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Pipe dream? Obamacare
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swchandler



Joined: 08 Nov 1993
Posts: 5777

PostPosted: Fri Nov 23, 2012 7:05 pm    Post subject: Reply with quote

I think that is fair to say that if you have health insurance today, you have a pretty good idea generally how things will work under the ACA. Of course, the specific details of coverage might represent a change of sorts from the way things are set up now, but it is important to remember that health insurance today can be a lot different when contrasting one policy versus another. Right now, in my current "individual" enrollment choices (5) span a monthy cost between $127 all the way up to $930, with managed care coming in the $467 to 515 range.

What I don't know now is whether the certain policy types available today will fulfill the minimum standards required by the ACA after 2014. They could be better or maybe a bit worse, but one would still think that choice would remain to be an important facet in the decision to select one policy versus another. Also, I would expect that the cost for different policy choices will still be a factor in selecting coverage. For instance, the cost and coverage for folks in their 20s will probably less expensive than the type of cost and coverage for folks in their 40s or 50s. Furthermore, what might be available from employers versus the insurance exchanges could be significantly different, especially with respect to the cost, as employer provided coverage could be viewed as a benefit designed to attract potential employees to their company. Lastly, add to that the probability that state and/or regional factors will affect coverage and its costs.

All in all, I seriously doubt that there will be any real big surprises for those of us insured already. For those that don't have health insurance, they will learn what it takes to be responsible for one's health. I would guess that those now who are too poor to buy insurance will be getting something for nothing, which undoubtedly will piss off folks on the right. But considering the situation today for the poor, we can be better assured that they will seek care early rather than later, and that will factor in to reduce health care costs.
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swchandler



Joined: 08 Nov 1993
Posts: 5777

PostPosted: Fri Nov 23, 2012 7:14 pm    Post subject: Reply with quote

"I don't even see anything to apologize for. I simply don't understand your reaction."


It's hard to believe that isobars is that clueless. But maybe he just doesn't understand that attitude has everything to do with communication and acceptance. A bit of humility and introspection would go a long way, but unfortunately, I don't think that's in the cards in isobars' self absorbed world.
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coboardhead



Joined: 26 Oct 2009
Posts: 1927

PostPosted: Fri Nov 23, 2012 9:15 pm    Post subject: Reply with quote

swchandler...Everything I have read would indicate that you are correct in noting that very little will change for you under the ACA. The cost cutting incentives to providers, so far, have been limited to Medicare and Medicaid. Private health insurance policies will have minimum coverage requirements, but are not subject to the same restrictions set on providers to reduce costs.

What will change, is that, short term, Medicaid will see increased enrollment and, therefore, increased costs. Some of that is offset by reducing payments to hospitals. The providers have gone along with this because, currently, they "eat" the costs of treating those with no insurance. Now, they will receive less reimbursement on more of their patients.

The biggest issue, IMO, with the implementation of the ACA is that, for years, the system has rewarded specialists at the expense of primary care. The new influx of patients (the ones that used to wait for acute illness before seeking care) to primary care will cause a shortage of available primary care physicians. This is exacerbated by the increase in older (and overweight) population.
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isobars



Joined: 12 Dec 1999
Posts: 14054

PostPosted: Sat Nov 24, 2012 9:58 am    Post subject: Reply with quote

On the downside, just for starters ...

Millions more patients treated by thousands fewer doctors = reduced availability.

Tens of thousands of people fired and hundreds of businesses closed/expansions canceled already, based just on what's already known about its impact.

We've all seen Obama and many congressmen state clearly, without shame, that their ultimate goal, immediately or at least well before 2030, is single-payer, taxpayer-funded, fully government managed health care ... 100% socialized medicine by definition. I won't be around then, but many of you and most of your children will be. That should scare all of you.

Government rationing of health care. I've experienced it in the VA for decades, and it's not pretty.
Think UK and Canadian and VA health care. Think the actual facts, rather than the leftstream media hype, about the cancer and infant survival rates in countries/areas such as Germany, Scandanavia, the U.K., etc. You want no part of those rates.

Vastly reduced medical research.

I've not seen any data or even speculation on where physician expertise may go under Obamacare, but logic insists that the best minds and biggest egos will migrate elsewhere as pay and autonomy decline. The arrogant, useless, now-fired ass I consulted just Wednesday was angry to learn that my insurer was Medicare and thus that he was losing money treating me, and swore to retire the minute he saw Ocare impacting him any further. (He says Obama is too far to the right to suit him.)

Tell me you guys think that cattle-car, government-bungled health care will not reduce the median level of competence, pride, and professionalism of physicians to what you’d expect, rightly or wrongly, from a Walmart clinic … or, far worse, in a VA hospital. Most of you have absolutely no CONCEPT how bad the care is in the VA system.

Insurance premiums are rising rapidly in anticipation, and Ocare hasn't even kicked in yet.

The administration has already announced tax increases of several hundred billion to support the ACA ... arguably the biggest tax increase in history and expected to decrease revenue per GDP. Sorry, guys, but that hits YOUR pockets, not just those of Buffet and Gates.

The CBO keeps shouting that the ACA is fiscally unsustainable … and look at the government’s history of predicting the sustainability of Medicare.

The first incident in history our government has forced citizens to purchase anything (anyone who still compares this to auto insurance is uninformed.) Even Justice Roberts was against it on that grounds, changing his vote at the last moment to appease those who think the Supreme Court is becoming irrelevant or too far Right.
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swchandler



Joined: 08 Nov 1993
Posts: 5777

PostPosted: Sat Nov 24, 2012 2:35 pm    Post subject: Reply with quote

coboardhead, I have to admit that for some years now that I have steered clear of the PCP or HMO concepts, and instead favored specialists. But as one ages, we tend to understand what our weaknesses and health care issues are, and the value and importance of specialists becomes more central in managing things. Even if I was required to go to an HMO or see a primary care physician, I would end up seeing the specialists anyway given my preexisting health conditions. Ironically though, I pay far less monthly following the path that I am. From the different monthly costs that I highlighted earlier, I'll be paying at the $127 rate. Where I get hit is having to pay the first $2000 out-of-pocket to fulfill my deductible requirements. After that, it's an 80/20 split until I spend $4000 overall. After hitting that threshold, I'm 100% covered. Even though I always have to pay the $2000, and then some, I believe I still come out ahead at the end of the year. Also, none of the other plans available to me offer the HSA opportunity.

Now, when I have a health issue come up that requires attention, and it is outside the area of my specialists, I can go to a neighborhood clinic that is approved as "in network" by UHC. I kind of view this option as my opportunity to see a PCP only when I need it.

Regarding your concerns about a shortage of PCPs, I don't doubt you that there could be a potential shortage of trained personnel with a greater influx in patient numbers. However, it could be an opportunity for some to move out of emergency care and into managed care scenarios to lessen the impact over the short run. In the long run though, I see the opportunity for jobs and careers in what would be a vibrant and growing field. These would be American jobs that really can't be moved offshore. That dovetails quite well with President Obama's focus on funding and increasing educational opportunities, especially in the sciences.

Overall, in stark contrast to the "sky is falling" deniers out there, I remain very optimistic in moving ahead with the ACA. Undoubtedly, there will be changes in the years ahead to improve many of the facets of the law, and who knows, things may ultimately lead to a single payer system in the end. As things now stand though, we're now on a far more sensible path that will be better able to improve care and drive down costs.
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DanWeiss



Joined: 24 Jun 2008
Posts: 1933
Location: Connecticut, USA

PostPosted: Sat Nov 24, 2012 4:37 pm    Post subject: Reply with quote

isobars wrote:
Mr. Make-it-up says:

The first incident in history our government has forced citizens to purchase anything (anyone who still compares this to auto insurance is uninformed.) Even Justice Roberts was against it on that grounds, changing his vote at the last moment to appease those who think the Supreme Court is becoming irrelevant or too far Right.


Really? Hardly. Workers Comp insurance? Ever heard of that? Of course, not.

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coboardhead



Joined: 26 Oct 2009
Posts: 1927

PostPosted: Sat Nov 24, 2012 7:10 pm    Post subject: Reply with quote

swchandler

I am the same. I always self-refer to specialists. Although, luckily, I have not needed to seek medical care often. Maybe, three times in thirty years. I do not even have a primary care physician.

But, I am afraid this does not work for most folks. The "gate keeper" concept is, generally, less costly. It is worth noting that my insurance is ACA compatible (as required in Colorado). It will allow me (here we go again) to see a specialist, and still provide reimbursement, without first seeing a PCP.

Medicare and Medicaid are encouraging the use of PCP's through better reimbursement rates to try and encourage the use of less costly PCP use.
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pueno



Joined: 03 Mar 2007
Posts: 2643

PostPosted: Sat Nov 24, 2012 7:15 pm    Post subject: Reply with quote

Mikey wrote:
...the ACA ... arguably the biggest tax increase in history and expected to decrease revenue per GDP. Sorry, guys, but that hits YOUR pockets, not just those of Buffet and Gates.

Mikey, here's a bit of QUANTITATIVE data. We all realize that you'll probably reject it because it didn't come from Fox, Brietbart, Newsmax, Limbaugh... but take a look and consider it.

See if you can coexist with a bit of objective truth for a short time.
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isobars



Joined: 12 Dec 1999
Posts: 14054

PostPosted: Sat Nov 24, 2012 8:57 pm    Post subject: Reply with quote

PCP referral is required to get insurance coverage in some instances such as physical therapy and is required by some specialists just to filter their patient load. I've also had "quick care" clinic physicians express irritation that I hadn't taken my problem to my PCP.
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pueno



Joined: 03 Mar 2007
Posts: 2643

PostPosted: Sat Nov 24, 2012 9:12 pm    Post subject: Reply with quote

Mikey wrote:
I've also had "quick care" clinic physicians express irritation that I hadn't taken my problem to my PCP.

WHAT? You irritated somebody?

What a surprise!
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