Yeah, About That Keep Your Doctor Thing

[McDad]

The problem with healthcare was that before Obamacare, if a person had any kind of previous health issue, the cost to buy an insurance policy was cost prohibitive, so people did without.

People that are sick are the ones that need healthcare. The ones that brag about how well they are and how they don't need healthcare are the same ones that will ***** as soon as they or someone else in their family gets sick and they need it.

There are numerous problems with USA Healthcare. The one you outlined is only one of many.

 

[slobberknocker]

If it is administered like Medicare, very few health care personnel will recommend procedure which is not covered as an outlined benefit.

Kinda like those "death panels" huh?

 

[LouderVol]

It's absolutely coming, even before Obamacare the healthcare oligopoly was out of control. Now that they have to insure the sick and healthy people are opting out taking the fines (and understandably so).... No wonder Aetna is hauling ass, that's good business.

We're going to either stop whining about the high cost and live with the fact that the health insurance bill are going to bend us over every year (without lube.) Or accept a single payer model like every other advanced country.

that in pretty much every single case is going bankrupt despite HUGE government support? Its one of the reasons the UK left the EU, they had to redo their healthcare system and weren't allowed under some of the laws. (no idea why)

 

[slobberknocker]

Switzerland isn't single payer and they have some of the lowest costs per insured in the world - it's all private insurance.

There is a mandate and there are subsidies to purchase based on income but it's all private insurance.

Works like a charm.

Excellent point. Such a system would possibly appeal to both conservatives and liberals here. But I doubt it with our nimwads in control.

 

[volinbham]

Excellent point. Such a system would possibly appeal to both conservatives and liberals here. But I doubt it with our nimwads in control.

I'll tell you one place it would break down is what is required in the mandate. In the ACA mess they put in all sorts of care to be covered that goes beyond basic healthcare.

If we have a mandate it should be preventative, basic and catastrophic care but not include fertility treatment, gender reassignment, ED drugs, etc.

Then require all insurers to offer the basic care package as a stand alone. Provide government subsidies to help the poor buy the policy and use HSA's liberally to incentivize people to use care wisely.

Allow insurers to compete nationwide and offer any number of different premium add-ons or policies as the market sees fit.

(Basically do what Switzerland does).

 

[VolnJC]

I'll tell you one place it would break down is what is required in the mandate. In the ACA mess they put in all sorts of care to be covered that goes beyond basic healthcare.

If we have a mandate it should be preventative, basic and catastrophic care but not include fertility treatment, gender reassignment, ED drugs, etc.

Then require all insurers to offer the basic care package as a stand alone. Provide government subsidies to help the poor buy the policy and use HSA's liberally to incentivize people to use care wisely.

Allow insurers to compete nationwide and offer any number of different premium add-ons or policies as the market sees fit.

(Basically do what Switzerland does).

Wasn't that the Tenncare model?

 

[volinbham]

Wasn't that the Tenncare model?

Not sure but I didn't think there was a mandate for Tenncare and the number of insurers participating in any given state is typically small.

Switzerland has a significant # of insurers to choose from

Edit - TennCare appears to have been a medicaid program which is single payer (well state and Feds).

I'm talking about all private but a mandate that all must hold basic policy (whether government buys it for you from private insurer or you pay it yourself).

 

[VolnJC]

Not sure but I didn't think there was a mandate for Tenncare and the number of insurers participating in any given state is typically small.

Switzerland has a significant # of insurers to choose from

Edit - TennCare appears to have been a medicaid program which is single payer (well state and Feds).

I'm talking about all private but a mandate that all must hold basic policy (whether government buys it for you from private insurer or you pay it yourself).

Im not an insurance expert but it kinda sounds like Medicare C Medicare Advantage Plans

 

[BigOrangeTrain]

Does anyone think there is a real solution to getting great, affordable healthcare in this country? I know physicians that have retired very early because of the ridiculous regulations and limitations that Obamacare has brought. I fear that the already big shortage of physicians is only going to increase if the current system is kept in place.

 

[VolnJC]

Does anyone think there is a real solution to getting great, affordable healthcare in this country? I know physicians that have retired very early because of the ridiculous regulations and limitations that Obamacare has brought. I fear that the already big shortage of physicians is only going to increase if the current system is kept in place.

I like the idea of a public supported basic plan where everyone gets 2 doctors visits with labs per year and a small amount monthly for maintenance meds...then the freedom to purchase however much coverage they want via catastrophic care..of course the poor and retired would still have their plans.

 

[BigOrangeTrain]

I like the idea of a public supported basic plan where everyone gets 2 doctors visits with labs per year and a small amount monthly for maintenance meds...then the freedom to purchase however much coverage they want via catastrophic care..of course the poor and retired would still have their plans.

I think that might be a good idea. I have a few questions about it though. We all know the cost of emerging medical technology is rising, so how do we keep things progressing technologically speaking and keep cost in line? Also, what about physician compensation? Would that factor in at all?

 

[DancingOutlaw]

The gender reassignment and hormone therapy coverage to me is ridiculous. How is that a medical necessity? And if gender is fluid what is to stop someone from getting reassigned and then wanting to be rereassigned? After all anything less is an infringement of civil rights. There are lots of people in need of basic care that paying for that stuff is unethical.

 

[AM64]

The evolution of Obama's "guarantee"

Obamacare Website No Longer Addresses 'You Can Keep Your Doctor' | The Weekly Standard

Otherwise known as "bait and switch" - the scam has been around for forever, but Obama and the Dims play it so well.

 

[AM64]

I'll tell you one place it would break down is what is required in the mandate. In the ACA mess they put in all sorts of care to be covered that goes beyond basic healthcare.

If we have a mandate it should be preventative, basic and catastrophic care but not include fertility treatment, gender reassignment, ED drugs, etc.

Then require all insurers to offer the basic care package as a stand alone. Provide government subsidies to help the poor buy the policy and use HSA's liberally to incentivize people to use care wisely.

Allow insurers to compete nationwide and offer any number of different premium add-ons or policies as the market sees fit.

(Basically do what Switzerland does).

I particularly agree with limits on elective care; if you want it, you pay for it.

One of the biggest problems for me is cost and cost containment. I really dislike government intervention, but the recent price gouging begs for it. On the other hand, market constriction due to constant mergers regardless of existing laws to prevent monopolistic behavior, and patent laws (tweaking drugs to extend a patent and some other abuses) say the government isn't doing much to prevent or even limit age old greed games.

Insurance makes those games work because someone else picks up the tab and spreads the damage; you are much more accountable when you pay the bill directly. Which goes back to the elective care thing; pressure on lawmakers and regulators by patients and providers (including drug and medical equipment producers) ensures ever expanding coverage for non essential procedures.

 

[marcusluvsvols]

Would swiss healthcare scale to our size and be able to include our obese asses? About 1 in 3 americans is obese. Also we have a lot of blacks who statistics say have more heart problems diabeetuses etc. I dont know if there is any way to have decent medical for american lives of excess...

 

[DancingOutlaw]

Would swiss healthcare scale to our size and be able to include our obese asses? About 1 in 3 americans is obese. Also we have a lot of blacks who statistics say have more heart problems diabeetuses etc. I dont know if there is any way to have decent medical for american lives of excess...

The Swiss have a very homogenous pool and good overall health. Their system works because the pool is small, normally distributed, and healthy. Their entire population is like the cream of the cream of our country. So no, it won't work here. The larger the population is, the more exponential the complexity becomes.

 

[Orangedogsrule]

Probably would, initially. Likely transition to something resembling city hospitals which serve the indigent population. Finally morphing into taxpayer owned facilities.

There has to be a way to sort those seeking care. My son is an ER Doc in training..a resident. Not an attending.
They are trained to save your life if at all possible, and treat major and minor trauma. Stop the bleeding from gunshots and stabilize for surgery.

They recognize Internal Medicine cases (or any of the other specialties) cases..put a band aide on it and refer you to a specialty doctor for that or admit to the hospital.

In other words .. the vast majority of cases are not emergencies. Say sinus infection. So what Emergency Departments do is "Treat em and street em" ... get you in and out with a referral and a Rx.

But people need to see an ENT, an internist, neurologist, pediatrician, orthopod, ...

They don't, they use the most expensive choice they have. The ER. And often do not get treated by a specialist in the field of what the patient has wrong.

 

[DancingOutlaw]

Then has to be a way to sort those seeking care. My son is an ER Doc in training..a resident. Not an attending.
They are trained to save your life if at all possible, and treat major and minor trauma. Stop the bleeding from gunshots and stabilize for surgery.

They recognize Internal Medicine cases (or any of the other specialties) cases..put a band aide on it and refer you to a specialty doctor for that or admit to the hospital.

In other words .. the vast majority of cases are not emergencies. Say sinus infection. So what Emergency Departments do is "Treat em and street em" ... get you in and out with a referral and a Rx.

But people need to see an ENT, an internist, neurologist, pediatrician, orthopod, ...

They don't, they use the most expensive choice they have. The ER. And often do not get treated by a specialist in the field of what the patient has wrong.

Indigent use the ER like insured people use a GP. Stomach ache, ER. Stuffy nose, ER. Leg hurts, ER. They don't want to wait for an appointment, they don't want to find a doctor. They don't care. What's worse is they're clogging up facilities that should be handling serious cases. But they can't be bothered with that, their belly hurts and they need meds. ACA was supposed to fix this, the numbers have actually gotten worse. ER is by far the most expensive way to see a doctor, and until we can get these morons out of the lobby it will continue to operate below potential.

 

[marcusluvsvols]

There has to be a way to sort those seeking care. My son is an ER Doc in training..a resident. Not an attending.
They are trained to save your life if at all possible, and treat major and minor trauma. Stop the bleeding from gunshots and stabilize for surgery.

They recognize Internal Medicine cases (or any of the other specialties) cases..put a band aide on it and refer you to a specialty doctor for that or admit to the hospital.

In other words .. the vast majority of cases are not emergencies. Say sinus infection. So what Emergency Departments do is "Treat em and street em" ... get you in and out with a referral and a Rx.

But people need to see an ENT, an internist, neurologist, pediatrician, orthopod, ...

They don't, they use the most expensive choice they have. The ER. And often do not get treated by a specialist in the field of what the patient has wrong.

My sister was a paramedic for a decade plus. She stayed frustrated because po folks would use the ambulance as a ride to the doctor. Call 911 because they had a stomach ache, or baybay kid had an ear infection...get a ride to the hosp. And clog up the ER for nothing....and we pay for it. Yet another way for the welfare crowd to abuse the system. Meanwhile people that actually had heart attacks are dying due to response times bc ambulances are full of deadbeats. She eventually quit, moved on. Much like cops, paramedics deal with dregs of society. For very little pay.

 

[Orangedogsrule]

Indigent use the ER like insured people use a GP. Stomach ache, ER. Stuffy nose, ER. Leg hurts, ER. They don't want to wait for an appointment, they don't want to find a doctor. They don't care. What's worse is they're clogging up facilities that should be handling serious cases. But they can't be bothered with that, their belly hurts and they need meds. ACA was supposed to fix this, the numbers have actually gotten worse. ER is by far the most expensive way to see a doctor, and until we can get these morons out of the lobby it will continue to operate below potential.

It's not just indigent.

 

[kiddiedoc]

Indigent use the ER like insured people use a GP. Stomach ache, ER. Stuffy nose, ER. Leg hurts, ER. They don't want to wait for an appointment, they don't want to find a doctor. They don't care. What's worse is they're clogging up facilities that should be handling serious cases. But they can't be bothered with that, their belly hurts and they need meds. ACA was supposed to fix this, the numbers have actually gotten worse. ER is by far the most expensive way to see a doctor, and until we can get these morons out of the lobby it will continue to operate below potential.

There is much truth to this. For years, I have suggested that putting a small co-pay on ER visits for Medicaid patients would save an insane amount of money. As it stands, patients on no-cost government-supported plans use the ER like a fast-food restaurant. Those visits probably average 5-10x what a visit in my office would cost, due to the discrepancy in hospital vs office charges and (often) unnecessary tests.

Ex: kid falls, hits his head, no LOC, has a nosebleed, no vomiting or neuro symptoms. Parents take him to the nearest hospital, since it's free. ER almost invariably gets bloodwork and a CT scan as they are busy and don't have time to really examine and watch him, plus they are nervous because they aren't staffed with Pediatricians. With that story, the CT is abnormal basically never, they get sent home and are told to follow up with me the next day. SO: they rack up $1000+ in charges for something that has happened to my kids probably a half a dozen times without me even blinking.

Plus, honestly, that's a semi-understandable reason to go to the ER. Plenty of my patients are taken for cold symptoms, headaches, GI bugs, etc. $10 co-pay might just fix the entire problem.

 

[kiddiedoc]

Naturally, the problem is magnified because Medicaid pays crap, and most PCP's cap their TN-care enrollment (or don't see any), which makes it difficult for many to find a decent provider.

 

[VolnJC]

There is much truth to this. For years, I have suggested that putting a small co-pay on ER visits for Medicaid patients would save an insane amount of money. As it stands, patients on no-cost government-supported plans use the ER like a fast-food restaurant. Those visits probably average 5-10x what a visit in my office would cost, due to the discrepancy in hospital vs office charges and (often) unnecessary tests.

Ex: kid falls, hits his head, no LOC, has a nosebleed, no vomiting or neuro symptoms. Parents take him to the nearest hospital, since it's free. ER almost invariably gets bloodwork and a CT scan as they are busy and don't have time to really examine and watch him, plus they are nervous because they aren't staffed with Pediatricians. With that story, the CT is abnormal basically never, they get sent home and are told to follow up with me the next day. SO: they rack up $1000+ in charges for something that has happened to my kids probably a half a dozen times without me even blinking.

Plus, honestly, that's a semi-understandable reason to go to the ER. Plenty of my patients are taken for cold symptoms, headaches, GI bugs, etc. $10 co-pay might just fix the entire problem.

Funny you say that..one of the 70 year old Pharmacists that I used to work with, way back when Tenncare was eating up 1/3 of the state budget, suggested a modest copay of $1 or so for dr visits and drugs..I thought it was silly that it would help...turns out she was exactly right.

 

[VolnJC]

I'm hearing more and more of my friends tell me that they can afford only the bronze plan but won't be able to use it unless it's an emergency. I thought that the ACA was supposed to focus on good preventive care and was to get rid of those "terrible" catastrophic plans? That's what the bronze plans are, but now they are twice as expensive.

 

[slobberknocker]

I'm hearing more and more of my friends tell me that they can afford only the bronze plan but won't be able to use it unless it's an emergency. I thought that the ACA was supposed to focus on good preventive care and was to get rid of those "terrible" catastrophic plans? That's what the bronze plans are, but now they are twice as expensive.

That's the way it's headed, but most preventive care costs $0.