The ACA and Small Businesses

[dayman]

I'd force everyone to have insurance. No exceptions, and that goes for the politicians. HDHP's/HSA's would be the preferred insurance so that the consumer is responsible for his/her health care spending. Allow insurance to be sold across state lines. I'd mandate how to live and penalize people for not following it. Tort reform.

 

You're saying conservatives don't want everyone covered and/or costs to go down? Or that Obamacare is the worst way to achieve those goals?

 

The Brill article was, IMO, one of the better pieces of actual journalism that highlighted why the whole "responsible for your own health care spending" only goes so far on its own. Also the state lines and tort reform is meaningless won't do a thing to lower costs...

Edited March 24, 2013 by SameOldBills

[birdog1960]

 

You're saying conservatives don't want everyone covered and/or costs to go down? Or that Obamacare is the worst way to achieve those goals?

i'm saying conservatives don't much care about universal coverage. and everyone buying insurance isn't a viable solution to achieve univesral coverage. they'd be happy to see costs come down overall but realize that covering 30 - 50 million more people may decrease per capita cost but not overall cost. that's not a tradre most conservatives are happy to accept especially if it means their own coverage suffers the least bit.

[ExiledInIllinois]

i'm saying conservatives don't much care about universal coverage. and everyone buying insurance isn't a viable solution to achieve univesral coverage. they'd be happy to see costs come down overall but realize that covering 30 - 50 million more people may decrease per capita cost but not overall cost. that's not a tradre most conservatives are happy to accept especially if it means their own coverage suffers the least bit.

 

There you go again bird, claiming the moral high ground.

 

~Signed, Your PPP Cons

 

[3rdnlng]

The Brill article was, IMO, one of the better pieces of actual journalism that highlighted why the whole "responsible for your own health care spending" only goes so far on its own. Also the state lines and tort reform is meaningless won't do a thing to lower costs...

 

Spoken like a true personal injury attorney. Not only would malpractice insurance rates go down but there would be less practicing of defensive medicine. Do you have any idea the amount of needless tests that are performed because the doctor/hospital is afraid of being taken to court?

[dayman]

Spoken like a true personal injury attorney. Not only would malpractice insurance rates go down but there would be less practicing of defensive medicine. Do you have any idea the amount of needless tests that are performed because the doctor/hospital is afraid of being taken to court?

 

If hard caps on damages are imposed malpractice rates probably would adjust accordingly...but in states w/ aggressive tort reform that saving has not made it to the price tag and just as much if not more in some cases medical spending occurs it has had not effect in Texas (for one...being the golden child of tort reform) at all on saving for instance

[Dean Cain]

One thing I've heard and perhaps Doc can confirm is that there is a serious shortage of GPs, and DRs in general. Now adding 50 million more people plus the 20 million illegals that already flood out emergency rooms is somehow not going to put a greater strain on the limited # of Docs?

 

Medical school for most means taking on record debt and the health care field as a whole is so regulated its impossible to project how adding these 50 million won't have a negative effect of the other 250 million that do.

 

To me this is just another tax shift on the middle class. Just like how Governors run around saying they cut taxes, when in reality they increased user fees and other sources of revenue. The ACA is a beaurcratic nightmare 10,000 pages long.

 

The big winner is not the health care industry but the private insurers.

[Rob's House]

So we'll go from 15M uninsured to 30M uninsured, we'll have a massive shortage of doctors, quality will suffer, lawsuits will increase, premiums will rise, cancer rates will rise, and we'll add 3T (at least) to the deficit. What's not to love?

I saw some ass hole the other day with an "I Love Obamacare" bumper sticker on his SUV.

 

One thing I've heard and perhaps Doc can confirm is that there is a serious shortage of GPs, and DRs in general. Now adding 50 million more people plus the 20 million illegals that already flood out emergency rooms is somehow not going to put a greater strain on the limited # of Docs?

 

Medical school for most means taking on record debt and the health care field as a whole is so regulated its impossible to project how adding these 50 million won't have a negative effect of the other 250 million that do.

 

To me this is just another tax shift on the middle class. Just like how Governors run around saying they cut taxes, when in reality they increased user fees and other sources of revenue. The ACA is a beaurcratic nightmare 10,000 pages long.

The big winner is not the health care industry but the private insurers.

I hear this, but it seems to be the opposite. The insurers have to cover everything they already cover and then some, but the premiums are capped. How do they not go under?

[birdog1960]

One thing I've heard and perhaps Doc can confirm is that there is a serious shortage of GPs, and DRs in general. Now adding 50 million more people plus the 20 million illegals that already flood out emergency rooms is somehow not going to put a greater strain on the limited # of Docs?

 

Medical school for most means taking on record debt and the health care field as a whole is so regulated its impossible to project how adding these 50 million won't have a negative effect of the other 250 million that do.

 

To me this is just another tax shift on the middle class. Just like how Governors run around saying they cut taxes, when in reality they increased user fees and other sources of revenue. The ACA is a beaurcratic nightmare 10,000 pages long.

 

The big winner is not the health care industry but the private insurers.

they are incentivizing primary care and disincentiving proceduralists...a strategy that has produced better outcomes at lower cost the world over. just the opposite of what has happened here over the last 50 years because the more you do the more you get regardless of outcome....which is really stupid. so, we'll see more midlevels doing what they were originally supposed to do: primary care. and primary care doctors will oversee the teams of midlevels. as the editorial says, there will be bumps in the road but the goals are worth pursuing. it will take longer to get elective procedures because there will be less proceduralist capacity but the outcomes should still improve just as they have in virtually every other system in the world. the big winner is meant to be the overall health of the nation, including that of the 50 million uninsured. the success or failure of the insurance industry and the healthcare industry shouldn't matter outside of this goal.

[dayman]

More reason to be a pcp now than before

[Doc]

One thing I've heard and perhaps Doc can confirm is that there is a serious shortage of GPs, and DRs in general. Now adding 50 million more people plus the 20 million illegals that already flood out emergency rooms is somehow not going to put a greater strain on the limited # of Docs?

 

Medical school for most means taking on record debt and the health care field as a whole is so regulated its impossible to project how adding these 50 million won't have a negative effect of the other 250 million that do.

 

To me this is just another tax shift on the middle class. Just like how Governors run around saying they cut taxes, when in reality they increased user fees and other sources of revenue. The ACA is a beaurcratic nightmare 10,000 pages long.

 

The big winner is not the health care industry but the private insurers.

Yep, there is a shortage already of PMDs and it will get significantly worse as more retire early and fewer people enter medical school and enter internal medicine since specialties will still pay better. And getting giddy about Medcaid reimbursements going up to Medicare levels is fools gold, because I'm betting they'll cut Medicare reimbursement rates, like they do annually, but not insert a "doc fix" so that Medicare rates are where Medicaid rates used to be, citing spiraling costs for medical care. The field will then be run by mostly APRNs and PAs who have inadequate training, and with no tort reform, you'll probably get even more tests being ordered by them and poorer outcomes. Again, what's not to love?

[Magox]

The Brill article was, IMO, one of the better pieces of actual journalism that highlighted why the whole "responsible for your own health care spending" only goes so far on its own. Also the state lines and tort reform is meaningless won't do a thing to lower costs...

 

Holy contradiction! So you thought the Brill article was great, yet you believe tort reform is meaningless and won't do a thing to lower costs.

 

“When Obamacare was being debated, Republicans pushed this kind of commonsense malpractice-tort reform. But the stranglehold that plaintiffs’ lawyers have traditionally had on Democrats prevailed, and neither a safe-harbor provision nor any other malpractice reform was included.”

 

"Republicans are right when they argue that tort reform is overdue. Eliminating the rationale or excuse for all the extra doctor exams, lab test and use of CT scans and MRIs could cut tens of billions fo dollars a year while drastically cutting what hospitals and doctors spend on malpractice insurance and pass along to patients."

 

Where do you think those quotes came from?

 

Of course Tort reform would help lower costs, and the idea that increased competition not having an effect on prices is a purely partisan response. There are some states where the profit margins for health insurers are below 2%, in states such as those, increased competition wouldn't do much to push the needle, however there are some states where profit margins for health insurers are in the double digits.

 

More reason to be a pcp now than before

 

 

Sometimes I wonder if you even think before you type. This is categorically false. There have been numerous polls and studies that have shown that there will be more doctors that will be less inclined to become PCP because of the health care law. If it was a free market in health care, then you would be right, more demand for their services would mean higher pay. But that's not how it works here because of the Medicaid reimbursement rates, which caps payout. Since there is going to be an explosion of Medicaid recipients in the coming years, that means there will be more services paid out at Medicaid rates, which is not what most doctors are looking for.

 

I saw some ass hole the other day with an "I Love Obamacare" bumper sticker on his SUV.

 

 

I hear this, but it seems to be the opposite. The insurers have to cover everything they already cover and then some, but the premiums are capped. How do they not go under?

 

Actually, that's not the case. They aren't going to cap premiums per se, what they will be doing is mandating that 80% of all revenues collected from health insurance carriers go towards coverage, to help eliminate waste and limit profits.

Edited March 25, 2013 by Magox

[B-Large]

I'd force everyone to have insurance. No exceptions, and that goes for the politicians. HDHP's/HSA's would be the preferred insurance so that the consumer is responsible for his/her health care spending. Allow insurance to be sold across state lines. I'd mandate how to live and penalize people for not following it. Tort reform.

 

You're saying conservatives don't want everyone covered and/or costs to go down? Or that Obamacare is the worst way to achieve those goals?

 

I am still not sure how that helps the system.. Insurers will be regulated by someone, do people really want it to be regulated by the Federal Government versus State Governments? And Mandate how people live, and penalize them... don't isurers already do that via Rating? But I do like the HSA and Cat insurance much better that HMO plans.

 

More reason to be a pcp now than before

 

Heck, with more customers, better reimbursements- our internists are still making 150K on average, that still darn good change.. now most of them are outlining Research projects to reduce their clnical time, but that might just be because seeing sick people all day beats you down... and its way better to get a grant and study how many patient visits is takes to justofy 1/2 day of admin time, than to diagnosis and treat people...

[birdog1960]

Heck, with more customers, better reimbursements- our internists are still making 150K on average, that still darn good change.. now most of them are outlining Research projects to reduce their clnical time, but that might just be because seeing sick people all day beats you down... and its way better to get a grant and study how many patient visits is takes to justofy 1/2 day of admin time, than to diagnosis and treat people...

wow. then they either need to look for work elsewhere or see more patients. that's about 30% below mgma median 3 years ago. there probably below the bottom quartile.

[B-Large]

wow. then they either need to look for work elsewhere or see more patients. that's about 30% below mgma median 3 years ago. there probably below the bottom quartile.

 

they could go elsewhere, but why? Most only work 3-4 1/2 sessions per week, get at least 1/2- 1 full day adminstrattive time (in which some consider a half day off)- heck clinic sessions are short too, 4 hours in the morning and 3 in the afternoon... most of them after a few years are doign research and barely see patients... an easy 8-4, compared to a speciilist of surgeon working 60-80 hours a week.

 

They can get bonused if they hit certain RVU benchmarks over what covers their salary and benefits, but the bonus is not mind blowing considering how many RVU's you have to generate to get them. Many leave thinking the grass is greener, but end up workgin alot harder, paying their own E&O, and come back... plus the Division of Internal Medicine is a money loser here, they are subsidized essntially by specialities and surgical..

[Doc]

I am still not sure how that helps the system.. Insurers will be regulated by someone, do people really want it to be regulated by the Federal Government versus State Governments? And Mandate how people live, and penalize them... don't isurers already do that via Rating? But I do like the HSA and Cat insurance much better that HMO plans.

Wait, Medicare is regulated by the Federal Government and is supposedly the most efficient system. Why wouldn't you want private insurers regulated by it? And yes insurers penalize people, but Obamacare cuts the penalty in half (sickest patient pay 3 times healthy versus 6 times).

Heck, with more customers, better reimbursements- our internists are still making 150K on average, that still darn good change.. now most of them are outlining Research projects to reduce their clnical time, but that might just be because seeing sick people all day beats you down... and its way better to get a grant and study how many patient visits is takes to justofy 1/2 day of admin time, than to diagnosis and treat people...

That might appeal to a small percentage of current IM docs. But a large number will retire early and I can't see younger people saying "I really want to spend 12 years post-HS studying, working like a slave, and making no money, so that the government can continue to limit what I make. I can go in another profession and do better."

[B-Man]

GO AHEAD AND EMBRACE OBAMACARE:

The problem with Obamacare is not that it is being badly presented; the problem is that there is a limit to how well you can present a law that is this bad.

 

It’s like trying to put a positive spin on having your leg bitten off by a shark: sure, yes, in the long run you’re going to see a 50% saving on socks, but that’s not exactly comforting news while you’re watching the water around you go pink…

 

.

 

 

ObamaCare Premium Spike Goes National.

 

“As in California, the costs will fall primarily on individuals and small businesses, and as in California, they will fall disproportionately on the young.”

 

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Edited March 25, 2013 by B-Man

[birdog1960]

they could go elsewhere, but why? Most only work 3-4 1/2 sessions per week, get at least 1/2- 1 full day adminstrattive time (in which some consider a half day off)- heck clinic sessions are short too, 4 hours in the morning and 3 in the afternoon... most of them after a few years are doign research and barely see patients... an easy 8-4, compared to a speciilist of surgeon working 60-80 hours a week.

 

They can get bonused if they hit certain RVU benchmarks over what covers their salary and benefits, but the bonus is not mind blowing considering how many RVU's you have to generate to get them. Many leave thinking the grass is greener, but end up workgin alot harder, paying their own E&O, and come back... plus the Division of Internal Medicine is a money loser here, they are subsidized essntially by specialities and surgical..

i suppose my point is the number you threw out is not a benchmark on which to consider the effect of reform on specialty choice. these are atypical conditions. and, btw, the reason they are "subsidized" is likely 2 fold: they're not producing median or better rvu quantities and rvu's have been adulterated beyond the recognition of the original concept. we now have different dollars per rvu for different specialties when the original purpose was that rvu's (relative value units) were equal amounts of work value. that's what reform is, in part, addressing - a return to that concept that equalizes payment for relative work value. if the rvu concept is ever used as it was meant to be, you'll see an increase in primary care residents and consequently, doctors.

[B-Man]

How much does an ObamaCare State Insurance Exchange cost ? ?

 

In California, a whopping $910 million– and counting!

 

Funded by you and me.

 

By contrast, online insurance giant esurance cost about $40 million to get up and running, facilitating the comparison and purchase of all types of insurance, not just health insurance.

 

Ah, the efficiencies of government!

 

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[B-Man]

UNEXPECTEDLY:

 

We had to pass the bill to find out what was in it — and now we know: under the Orwellian named Affordable Care Act, “medical claim costs, the largest driver of health insurance premiums, are expected to increase by 32 percent for individuals, a new study by the Society of Actuaries finds.”

 

 

And 2014 is just around the corner…

 

 

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In yet another Obamacare post-passage surprise, we now now that the 61-page online “free stuff!” Obamacare application contains information to help steer applicants towards voter registration.

 

 

Gee, I wonder what liberal/progressive groups might start “helping” folks fill out these applications– and of course “help” them register to vote as well?

 

 

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Edited March 27, 2013 by B-Man

[birdog1960]

UNEXPECTEDLY:

 

We had to pass the bill to find out what was in it — and now we know: under the Orwellian named Affordable Care Act, “medical claim costs, the largest driver of health insurance premiums, are expected to increase by 32 percent for individuals, a new study by the Society of Actuaries finds.”

 

 

And 2014 is just around the corner…

 

"the higher claim costs are related to the increase in sick people expected to join the pool" which begs the question "who is paying for that care now?" is it mostly charity care? is it passed on to the costs of currently insured patients (ie cost shifting)? if, so are the actuaries factoring this is? are they just not getting care? no matter the answers to those questions, it's clearer than ever that the answer to the big question is single payer..

 

 

 

In yet another Obamacare post-passage surprise, we now now that the 61-page online “free stuff!” Obamacare application contains information to help steer applicants towards voter registration.

 

 

Gee, I wonder what liberal/progressive groups might start “helping” folks fill out these applications– and of course “help” them register to vote as well?

 

 

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