Progressives tout California Health care "success"

[Jauronimo]

i've said all along that the aca is a work in progress. ehr's are as well but also part of the overall plan. just my opinion.

To clarify, your opinion is that the ACA has yet to take its final shape and that EHRs are included in the ACA?

[birdog1960]

To clarify, your opinion is that the ACA has yet to take its final shape and that EHRs are included in the ACA?

to clarify, i think the aca will eventually lead to single payer and that ehr's will be even more important in that framework. whether progression from aca to single payer is by design is purely speculation.

[Doc]

to clarify, i think the aca will eventually lead to single payer and that ehr's will be even more important in that framework. whether progression from aca to single payer is by design is purely speculation.

Again, single payer won't happen. The Dems couldn't get it done with Barry and both the House and Senate, and people now see the shitstorm Obamacrap truly is, thanks to the gubment. You think anyone will support single payer, which is run by the gubment?

Edited July 12, 2013 by Doc

[DC Tom]

to clarify, i think the aca will eventually lead to single payer and that ehr's will be even more important in that framework. whether progression from aca to single payer is by design is purely speculation.

 

Wasn't it you who openly speculated that that was the intent of the ACA? Or am I confusing you with the other Blunder Twin again?

[B-Man]

Pelosi: ‘The Employer Mandate Was Not Delayed’

 

No words can describe . . . . . .

 

http://www.youtube.com/watch?v=8avTo-4NXCA&feature=player_embedded

 

. . . although “mendacious,” “unfathomable,” and “false” might be a start.

 

 

.

[DC Tom]

Pelosi: ‘The Employer Mandate Was Not Delayed’

 

No words can describe . . . . . .

 

http://www.youtube.com/watch?v=8avTo-4NXCA&feature=player_embedded

 

. . . although “mendacious,” “unfathomable,” and “false” might be a start.

 

 

.

 

From the White House:

 

As we make these changes, we believe we need to give employers more time to comply with the new rules. Since employer responsibility payments can only be assessed based on this new reporting, payments won’t be collected for 2014. This allows

employers the time to test the new reporting systems and make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers.

 

Lying B word gets it completely backwards...

[IDBillzFan]

No words can describe . . . . . .

 

She is basically the Baghdad Bob of the Democratic party.

[B-Large]

 

Again, single payer won't happen. The Dems couldn't get it done with Barry and both the House and Senate, and people now see the shitstorm Obamacrap truly is, thanks to the gubment. You think anyone will support single payer, which is run by the gubment?

 

First, if Medicare happened, single payor is not impossible... And really, what **** storm?? The Conservative narrative **** storm? The law has not even gone into effect yet (for the most part outside of kids staying on parents insurance, included screenings, etc), how can it have already failed?? Paul Ryan wanted to basically ACA Medicare.... Ironic because Democrats called him Satan, Republicss hailed his boldness- and for all intents and purposes, he proposed what Obama signed 3 years ago.... Isn't that kind of crazy? Man, were splitting hairs on policy....

 

Look, i love a great **** storm debate as much as anyone, but kind of hard to evaluate a law when we have not even seen its main objective go into effect yet, no?

 

Right now isn't it all conjecture and fear in the minds of opponents?? How do you empirically measure it at this point???

[Koko78]

First, if Medicare happened, single payor is not impossible... And really, what **** storm?? The Conservative narrative **** storm? The law has not even gone into effect yet (for the most part outside of kids staying on parents insurance, included screenings, etc), how can it have already failed?? Paul Ryan wanted to basically ACA Medicare.... Ironic because Democrats called him Satan, Republicss hailed his boldness- and for all intents and purposes, he proposed what Obama signed 3 years ago.... Isn't that kind of crazy? Man, were splitting hairs on policy....

 

Look, i love a great **** storm debate as much as anyone, but kind of hard to evaluate a law when we have not even seen its main objective go into effect yet, no?

 

Right now isn't it all conjecture and fear in the minds of opponents?? How do you empirically measure it at this point???

 

The problem with this line of thinking is that when the gloom and doom predictions all come true, the Democrats will start crying that the GOP knew about the ramifications and somehow should have done something sooner, despite their opposition to Obamacare and Democrat attempts to block anything to do with repealing or tweaking it.

 

You know, sort of like how they blamed the GOP for not being in lock step with Pelosi, forcing the democrats to give in to their more moderate members' demands just to get the votes to get the thing passed.

[Doc]

First, if Medicare happened, single payor is not impossible... And really, what **** storm?? The Conservative narrative **** storm? The law has not even gone into effect yet (for the most part outside of kids staying on parents insurance, included screenings, etc), how can it have already failed?? Paul Ryan wanted to basically ACA Medicare.... Ironic because Democrats called him Satan, Republicss hailed his boldness- and for all intents and purposes, he proposed what Obama signed 3 years ago.... Isn't that kind of crazy? Man, were splitting hairs on policy....

 

Look, i love a great **** storm debate as much as anyone, but kind of hard to evaluate a law when we have not even seen its main objective go into effect yet, no?

 

Right now isn't it all conjecture and fear in the minds of opponents?? How do you empirically measure it at this point???

Medicare happened almost 50 years ago. And ACA'ing it makes sense. ACA'ing all of health insurance...not so much. Romneycare has proven to not reduce costs. And for Obamacare to just hit $1T in costs, everything will have to turn out exactly as they predict. And still the CBO estimates that 30M people will remain uninsured.

[OCinBuffalo]

all very interesting stuff. supports my theory that most people are fundamentally good. we'll make a progressive of you, yet. a right leaning progressive probably, but a progressive nonetheless.

How about you clowns start using the word progress properly? As in: "empirical, then quantifiable, and then reproducable improvement"? The minute that you do, you will join me, not the other way around.

 

There is nothing at all progessive about demanding that we keep Medicare, and HHS as a whole, SSI and Medicaid as it is(doomed to fail). Teddy Roosevelt would kick all of you "no refom of entitlements, protect ideas from 50+ years ago" people square in the nuts, and then throw you out of his party.

 

Teddy Roosevelt invented the concept. Hint: it is not "duplicitous, claims moral superiority, yet is in fact morally inferior, corrupt, closeted Communist/socialist who talks a lot about IT stuff(they don't understand, at all), yet clings to the solutions of 50-70 years ago, and demands more backward looking/legacy protection". It is not a person that proceeds to demonstrate their "progressive solutions" in the form of Obamaphones and calls that not only "more moral" but, "progessive"?

 

The Obamaphone: the single, best culmination of evidence that you sir, are no progressive.

 

You and your pals are from Tammany Hall. You are the people TR was fighting, when he coined the term progressive, and defined himself as one. The only reason you don't know that? You lie so often, so large, and so much, to yourselves, never mind the rest of us, that you really have no idea that's precisely where you belong, do you? You define yourself based on distortion and lies.

the hemingway imitations in notes aren't primarily about style.

No schit. This whole metaphor has been lost on you. Oh well, let's deal with the rest....

they're about the difference between a note that immediately paints a vibrant picture of a patient and her problems in a few sentences and one that conveys almost nothing in 3 pages of computer template generated, cookie cutter vomitus. every colleague i discuss this with does the same thing on such notes: reads the first sentence to obtain demographic info then skips to the end to see the impression and plan. even this is usually woefully inadequate because this is usually free form and most docs hate typing.

Dude. I've literally met nurse consultants who do nothing at all other than teach people how to write notes and/or teach them to write them so that they can extract more $ from Mediciare. It's pathetic. These are well paid people who could add infinitely more value to society(in birdog-ese "think of all the children they could treat ")...yet this is what they do? Want to lay claim to this "progress" there, Mr. "Progressive"? Why the F not? It's your government-centered idiocy that has created this situation, where legions of FTE nurses don't nurse at all, and instead, F about with paper.

 

If the cookie cutter vomitus = boiler plate had actual value, to anyone but lawyer douchebags, it wouldn't be boiler plate. Driving our business off of lawyers is patently stupid. Been saying it for years: it's far past time to go on offense on that front. You know who says it isn't? The other lawyers. Shocking. The reason: my plan for going on offense...doesn't require those lawyers. Again, a mighty shock.

 

Anyway, the metaphor, explained literally, is this: "vibrant picture"? My ass. This isn't story time, and you ain't Allistar Cooke, or his audience, receiving your wonderfully prepared "story of the patient".

 

There is nothing "vibrant" about this data set whatsover. It's a set of raw data that you use to either make decisions, or request that more tasks be done such that your observations can be coupled with empirical study to produce more/better info, and then you use that to make decisions with. It's value dissipates relative to the condition of the patient and the # and scope of decisions you have to make. Patient dies/gets better...value drops. Patient stays the same? Ordering what you ordered yesterday doesn't require prose. It certainly doesn't require anything: vibrant.

 

Moving on, if you hate typing: Stop. Stop buying into systems/the lie that says you need to type. Realize that the emporer has no clothes, and that your notes are are more about Clara F'ing Barton, and less about getting the job done.

 

The only way the bad goes away is: we make it go away.

the bright side is that ehr's are moving the system closer to single payer. small practices can't afford them and are thus joining mega groups and systems. this advances ACO's and integrated delivery systems. it's a blunt, rude, impersonal, inefficient and often hated implement but it is surely advancing us towards that endpoint. now, if we could get the ehr systems to actually communicate with each other....

Hehehe...and then we(and our partners) came along and blew this whole thing up. We'll see. By the time we do, it will be obvious, or it won't, and there won't be any point in discussion.

 

You know, I actually wrote out exactly how? I cut it.

 

Why would I tell you anything? It's not like you will get it, like it, or want to see it. As I've been rolling this over and over in my mind: Atilla crossing the Danube, despite the shameful allegory, keeps coming up.

You are correct.

 

and once everyone is enrolled in Obamacare and hooked up to the big database.............we will save billions.

 

we were promised..................

Um system integration '= activity based costing, or cost accounting in general. Nor does it do a lick for improving business process, or more importantly adapting business process.

 

People that should be in charge of Obamacare, or what is actually needed: "the solution to rising costs and the need, NOT to insure more people, but to deliver the low level care most people require at an efficient rate and for a reasonable price", know this both didactically and experientially.

 

Unfortunately, the people that were put in charge of this have no idea what many of the words above mean individually, never mind understanding what they mean in combination, and double never mind, how to actually deploy anything in the context of those words.

Yes, we were promised. Efficiencies through EMRs and system integration were going to offset "free sh%t for everyone" and preventative care was going to eliminate ailments such as old age.

Because in the entire history of IT, the two things computers have saved are paper and money.

Exactly. This is why I ain't talking about either. I'm talking about solving the F'ing problem, which absolutely is:

 

Even if IT saved money, they can't tell you how much or if it even did, because these clowns, for all their North Korean bravado...have no idea what it costs them per patient, per day/visit. Yes, 1/6th of our economy cannot tell you their cost of doing business...but I'm the a-hole, for demanding that they start acting like real managers, given the amount of $/GDP they are responsible for.

 

And, I have news: another idiotic note about "the patient presented with a gerbil up his ass"...or another EMR that plans care...but does nothing about unplanned care(ahem = the real world), or unplanned work in general, or another Ph.D idiot nurse who secures yet another $20 million from the government, only to bumbleF around trying to do my job?

 

None of this solves the real problem: management of cost and resources.

Edited July 15, 2013 by OCinBuffalo

[B-Large]

 

Medicare happened almost 50 years ago. And ACA'ing it makes sense. ACA'ing all of health insurance...not so much. Romneycare has proven to not reduce costs. And for Obamacare to just hit $1T in costs, everything will have to turn out exactly as they predict. And still the CBO estimates that 30M people will remain uninsured.

 

Please explain how ACA system make sense for the Elderly, but not the rest of the population...

[birdog1960]

Please explain how ACA system make sense for the Elderly, but not the rest of the population...

well, because then he gets medicare rates for everyone he treats and that would be bad for him.been learning about aco's (accountable care organizations) recently... the next panacea to save for-profit healthcare from collapse. in short, they're a lot like hmo's that we all knew as such successes. once again, cost savings are to come from primary care doctors delivering more care and discouraging utilization. doesn't matter that there's not enough primary care docs now or in the pipeline to do the job and that this will discourage even more as it adds no tangible incentives. doesn't matter that in the current fee for service environment, discouraging utilization is nearly impossible. doesn't matter that we pump out more and more proceduralists from training programs that increase utilization more every year. another brilliant idea originating in the bush admin (mcclellan). 7 pages on it in the aca and everybody with an interest in maintaining the status quo jumps on it. reducing costs takes fundamental change that almost all the stakeholders are fighting tooth and nail. these piecemeal interventions have failed again and again. utilization differences account for about 17% of the large cost difference for caring for pt in the us vs canada. most of the rest come from administrative costs, inflated fees and profit. so this model attacks utilization and not administrative costs and profits....makes perfect sense right? and oc questions why a nurse wastes her talent teaching people how to write notes for maximal reimbursement...

[Doc]

Please explain how ACA system make sense for the Elderly, but not the rest of the population...

I meant to say ACA'ing it a la Paul Ryan's plan makes sense.

well, because then he gets medicare rates for everyone he treats and that would be bad for him.been learning about aco's (accountable care organizations) recently... the next panacea to save for-profit healthcare from collapse. in short, they're a lot like hmo's that we all knew as such successes. once again, cost savings are to come from primary care doctors delivering more care and discouraging utilization. doesn't matter that there's not enough primary care docs now or in the pipeline to do the job and that this will discourage even more as it adds no tangible incentives. doesn't matter that in the current fee for service environment, discouraging utilization is nearly impossible. doesn't matter that we pump out more and more proceduralists from training programs that increase utilization more every year. another brilliant idea originating in the bush admin (mcclellan). 7 pages on it in the aca and everybody with an interest in maintaining the status quo jumps on it. reducing costs takes fundamental change that almost all the stakeholders are fighting tooth and nail. these piecemeal interventions have failed again and again. utilization differences account for about 17% of the large cost difference for caring for pt in the us vs canada. most of the rest come from administrative costs, inflated fees and profit. so this model attacks utilization and not administrative costs and profits....makes perfect sense right? and oc questions why a nurse wastes her talent teaching people how to write notes for maximal reimbursement...

You're damn right I'm not working for Medicare and Medicaid rates, unless they increase significantly. Neither will a slew of doctors. And then you'll have a mass exodus.

[birdog1960]

I meant to say ACA'ing it a la Paul Ryan's plan makes sense.

 

You're damn right I'm not working for Medicare and Medicaid rates, unless they increase significantly. Neither will a slew of doctors. And then you'll have a mass exodus.

hear this all the time but rarely see it come to fruition...what are you gonna do instead? even at medicare rates what will you do that will make you anywhere near the income? if you've got enough to retire early then you're in the minority based on data i've recently seen. if that's the case, then more power to you. if not, then go for it. everyone is replaceable and there's almost no where in the world you'll make as much on average as you make here.

[Nanker]

 

hear this all the time but rarely see it come to fruition...what are you gonna do instead? even at medicare rates what will you do that will make you anywhere near the income? if you've got enough to retire early then you're in the minority based on data i've recently seen. if that's the case, then more power to you. if not, then go for it. everyone is replaceable and there's almost no where in the world you'll make as much on average as you make here.

So it really boils down to everyone's favorite radio station WIIFM What's In It For Me for you doesn't it?

[Doc]

hear this all the time but rarely see it come to fruition...what are you gonna do instead? even at medicare rates what will you do that will make you anywhere near the income? if you've got enough to retire early then you're in the minority based on data i've recently seen. if that's the case, then more power to you. if not, then go for it. everyone is replaceable and there's almost no where in the world you'll make as much on average as you make here.

You've rarely seen it come to fruition because doctors haven't been pushed to their limits. This will be the straw that broke the camel's back, at a time when needing doctors will be at an all-time high. There's only so many doctors you can replace, and almost none of them will be replaced by people who are qualified enough.

 

As for me, thanks for the concern, but I have a sizable rainy day fund, quite a bit socked-away in retirement vehicles if needed, a decent amount of equity in my house (and will be able to make a profit on selling it if need be), and several investments with one in particular that looks like it's going to pay-off handsomely. In addition, I can always do per diem work I could also be an expert witness as quality erodes while lawsuits continue unabated.

[B-Man]

WHO COULD HAVE SEEN THIS COMING? Fraud fear raised in California’s health exchange.

 

As California prepares to launch its health care exchange, consumer groups are worried the uninsured could fall victim to fraud, identity theft or other crimes at the hands of some of the very people who are supposed to help them enroll.

 

The exchange, known as Covered California, recently adopted rules for a network of more than 21,000 enrollment counselors who will provide consumers with in-person assistance as part of the federal Affordable Care Act. In some cases,

they will have access to personal and financial information, from ID cards to medical histories.

 

But the state insurance commissioner and anti-fraud groups say the exchange is falling short in ensuring that

the people hired as counselors are adequately screened and monitored.

 

Insurance Commissioner Dave Jones also said the exchange does not have a plan for investigating any complaints that might arise once the counselors start work. That means consumers who might fall prey to bogus health care products, identity theft and other abuses will have a hard time seeking justice if unscrupulous counselors get hold of their Social Security number, bank accounts, health records or other private information, he said.

 

“We can have a real disaster on our hands

,” Jones, a Democrat, said in an interview.

 

 

 

 

 

Oh, we already do.

 

 

 

 

.

[B-Man]

More California dreamin.................

 

 

No Obamacare Health Savings Accounts in Calif.

 

By Wesley J. Smith

 

California (my native state) has perhaps the most radical state government in the country. Out here, the powers that be love Obamacare and are enthusiastically establishing the exchanges. But the currently available polices are not compatible with health savings accounts. From the SF Chronicle’s always informative Kathleen Pender column:

 

 

Q:

Spencer H. writes, “I was reviewing health care plans on the Covered California site and couldn’t figure out which, if any, of the plans are compatible with health savings accounts. Do you know?”

A: Covered California, the state’s health insurance exchange, “is

not

offering HSA-compatible individual health insurance policies,” says Santiago Lucero, a spokesman for the exchange.

 

 

 

 

 

Yes, we wouldn’t want people to have an incentive to save for a time of illness or injury. We wouldn’t want them thinking they are responsible for themselves. Good grief.

 

 

.

[birdog1960]

More California dreamin.................

 

 

No Obamacare Health Savings Accounts in Calif.

 

By Wesley J. Smith

 

California (my native state) has perhaps the most radical state government in the country. Out here, the powers that be love Obamacare and are enthusiastically establishing the exchanges. But the currently available polices are not compatible with health savings accounts. From the SF Chronicle’s always informative Kathleen Pender column:

 

 

 

 

Q:

Spencer H. writes, “I was reviewing health care plans on the Covered California site and couldn’t figure out which, if any, of the plans are compatible with health savings accounts. Do you know?”

A: Covered California, the state’s health insurance exchange, “is

not

offering HSA-compatible individual health insurance policies,” says Santiago Lucero, a spokesman for the exchange.

 

 

 

 

Yes, we wouldn’t want people to have an incentive to save for a time of illness or injury. We wouldn’t want them thinking they are responsible for themselves. Good grief.

 

 

.

This site disagrees with the basic facts you presented: http://www.calhealth.net/California_HSA_Plans_and_Health_Reform.htm. but ya'll never let facts get int he way of bashing the aca. Even if your version of the truth holds "the only reason to purchase in the exchange is if you are eligible for a health subsidy...it's hard to imagine how people making up to the poverty level might also want to fund a separate hsa".

 

no doubt, there will be problems with the roll out of this huge plan. this is just not one of them.

 

So it really boils down to everyone's favorite radio station WIIFM What's In It For Me for you doesn't it?

how so?

 

You've rarely seen it come to fruition because doctors haven't been pushed to their limits. This will be the straw that broke the camel's back, at a time when needing doctors will be at an all-time high. There's only so many doctors you can replace, and almost none of them will be replaced by people who are qualified enough.

 

As for me, thanks for the concern, but I have a sizable rainy day fund, quite a bit socked-away in retirement vehicles if needed, a decent amount of equity in my house (and will be able to make a profit on selling it if need be), and several investments with one in particular that looks like it's going to pay-off handsomely. In addition, I can always do per diem work I could also be an expert witness as quality erodes while lawsuits continue unabated.

the value of per diem and expert witness work is likely to decrease proportionally to average reimbursement for conventional practice.

Edited July 16, 2013 by birdog1960