(08-01-2014 10:44 AM)Machiavelli Wrote:  and you think hospitals or individual Dr.s are different??????????? It's also the reason why we needed a change from before. The people who were propping up the whole system were the unlucky ones who had kids or they themselves were sick and had insurance. The Hospitals piled the margin up on us to cover their expenses on those that didn't have insurance.

Did I say that?

You said insurance runs up costs, but if you think about what you're saying.... you're upset that the hospitals make you pay more because you don't have insurance... yet it only does exactly what Obamacare does.... you're just on the other side now.

Insurance actually runs DOWN costs for the insured.

I'd note that what you said is true prior to I think 1990, before ICD-9. But after then, things changed. Before 1990, it was a percentage of the billed fees (which ran up bills). After 1990, it was fee for service.

Insurance is math, not magic. Insurers negotiate lower than 'normal' reimbursements to lower premiums to attract customers... and then clip a coupon on that money.

If insurance doesn't run up costs then explain to me how Lasik surgery without insurance coverage can come down in costs while procedures with insurance coverage for the most part keep going up. I know there are outliers but the vast majority keep going up.

I could use OTC drugs as an example too. That one allergy medicine once it was registered as an OTC where insurance couldn't cover the cost went down 90%. Claritin D?

(08-01-2014 11:09 AM)Machiavelli Wrote:  If insurance doesn't run up costs then explain to me how Lasik surgery without insurance coverage can come down in costs while procedures with insurance coverage for the most part keep going up. I know there are outliers but the vast majority keep going up.

I could use OTC drugs as an example too. That one allergy medicine once it was registered as an OTC where insurance couldn't cover the cost went down 90%. Claritin D?

Patents expire. When patents expire and there are generics, the costs go down. Walatin-D. The purpose of the patent is to allow the manufacturer time to recoup his R&D costs, which generic producers don't have

I get that. I understand that the pharmaceuticals need to recoup their investments to keep the pipeline full of promising medicines. I'm not saying insurance is not a necessity. I'm saying they inflate costs. In a true free market you wouldn't have the safety net of patents or IP.

(08-01-2014 11:26 AM)Machiavelli Wrote:  I get that. I understand that the pharmaceuticals need to recoup their investments to keep the pipeline full of promising medicines. I'm not saying insurance is not a necessity. I'm saying they inflate costs. In a true free market you wouldn't have the safety net of patents or IP.

Okay... but you can argue that they also wouldn't make those same investments... that's projection, but it is logical.

There are definitely different business models that will work best with the changes that are taking place in medical care regardless of whether they are ACA induced or not. The winners are the ones that adapt quickly and make the correct move. The losers are the ones that are slow to react or make the wrong move. Change is constant and there are always winners and losers.

Here hospital systems are buying up practices, forming alliances, purchasing small hospitals, changing or limiting services offered at specific locations. There are three big players here, UNC, Duke, and Wake Medical. The small system in my community that just built a hospital in my hometown to go along with an existing one 15 miles away has a local network of medical practices and facilities. They are feeling the crunch and are in negotiations with larger networks to merge. The big question is which of the big groups will absorb it? Rumor has it that there is one non-profit (UNC or Duke?) and one for profit involved. I'm hoping for one of the non-profits.

These changes have as a whole been of benefit for our community. Specialist practices are locating here or nearby more and more. Unlike in the past when these were stand alone practices and the elephant in the room was, "why would a cardiologist, urologist, etc. locate in our little town instead of Raleigh or Wilmington or Charlotte? Is it because he is incompetent?" These are branches of the UNC, Duke or Wake Med system and are their doctors. We use to by-pass the little local hospitals for the same reason but now those little small hospitals are either managed by or a part of one of the major networks so there is a great deal more confidence in the quality of care offered.

This isn't to say that everything is coming up roses. There are issues and problems as well. The closing or changing of focus of some of the small rural hospitals is one. One need only to look at the closing of Pungo Hospital in Belhaven NC to find the downside.

(08-01-2014 11:56 AM)dawgitall Wrote:  There are definitely different business models that will work best with the changes that are taking place in medical care regardless of whether they are ACA induced or not.

Talk about obfuscation. What other significant changes are taking place other than the ACA?

Yes, all of those things are happening... and will continue to happen... but they didn't involve collecting trillions in payments from 'the people' only to not create one single additional residency slot... which means we aren't creating one single additional more PHYSICIAN (different from a doctor.. You can't treat patients without a residency but you CAN work for pharma or 'supplement' companies or do TV shows) to deliver one single additional patient encounter.

This is entirely the crux of my argument.

The ACA merely shuffles the deck around. It doesn't in any way create any additional healthcare.

According to Obama and others, we already faced a crisis in healthcare where there weren't enough doctors, and the ACA does nothing to alleviate this. I'm sure I can find speeches where Obama talks about this. He already talked about long waits for care. It's not as if there were doctors out there who couldn't fill their waiting rooms.

(08-01-2014 12:16 PM)Hambone10 Wrote:  

(08-01-2014 11:56 AM)dawgitall Wrote:  There are definitely different business models that will work best with the changes that are taking place in medical care regardless of whether they are ACA induced or not.

Talk about obfuscation. What other significant changes are taking place other than the ACA?

Yes, all of those things are happening... and will continue to happen... but they didn't involve collecting trillions in payments from 'the people' only to not create one single additional residency slot... which means we aren't creating one single additional more PHYSICIAN (different from a doctor.. You can't treat patients without a residency but you CAN work for pharma or 'supplement' companies or do TV shows) to deliver one single additional patient encounter.

This is entirely the crux of my argument.

The ACA merely shuffles the deck around. It doesn't in any way create any additional healthcare.

According to Obama and others, we already faced a crisis in healthcare where there weren't enough doctors, and the ACA does nothing to alleviate this. I'm sure I can find speeches where Obama talks about this. He already talked about long waits for care. It's not as if there were doctors out there who couldn't fill their waiting rooms.

So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?

It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?

It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

Except that it doesn't do any of those things. Given the opportunity to do those things, it didn't.

And its mechanism for controlling costs--reducing payments to docs--will clearly disincentivize it for potential docs in the future. There may not be many up and quit right now. But the flow of new docs going forward will clearly be affected for the worst. You may want to wait until that happens before taking. That will be too late.

(08-01-2014 12:16 PM)Hambone10 Wrote:  This is entirely the crux of my argument.

The ACA merely shuffles the deck around. It doesn't in any way create any additional healthcare.

We get it. But, you're just plain wrong.

People without insurance can now get it. Insurance that will allow them to see a doctor regularly without a huge bill they can't afford. That alone improves their health through care they would not have gotten before the ACA.

You keep on complaining that the ACA doesn't do something it was never intended to do and we all know it. The horse is dead already!

And as the other posters said, then start working on something to increase doctors and improve health care further. If the Republicans gave a **** about it they would be doing something...they're not...they're too busy taking a month vacation, working half-time, and authorizing frivolous law suits.

You must be proud.

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it.

ok, repeal Obamacare. That would be a start. Then privatize the payments so that doctors and hospitals would get paid rates based upon free market, and not some low-ball government number.

(08-01-2014 12:48 PM)Redwingtom Wrote:  

(08-01-2014 12:16 PM)Hambone10 Wrote:  This is entirely the crux of my argument.
The ACA merely shuffles the deck around. It doesn't in any way create any additional healthcare.

We get it. But, you're just plain wrong.
People without insurance can now get it. Insurance that will allow them to see a doctor regularly without a huge bill they can't afford. That alone improves their health through care they would not have gotten before the ACA.
You keep on complaining that the ACA doesn't do something it was never intended to do and we all know it. The horse is dead already!
And as the other posters said, then start working on something to increase doctors and improve health care further. If the Republicans gave a **** about it they would be doing something...they're not...they're too busy taking a month vacation, working half-time, and authorizing frivolous law suits.
You must be proud.

Insurance does nothing for them without more supply. You're right, Obamacare was never intended to increase the supply. That's the problem, you can't fix health care without increasing the supply.

Insurance is a zero sum game. You can't have winners without having losers. All we are doing with Obamacare is taking a fixed number of resources (which will be shrinking, already started) and allocating them differently than before. Somebody gets more and better health care, somebody else gets less and worse. That's the only possible outcome.

Good for the winners.

(08-01-2014 12:45 PM)Owl 69/70/75 Wrote:  

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?

It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

Except that it doesn't do any of those things. Given the opportunity to do those things, it didn't.

And its mechanism for controlling costs--reducing payments to docs--will clearly disincentivize it for potential docs in the future. There may not be many up and quit right now. But the flow of new docs going forward will clearly be affected for the worst. You may want to wait until that happens before taking. That will be too late.

My post was all about saying lets take action to increase and encourage now. The ACA isn't going away. It is time to stop fighting it and move on. Legislation to encourage the development of more health care professionals should be introduced.

(08-01-2014 12:48 PM)Redwingtom Wrote:  

(08-01-2014 12:16 PM)Hambone10 Wrote:  This is entirely the crux of my argument.

The ACA merely shuffles the deck around. It doesn't in any way create any additional healthcare.

We get it. But, you're just plain wrong.

People without insurance can now get it. Insurance that will allow them to see a doctor regularly without a huge bill they can't afford. That alone improves their health through care they would not have gotten before the ACA.

You keep on complaining that the ACA doesn't do something it was never intended to do and we all know it. The horse is dead already!

And as the other posters said, then start working on something to increase doctors and improve health care. If the Republicans gave a **** about it they would be doing something...they're not...they're too busy taking a month vacation, working half-time, and authorizing frivolous law suits.

You must be proud.

You say I'm wrong, but you can't show where I am. You actually admit that it doesn't increase the amount of healthcare, so how am I wrong? Or does it merely make you feel better to try and claim I am wrong?

The best you can do is claim that Republicans didn't have a plan, despite the fact that candidate McCain articulated one, and parts of Obamacare was supposedly modeled after a Heritage proposal and/or Romneycare... So which was it?

The ACA was never intended to create more doctors or more available doctors visits? It wasn't intended to be able to deliver more healthcare?

Do you believe that most who voted for Obama or anyone else as a result of what they thought Obamacare was about thought it wouldn't increase the amount or availability of doctors to DELIVER that healthcare? Do you have any idea how LONG it takes to create doctors?

YOU must be proud.

I get it. You robbed from the rich and gave to the poor, but since all these policies have copays and deductibles (often of 40%)... you've created situations where someone who often can't afford to make his own premium payments... STILL has to make thousands of dollars in deductible payments... so have you REALLY changed anything for them? You've perhaps reduced the amount of the total debt they can't pay and transferred that to the rest of us, but they still have a massive debt they can't pay.

Didn't Obamacare claim to keep people from having their credit ruined? How does a $5-10,000 out of pocket ANNUAL (not lifetime) max for someone who can't afford a $300/month ($3600/yr) insurance premium keep them from having their credit ruined? Sure, it might help a few who have $100,000+ in bills and can't afford that, but CAN afford $5-10,000 a year in copays... but THOSE people wouldn't generally get subsidies and could have been 'saved' merely by the individual mandate without all of the other stuff... a-la Romneycare.

(08-01-2014 01:12 PM)dawgitall Wrote:  

(08-01-2014 12:45 PM)Owl 69/70/75 Wrote:  

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?
It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

Except that it doesn't do any of those things. Given the opportunity to do those things, it didn't.
And its mechanism for controlling costs--reducing payments to docs--will clearly disincentivize it for potential docs in the future. There may not be many up and quit right now. But the flow of new docs going forward will clearly be affected for the worst. You may want to wait until that happens before taking. That will be too late.

My post was all about saying lets take action to increase and encourage now. The ACA isn't going away. It is time to stop fighting it and move on. Legislation to encourage the development of more health care professionals should be introduced.

Would you favor such legislation if it repealed the sections of Obamacare that discourage the development of more health care professionals?

Quite frankly, if you replaced the sections that discourage development of more health care providers with provisions that would encourage such growth, got rid of IPAB and HCC and CCO (the latter was technically part of the "stimulus"), changed the provisions affecting HSAs to encourage them rather than discourage them, and had a reasonable malpractice reform provision, you might have a bill that would do some good.

(08-01-2014 01:18 PM)Owl 69/70/75 Wrote:  

(08-01-2014 01:12 PM)dawgitall Wrote:  

(08-01-2014 12:45 PM)Owl 69/70/75 Wrote:  

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?
It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

Except that it doesn't do any of those things. Given the opportunity to do those things, it didn't.
And its mechanism for controlling costs--reducing payments to docs--will clearly disincentivize it for potential docs in the future. There may not be many up and quit right now. But the flow of new docs going forward will clearly be affected for the worst. You may want to wait until that happens before taking. That will be too late.

My post was all about saying lets take action to increase and encourage now. The ACA isn't going away. It is time to stop fighting it and move on. Legislation to encourage the development of more health care professionals should be introduced.

Would you favor such legislation if it repealed the sections of Obamacare that discourage the development of more health care professionals?

Yes, as long as the general structure of the act remained in place.

(08-01-2014 01:21 PM)dawgitall Wrote:  

(08-01-2014 01:18 PM)Owl 69/70/75 Wrote:  

(08-01-2014 01:12 PM)dawgitall Wrote:  

(08-01-2014 12:45 PM)Owl 69/70/75 Wrote:  

(08-01-2014 12:32 PM)dawgitall Wrote:  So lets work for ways to increase the number of Physicians in the US. I am all for it. Lets provide incentives for an increased number of residency slots. Lets recruit more physicians from overseas. What is the status of NA and PA programs as far as numbers are concerned? Do we need to increase these programs?
It isn't an either / or situation. The ACA can be in place while efforts to increase medial care providers can take place simultaneously.

Except that it doesn't do any of those things. Given the opportunity to do those things, it didn't.
And its mechanism for controlling costs--reducing payments to docs--will clearly disincentivize it for potential docs in the future. There may not be many up and quit right now. But the flow of new docs going forward will clearly be affected for the worst. You may want to wait until that happens before taking. That will be too late.

My post was all about saying lets take action to increase and encourage now. The ACA isn't going away. It is time to stop fighting it and move on. Legislation to encourage the development of more health care professionals should be introduced.

Would you favor such legislation if it repealed the sections of Obamacare that discourage the development of more health care professionals?

Yes, as long as the general structure of the act remained in place.

Edited prior post to add, and am repeating it here.

Quite frankly, if you replaced the sections that discourage development of more health care providers with provisions that would encourage such growth, got rid of IPAB and HCC and CCO (the latter was technically part of the "stimulus"), changed the provisions affecting HSAs to encourage them rather than discourage them, and had a reasonable malpractice reform provision, you might have a bill that would do some good.

Put me in the YES column for making changes to the ACA to encourage more doctors. Even up to repealing certain parts.

But that's the problem, Tom.

Obamacare eliminates/discourages independent primary care physicians/business owners, especially in smaller or poorer areas and encourages them to become 'shift workers' in nebulous corporate clinics... or elimination of smaller community hospitals in favor of the larger ones...

We're what, 6 years since passage and if we funded more residency slots today, it would be another 3 years at least before we saw a single new doctor... so we have 3 more years of consolidation of both PCPs and hospital services before you've created the FIRST new doctor... and of course, you have to somehow find the additional money ON TOP of what we've already spent and committed to spend to fund them.... and then somehow, you have to also incentivize these new docs to do exactly the opposite of what the ACA has encouraged every other existing doctor and hospital system to do for the previous 9 years.

Do you get it?

I agree with Hambone. If everything is so great for hospitals, why are they downsizing and freezing salaries. I have multiple friends who have worked at hospitals for 10+ years and this year is the first time that they have seen downsizing and no raises. They have averaged between 3-5% raises every year consistently. The outcomes certainly don't match the story. And this is at the second largest healthcare conglomerate in my state.

One of my friends who is a doctor said if things were like they are today when he was in college, he never would have gone to be a doctor. Long term this doesn't work.