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Obama's Healthcare

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  • Obama's Healthcare

    Not to beat a dead horse, but his vast plan , requiring 1/2 a billion from Medicare, is a disaster that will probably lead to single payer
    when the costs rise,and lead to retirement of many physicians.

    And Obama provided little leadership leadership except his bribing and pushing to get it passed at the end.
    He let congressional aids and acidemics formulate a Healthcare bill, w/o consulting practicing physicians and ended up with a monstrosity that is yet to totally unfold(as per Pelosi), with many panels of burocrats designed to cut costs but will cut quality and access. Malpractice tort reform was not addressed.

    BO does not understand the practicing physician.
    As an MD, this is painfully obvious to me when in a press conference he says a hypothetical: "a patient sees a doc for repeated sore throat which the doc allows to fester so he can make more money by operating".
    Actually the doc would be a pediatrician or internist who ,in a case with huge repeatedly infected tonsils, would refer to a surgeon. The original doc would make NO Money on the referral----that would be illegal and he could lose his med license.

    BO pushes Medicaid on the uninsured, an inferior insurance not accepted by most good docs because the reimbursement is not sufficient to even cover costs.
    And then BO has to resort to old time back door politics to bribe the Bill into passing, politics he promised he would change in DC.
    But it all fits into his socialistic agenda and BO believes will add to his legacy.

    There has got to be a better way for Healthcare, tho admittedly it is a tough nut to crack.

  • #2
    Re: Obama's Healthcare

    Originally posted by GeorgeLaw View Post
    BO does not understand the practicing physician.
    As an MD, this is painfully obvious to me when in a press conference he says a hypothetical: "a patient sees a doc for repeated sore throat which the doc allows to fester so he can make more money by operating".
    Actually the doc would be a pediatrician or internist who ,in a case with huge repeatedly infected tonsils, would refer to a surgeon. The original doc would make NO Money on the referral----that would be illegal and he could lose his med license.
    I think you're missing the forest for the trees here. The point is that, like anyone, physicians respond to financial incentives and at present our health care system is heavily reliant on payment incentives that reward volume, not performance.

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    • #3
      Re: Obama's Healthcare

      Originally posted by Greenbeard View Post
      I think you're missing the forest for the trees here. The point is that, like anyone, physicians respond to financial incentives and at present our health care system is heavily reliant on payment incentives that reward volume, not performance.
      That is true-- I wasn't trying to engage the entire huge complex "forest".
      Trying to evaluate performance is difficult--each case is different. At present Medicare pays a hospital and a hospital doctor for the diagnoses(codes) not the number of days in the hospital, and a doctor office and hospital visit for code representing the difficulty and time taken(must be documented but can be fudged).

      I was reffering more to way Obama care addresses cost-- with laymen panels that will reduce quality and access ,,,,,and poor quality insurance(Medicaid) that will be rejected by any doc wanting to avoid bankruptcy..

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      • #4
        Re: Obama's Healthcare

        Originally posted by GeorgeLaw View Post
        That is true-- I wasn't trying to engage the entire huge complex "forest".
        Trying to evaluate performance is difficult--each case is different. At present Medicare pays a hospital and a hospital doctor for the diagnoses(codes) not the number of days in the hospital, and a doctor office and hospital visit for code representing the difficulty and time taken(must be documented but can be fudged).

        I was reffering more to way Obama care addresses cost-- with laymen panels that will reduce quality and access ,,,,,and poor quality insurance(Medicaid) that will be rejected by any doc wanting to avoid bankruptcy..
        They are not 'laymen panels'

        The Facts About the Independent Payment Advisory Board

        Nancy-Ann DeParle
        April 20, 2011 at 05:46 PM EST

        Last week, the President outlined a framework for reducing our deficits and debt that is based on the values of shared responsibility and shared prosperity. We know we cant reduce our deficit without reducing the growth of health care spending. But we also cannot bring down health care cost growth by simply raising costs for seniors and States and ending Medicare as we know it. Thats why the President opposes any plan that would simply place the burden of deficit reduction on seniors and undermine Medicare.

        The Presidents framework instead builds on the improvements made by the Affordable Care Act. It tackles Medicare fraud and excessive payments for prescription drugs, proposes a stronger Federal-State partnership in Medicaid, and includes a series of health care reforms that would save $340 billion by 2021, $480 billion by 2023 and at least an additional $1 trillion in the following decade.

        Key to these savings is a proposal to strengthen the Independent Payment Advisory Board IPAB, which was created by the Affordable Care Act. Heres how IPAB works:

        15 experts including doctors and patient advocates would be nominated by the President and confirmed by the Senate to serve on IPAB.

        IPAB would recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care.

        IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.

        Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPABs recommendations.

        IPAB is a backstop it would only take effect if Medicare costs grow too fast.

        The Facts About the Independent Payment Advisory Board | The White House

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        • #5
          Re: Obama's Healthcare

          I was reffering more to way Obama care addresses cost-- with laymen panels that will reduce quality and access ,,,,,and poor quality insurance(Medicaid) that will be rejected by any doc wanting to avoid bankruptcy..
          What "layman panels" are you talking about?

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          • #6
            Re: Obama's Healthcare

            Originally posted by Greenbeard View Post
            What "layman panels" are you talking about?
            Many panels are in the works. One calculates the number of referrals(consultations) requested by each physician and penalizes(fines) those in the top 10% by number.
            This would incentivize physicians to limit referrals and take on the problem themselves,even tho less qualified than others.


            The IPAB mentioned above sounds very good.( altho Medicare fraud itself never required a new law to be addressed).
            The "ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care" sounds very good but would be very difficult, and somehow government imposing itself usually falls short, resulting in unintended consequences and increased total costs.
            Excessive cost of prescription drugs however in particular might well require the government.

            BTW , Obama's Affordable Care Act took 500 billion from Medicare(not the 500 million, I stated above). Now that is a real good start for saving Medicare costs, my ass!
            Last edited by GeorgeLaw; 01-28-2012, 03:21 PM.

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            • #7
              Re: Obama's Healthcare

              Originally posted by GeorgeLaw View Post
              Many panels are in the works. One calculates the number of referrals(consultations) requested by each physician and penalizes(fines) those in the top 10% by number.
              This would incentivize physicians to limit referrals and take on the problem themselves,even tho less qualified than others.
              Given the very strong emphasis in the ACA on care coordination and teamwork among clinicians, I find that doubtful. Do you have more information?

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              • #8
                Re: Obama's Healthcare

                Originally posted by GeorgeLaw View Post
                Many panels are in the works. One calculates the number of referrals(consultations) requested by each physician and penalizes(fines) those in the top 10% by number.
                This would incentivize physicians to limit referrals and take on the problem themselves,even tho less qualified than others.


                The IPAB mentioned above sounds very good.( altho Medicare fraud itself never required a new law to be addressed).
                The "ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care" sounds very good but would be very difficult, and somehow government imposing itself usually falls short, resulting in unintended consequences and increased total costs.
                Excessive cost of prescription drugs however in particular might well require the government.

                BTW , Obama's Affordable Care Act took 500 billion from Medicare(not the 500 million, I stated above). Now that is a real good start for saving Medicare costs, my ass!
                Do you have a link to your claim of fining doctors? It sounds like right wing propaganda. And the more I read your posts, the more it sounds like a pattern is developing...

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                • #9
                  Re: Obama's Healthcare

                  Originally posted by Greenbeard View Post
                  Given the very strong emphasis in the ACA on care coordination and teamwork among clinicians, I find that doubtful. Do you have more information?
                  Yeah. The 2600 pages are in the internet. Find it and read it to assuage your doubt. Or like Pelosi said(I paraphrase)--you will find out when it hits you in the ass.
                  And I find very doubtful( total BS) "the strong emphasis in the ACA on care coordination and teamwork among clinicians" since only acedemics and not practicing clinicians
                  were consulted about it.
                  AND PS :Tort reform was not addressed which was Pure PANDERING by BO to his Trial Lawyers backers($$$$$).

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                  • #10
                    Re: Obama's Healthcare

                    Originally posted by GeorgeLaw View Post
                    Yeah. The 2600 pages are in the internet. Find it and read it to assuage your doubt.
                    I have read it, which is why I'm curious what you're referring to. And it's about 950 pages long.

                    AND PS :Tort reform was not addressed which was Pure PANDERING by BO to his Trial Lawyers backers($$$$$).
                    The ACA's approach to tort reform is the same--to the point of borrowing some of the legislative language--used in several Republican bills over the last few years (e.g. Mike Enzi's health reform legislation, Paul Ryan's Roadmap, the Republican Study Committee bill, the Burr-Coburn/Ryan-Nunes Patient Choice Act, etc). Namely, grants to states in support of state-specific solutions.

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                    • #11
                      Re: Obama's Healthcare

                      All of the arguments against the healthcare bill sound good and do raise the ire of republicans, but as someone who lives in Massachusetts and heard the exact same arguments (including the ones posted here) when we instituted Romneycare here, I can say that the result of the fully instituted law has not lessened my doctor's voice in my care, created Medicaid HMOs that in many cases are run by the same companies that also run for profit HMOs, reduced the trend line as far as cost increases on me (I've paid an average 3% annual increase over the past 5 years), and did not raise my taxes (people still think we pay high taxes here, but our 5.3% rate is 31st highest in the nation). We are no closer to single payer than we were back then.

                      But we heard the same arguments - a law researched and passed by politicians not physicians, a potential problem with liberal judges, inferior Medicaid insurances, tax increases etc. Anyone from this state will remember the ads from interest groups, but none of it came true.

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