The Affordable Care Act II - Because Mr. Obama Loves You All

[3rdnlng]

I'm the last person to support PearlHowardsman Mohammed thread/post, but show me where he is wrong in this thread.

 

I already have. Multiple times.

 

Really weak response. You either have no balls yourself, or no knowledge. Again, I'm disappointed.

[Deranged Rhino]

Really weak response. You either have no balls yourself, or no knowledge. Again, I'm disappointed.

It's very difficult to go back through the thread, I know.

[3rdnlng]

It's very difficult to go back through the thread, I know.

 

I don't know if you are being sarcastic or not, but I'm not going to go back through the thread to prove your point for you.

[Deranged Rhino]

I don't know if you are being sarcastic or not, but I'm not going to go back through the thread to prove your point for you.

:lol:

[3rdnlng]

:lol:

 

You still need to show some substance here.

[DC Tom]

:lol:

 

That was impressive.

[Deranged Rhino]

That was impressive.

I thought so... I'm still laughing.

[birdog1960]

don't know how i missed this for a month but it's very entertaining. kinda like watching a lioness play with a mouse. and "mickey" burr is the purrfect foil. http://pnhp.org/blog/2014/03/15/canadas-dr-danielle-martin-educates-sen-richard-burr-on-single-payer/. she dispels many of the myths put forward here so regularly as well.

[Chef Jim]

 

 

I don't know if you are being sarcastic or not, but I'm not going to go back through the thread to prove your point for you.

 

Seriously?? And you call others lazy. Do your homework Sue.

[OCinBuffalo]

You´re on the clock: Doctors rush patients out the door

USA Today*, by Roni Caryn Rabin

Original Article

Yep. And it's only going to get worse if you are an Obamacare patient trying to see an Obamacare doctor....unless...you offer to pay extra. It's merely the next logical step in the process. Markets work. And the market for a doctor's "undivided attention" for a half hour is a commodity that has a value. By squeezing out the supply of doctors willing to see Obamacare patients, there is no other logical outcome other than would-be consumers of that commodity, separating themselves from the pack, by offering to pay for it. Thus a price will be set by supply and demand, just like it always is.

 

And, of course there's this:

How did visits get so truncated? No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare's 1992 adoption of a byzantine formula that relies on "relative value units," or RVUs, to calculate doctors' fees.

Yet another example of what happens when government employees are put in charge of doing my job. The entire approah to RVUs is fundamentally flawed. (You want details? Long post. You decide. That's my new policy.) And, as per normal Medicare propaganda: the RVU approach is supposed to ensure quality care. What can we observe about RVU vs. quality? The focus of RVU is by defintion not on quality, but on causing Medicare to pay less via "efficiency". If we actually moved the focus to quality, in the big picture, Meidcare would pay less, due to less improper diagnoses/wasted time of multiple doctor visits trying to get it right.

 

Sure looks like all it does is "move the widgets faster", doesn't it? Hint: efficiency is no gaurantee of effectiveness. Efficiency can be the enemy of quality, if it's implementation is left to amateurs.

 

Point of note: I'm anti-ACA, and I still don't take that jackass seriously.

I'm anti-ACA, and I I've gone out of my way to troll that jackass....seriously.

Edited April 22, 2014 by OCinBuffalo

[OCinBuffalo]

I already have. Multiple times.

Yes, and the results? B-man's contribution to this thread has more value.

 

At least Juan Guzman tried with his hilarious charts. Too bad for him I've seen those charts, and the Japan study I've linked totally blows them away = "illegal but common and condoned side payments".

 

Now? The same thing is inevitable here: forcing more people onto the roles of Obamacare(increasing demand), but, restricting the # of doctors available to them(decreasing supply), increases the price, 100/100 times. Inevitable. Somebody is going to pay that price. If we are restricting what insurance can pay, and we are also restricting what government will pay, which we are. Then that price has to come from somewhere: John Adams's pocket! Or else, all you do is force even more doctors out of the Obamacare market. Two words: Death Spiral. People that have paid for Obamacare, but, can't get it's value? Stop paying for Obamacare. Death Spiral.

 

Btw, John Adams's Pocket is a name for a twee little store on 2nd and Market in Center City that sells handbags and other "sundries".

[PearlHowardman]

I'm the last person to support PearlHowardsman Mohammed thread/post, but show me where he is wrong in this thread.

 

This isn't rocket science.

 

Christians/Jews deny that Muhammad was one of their Abrahamic Prophets of God so that makes Muhammad a Godless fraud.

 

Obamacare plans have high monthly premiums, high deductibles, no out of network benefits, and high patient copays so that makes Obamacare an insurance scam.

[DC Tom]

This isn't rocket science.

 

Christians/Jews deny that Muhammad was one of their Abrahamic Prophets of God so that makes Muhammad a Godless fraud.

 

Obamacare plans have high monthly premiums, high deductibles, no out of network benefits, and high patient copays so that makes Obamacare an insurance scam.

 

You have an entire thread devoted to your raving Islamophobic lunacy. Keep it there, !@#$.

Edited April 23, 2014 by DC Tom

[Keukasmallies]

All hail the IRS, the smooth running engine tasked with managing the ACA; but wait, bonuses to employees who, themselves, owe back taxes? What, you say, the IRS can't even manage its own house? Whatever do you mean?

 

http://www.washingtonpost.com/news/morning-mix/wp/2014/04/23/irs-gave-bonuses-to-employees-who-owed-back-taxes-and-thats-not-all/

 

For sake of continuity, the disaster that is the ACA is being administered by the disaster that is the IRS.

 

Good on yer', POTUS!

[keepthefaith]

All hail the IRS, the smooth running engine tasked with managing the ACA; but wait, bonuses to employees who, themselves, owe back taxes? What, you say, the IRS can't even manage its own house? Whatever do you mean?

 

http://www.washingto...-thats-not-all/

 

For sake of continuity, the disaster that is the ACA is being administered by the disaster that is the IRS.

 

Good on yer', POTUS!

 

Aren't the bonuses good news? Now these people can pay the taxes they owe! Problem solved!

[B-Man]

2.7 Million ObamaCare EnrolleesStill Unaccounted For

 

Original Article

 

President Obama has for a while been bragging that 8 million people have signed up for ObamaCare. But the administration still hasn´t released the state-by-state numbers to back up that number. You´d think that with such good news, the administration would want to put out as many details as possible, as soon as possible. But judging by previous months, the latest Health and Human Services enrollment report is now nearly two weeks behind schedule. As a result, we still don´t know where 2.7 million ObamaCare enrollees came from.

 

 

 

 

Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor.

 

 

A fatal wait: Veterans languish and die on a VA hospital´s secret list

CNN, by Scott Bronstein & Drew Griffin

 

Original Article

 

 

 

 

 

Highlighting the practically unknowable degree to which Obama’s crowning legislative achievement is expanding our bureaucracy

 

CRS report: The administration has missed 44 of its own ObamaCare deadlines

by Erika Johnsen

Original Article

[DC Tom]

CRS report: The administration has missed 44 of its own ObamaCare deadlines

by Erika Johnsen

Original Article

 

To be fair, the deadlines were statutory. So they weren't the administration's deadlines, only Congress's, and we all know those don't count if you have a press conference...

[B-Large]

Yep. And it's only going to get worse if you are an Obamacare patient trying to see an Obamacare doctor....unless...you offer to pay extra. It's merely the next logical step in the process. Markets work. And the market for a doctor's "undivided attention" for a half hour is a commodity that has a value. By squeezing out the supply of doctors willing to see Obamacare patients, there is no other logical outcome other than would-be consumers of that commodity, separating themselves from the pack, by offering to pay for it. Thus a price will be set by supply and demand, just like it always is.

 

And, of course there's this:

 

Yet another example of what happens when government employees are put in charge of doing my job. The entire approah to RVUs is fundamentally flawed. (You want details? Long post. You decide. That's my new policy.) And, as per normal Medicare propaganda: the RVU approach is supposed to ensure quality care. What can we observe about RVU vs. quality? The focus of RVU is by defintion not on quality, but on causing Medicare to pay less via "efficiency". If we actually moved the focus to quality, in the big picture, Meidcare would pay less, due to less improper diagnoses/wasted time of multiple doctor visits trying to get it right.

 

Sure looks like all it does is "move the widgets faster", doesn't it? Hint: efficiency is no gaurantee of effectiveness. Efficiency can be the enemy of quality, if it's implementation is left to amateurs.

 

 

I'm anti-ACA, and I I've gone out of my way to troll that jackass....seriously.

 

We accomplish appropriate time with the Doctor, meaning no rushing (except for sme providers who are just here to collect a check) by subsidizing the Dept of Internal Medicine revenues from specialties, and the lucrative surgical department. General Internal Medicine has been a mney loser for decades here, meaning provider fail to cover their salary and benefits for the fiscal year- we have a annual primary care support agreement in place, to make sure our Internist can see patients, do research and teach of needed.... I think that is why you will see more providers shut down stand alone practices for internal med, and come to large centers where they can earn a good salary, and not have to see a pateint every 10 minutes for 20 in a 4 hour clinic session. My last annual exam was 45 minutes- I needed 20, but they were thorough and my MD had a student in tow. Where I see the most time wasted in primary care is poor triage of the original call from the patient- complex cases put into a 20 minutes spot, routine stuff put into a 40 minute spot- alot of our issues is having non-medical staff laying out the schedule of and otherwise efficeint provider. I also think the advent of EMR has done more to occupy MD time than the ACA and its reimbursements... they spend alot of time typing, less time caring... kind of ironic consirding how EMR where desimged to be more efficeint.

 

This isn't rocket science.

 

Christians/Jews deny that Muhammad was one of their Abrahamic Prophets of God so that makes Muhammad a Godless fraud.

 

Obamacare plans have high monthly premiums, high deductibles, no out of network benefits, and high patient copays so that makes Obamacare an insurance scam.

 

Jesus, why do you continue to post in this thread, you're making everybody dumber by having to read this tripe- those components of an insurance plan you cited have been in place for decades, the ACA didn't all of the sudden create those utilization tactics of managed care... it simple doubled down on an innefficeint, wasteful convolued mess. Any reform plan including 3rd party insurance as its mainstay will be expensive, messy and cost more... but the ACA didn't create the problem in the first place.

Edited April 24, 2014 by B-Large

[Doc]

To be fair, the deadlines were statutory. So they weren't the administration's deadlines, only Congress's, and we all know those don't count if you have a press conference...

...and a phone and a pen.

[birdog1960]

We accomplish appropriate time with the Doctor, meaning no rushing (except for sme providers who are just here to collect a check) by subsidizing the Dept of Internal Medicine revenues from specialties, and the lucrative surgical department. General Internal Medicine has been a mney loser for decades here, meaning provider fail to cover their salary and benefits for the fiscal year- we have a annual primary care support agreement in place, to make sure our Internist can see patients, do research and teach of needed.... I think that is why you will see more providers shut down stand alone practices for internal med, and come to large centers where they can earn a good salary, and not have to see a pateint every 10 minutes for 20 in a 4 hour clinic session. My last annual exam was 45 minutes- I needed 20, but they were thorough and my MD had a student in tow. Where I see the most time wasted in primary care is poor triage of the original call from the patient- complex cases put into a 20 minutes spot, routine stuff put into a 40 minute spot- alot of our issues is having non-medical staff laying out the schedule of and otherwise efficeint provider. I also think the advent of EMR has done more to occupy MD time than the ACA and its reimbursements... they spend alot of time typing, less time caring... kind of ironic consirding how EMR where desimged to be more efficeint.

.

I think a review of the history of RVU use, the governance over their levels and what changes might be coming soon might clarify your thinking here. this article does a very good job: http://www.nejm.org/doi/full/10.1056/NEJMp1310583

 

"ideally, physicians work would be reimbursed on the basis of patient outcomes that use effective clinical risk assessment"

 

"natural reform of RVU_based systems is limited by the secretive, proprietary and specialty based nature of the AMA's RVU committee which functionally sets RVU levels".

 

from the outset, 1 RVU in 1 specialty was to be of equal value to an RVU in any other. Many would argue that even before the bastardization of the entire concept, the calculus valued specialists. I can't recall the number of diabetes office visits that originally equalled a single bypass surgery but i believe it approached a weeks worth. from a population based health perspective this is absurd. Then the secret little committee which is overwhelmingly specialty weighted decide to add on a conversion factor to rvu's which is a multiplier that is invariably higher for specialists than for primary care.

 

and the results? well, firstly we have the desired ratio (at least as found in most of the rest of the more cost and outcomes efficient nations in the world) of specialists to primary care reversed. This necessarily leads to time constraints and shorter patient visits since primary care is the front line. It also leads to very expensive care as people with scalpels and xray machines and those administrating them like to use them as profit centers.

 

we also have about 50% of all physicians employed, although I can't find any figures that substantiate your claim that those are majority primary care. personal experience tells me differently. And then we get claims like yours that primary care is subsidized and lucky to be so. nothing could be further from the truth. we're relatively undervalued and the corrupt system of setting RVU levels is to blame. Importantly, those responsible are not government officials.