhetoric, to kill off private insurance so as to install government control of medicine.
@Pete: Thank you; entering into the arena of conflicting ideas with you, armed with only the populist pabulum of Leftist propaganda, is a fool’s mission.
I thoroughly enjoyed the thrashing meted out to our resident leftist and I had a hearty laugh as well! Well done, sir, well done indeed.
@Pete – from your quote —
“The real substance of cost control is all about a single thing: telling patients they can’t have something they want. It’s about telling patients, “That surgery doesn’t do any good, so if you want it you have to pay the full cost.”
So what you’re saying is that refusing to pay for something that does not work is denying care.
If you want to treat a broken leg with crystals and unicorn horn, and your insurance policy under Obamacare does not cover crystals and unicorn horn, that’s denying care.
Welp, ok.
Like I said, it’s silly to argue the point.
You can still get the crystals-and-unicorn-horn treatment – you just have to pay for it yourself. Since it’s not covered by insurance, it didn’t jack up your premium, so it’s no loss to you. Everybody wins!
P.S. You seem not to understand the meaning of the word “troll’. That’s o.k. You seem not to understand “denying care” either, so at least you are consistent.