Health-care Reform Bill now in House

[Snipe]

A "big fail" will be no worse than we already have. Viewed in that light, it's all upside.

I think we are talking about comparative degrees here. A "big fail" compared to what we have would be worse. Is it indeed not possible to have a worse system than we have? Do you believe that?

I could imagine a worse system than we have now. When Medicare goes bankrupt we might all get to see it. I would agree that our system already sucks, but I don't think Obamacare addressed the root causes of those flaws.

Does this program "reform" health care in any substantive way? I am not sold on that. It does however impose new taxes, per the Supreme Court, so we are throwing new tax dollars at an unreformed system.

Much of the cost savings involves getting poor people to stop using emergency rooms, because they will have health insurance. Does anyone think that borderline retarded breeders on welfare will stop just going to the emergency rooms because they read all about their new free health care plan? What about illegal immigrants? Will they stop flooding emergency rooms? Where are those savings going to come from?

I can't see this ending well. I agree our system is broken, but if you are in a hole the first rule is to stop digging. Obama just bought some more shovels.

[LA Muskie]

Snipe,

You're not going to find me defending the law, other than to say that a change is needed -- and at least this is an attempt at change. There are about a million ways I think it could (and should) have been done better. But the legislative process waters just about everything down.

[LA Muskie]

I think it is admirable that you want to give your employees coverage. But you don't, because it is too expensive. That is a fact many business owners face. You will need a tax credit to give them coverage, but credits aren't free and that money will have to come from somewhere. Somebody else, the American taxpayer, will help you provide your employees coverage.

I am not against the American taxpayer chipping in, but do they need to do it for businesses, or should they just give everyone a tax credit? Your employees are already on their own for insurance, why not give the credit to them instead of you? You can't afford to give it to them. Why should the government pay you to buy their insurance? If you have 20 employees, you would be deciding on a plan for 20 people. If the government gave a credit to all of them, they could decide on the best plan for them.
I am all for cutting the artificial link between employment and health insurance. No disagreement there. Not because I don't want to provide it, but because there is no reason for the two to be linked -- and for those without employment to suffer the double-whammy of lost healthcare insurance as well.

[LA Muskie]

I can't see this ending well. I agree our system is broken, but if you are in a hole the first rule is to stop digging. Obama just bought some more shovels.
I give him credit for trying. Someone had to.

[kmcrawfo]

I give him credit for trying. Someone had to.

A saying used in medicine is, "First, do no harm." It is not always wise to treat something for the sake of treating it as unintentional worsening of the condition may ensue. It wiser to contemplatively take small steps with known outcomes to improve a condition.

Unfortunately, this was not the case with the horrendous legislation. We will all be the worse for it. The burdens, tax, and regulations in the bill will make it extraordinarily difficult for small/private physicians to run their offices. 3 primary care clinics in my city have already closed practices due to changes that have already been implemented vs. will be coming. This bill initiated a 4% cut in medicare payment in 2012, increased reporting/overhead, increased taxes, and many other things already.

Unfortunately, all healthcare will be trending towards the VA/country hospital model. If you have ever received care in one of those facilities, be prepared.

Don't complain that a system is "broke" / "horrible" unless you have first-hand knowledge of a superior system that can actually be implemented.

There is no better healthcare system than the USA that is currently being used in the world that could reasonably be implemented here. That does not mean we can not try to improve, but to instill something that is doomed to failure and will further bankrupt the country is not a wise move.

There is one more chance to correct this in November... I hope the citizens of this country choose wisely.

As Chief Justice Roberts said on this very case: "It is not the duty of the Court to save the people from the consequences of their political decisions."

Poling data shows about 71% of our country wanted the court to overule at least some portion of the legislation.
Justice Roberts clearly thought this was not good for the country, but tried to make his ruling outside of that paradigm and what he viewed as being an evaluation of the "law" and not the "people's will".

[bobbiemcgee]

As for larger businesses that won't be eligible for SHOP Exchanges, I don't see the insurance companies leaving the business, so I am confident they will find a way of competing with the exchanges to make it cost-effective for large companies to maintain their company-provided coverage.

Or they can just say "to hell with it" and pay the tax, if it's cheaper.

[LA Muskie]

Or they can just say "to hell with it" and pay the tax, if it's cheaper.

It may be cheaper to pay the tax. But then you have no insurance if catastrophe strikes. You can't apply for a policy on the way to the hospital.

[LA Muskie]

There is one more chance to correct this in November... I hope the citizens of this country choose wisely.

As Chief Justice Roberts said on this very case: "It is not the duty of the Court to save the people from the consequences of their political decisions."

Poling data shows about 71% of our country wanted the court to overule at least some portion of the legislation.
Justice Roberts clearly thought this was not good for the country, but tried to make his ruling outside of that paradigm and what he viewed as being an evaluation of the "law" and not the "people's will".
Polling data also showed that Americans overwhelmingly supported the key provisions of the law, even though they were supposedly "against" the law. At best the polling data shows that Americans don't understand the law and that they have bought into largely false political propaganda/rhetoric.

[GuyFawkes38]

There is no better healthcare system than the USA that is currently being used in the world that could reasonably be implemented here. That does not mean we can not try to improve, but to instill something that is doomed to failure and will further bankrupt the country is not a wise move.




Our health care system is indeed awesome. Some graphs to point out the awesomeness of our health care system.

Medicare and medicaid will take up a big chunk of out total national spending (GDP).
http://www.urban.org/Images/310914_figure3.jpg

We are just killing it compared to those idiots in Europe. The cool thing is that we are not actually getting better results with all the spending:

http://alainsaffel.com/wp-content/uploads/2010/04/OECD-per-capita-health-spending.png

ok. I'm going to try not to be so sarcastic. But it frustrates me when I hear anyone talk about how great our health care system is right now. It isn't. It's awful. It's a train wreck. I'm hoping the ACA brings some big changes.

[kmcrawfo]

Our health care system is indeed awesome. Some graphs to point out the awesomeness of our health care system.

Medicare and medicaid will take up a big chunk of out total national spending (GDP).
http://www.urban.org/Images/310914_figure3.jpg

We are just killing it compared to those idiots in Europe. The cool thing is that we are not actually getting better results with all the spending:

http://alainsaffel.com/wp-content/uploads/2010/04/OECD-per-capita-health-spending.png

ok. I'm going to try not to be so sarcastic. But it frustrates me when I hear anyone talk about how great our health care system is right now. It isn't. It's awful. It's a train wreck. I'm hoping the ACA brings some big changes.

We supply the best healthcare in the world, hands down. It is not even close. This is not the forum to best debate this. It is important to understand what you are looking at when reviewing these studies.

Look at studies that measure:
1. Access to care
2. Access to advanced imaging and other studies
3. Access to specialists
4. Cancer survival rates
5. Survival/success rates of specific surgeries and procedures.

This are not easily found as the stuff that is bounced around circles and the internet showing rankings that people constantly compare cost-per-capitia, infant mortality rates, and other things.

The bottom line is if you are really sick/have a significant medical problem (ie. not a runny nose) there is no where else in the world better for you to be than the USA. Outcomes and survival are better. Access is better.

You will get your wish to fix your "train wreck". It will be a big change, don't worry.

[LA Muskie]

We supply the best healthcare in the world, hands down. It is not even close. This is not the forum to best debate this. It is important to understand what you are looking at when reviewing these studies.

Look at studies that measure:
1. Access to care
2. Access to advanced imaging and other studies
3. Access to specialists
4. Cancer survival rates
5. Survival/success rates of specific surgeries and procedures.

This are not easily found as the stuff that is bounced around circles and the internet showing rankings that people constantly compare cost-per-capitia, infant mortality rates, and other things.

The bottom line is if you are really sick/have a significant medical problem (ie. not a runny nose) there is no where else in the world better for you to be than the USA. Outcomes and survival are better. Access is better.

You will get your wish to fix your "train wreck". It will be a big change, don't worry.
Statistics are statistics -- you can almost always find one to suit your cause. In response to your claim that we have the best QUALITY of care, I give you the infant mortality rates -- where the United States estimates we rank #48 (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html).

According to the World Health Organization, (http://www.who.int/healthinfo/paper30.pdf)the United States ranked #37 among their 191 member states, despite having the highest per capita spending rate among those same countries.

All of that said, I won't dispute that we have outstanding doctors and researchers in the United States, and that you can get world class (if not the best) care right here in the US of A. Well, as long as you are among the privileged elite who have a job and make enough to pay for it...

[paulxu]

We supply the best healthcare in the world, hands down. It is not even close. This is not the forum to best debate this. It is important to understand what you are looking at when reviewing these studies.

Look at studies that measure:
1. Access to care
2. Access to advanced imaging and other studies
3. Access to specialists
4. Cancer survival rates
5. Survival/success rates of specific surgeries and procedures.

This are not easily found as the stuff that is bounced around circles and the internet showing rankings that people constantly compare cost-per-capitia, infant mortality rates, and other things.

The bottom line is if you are really sick/have a significant medical problem (ie. not a runny nose) there is no where else in the world better for you to be than the USA. Outcomes and survival are better. Access is better.

You will get your wish to fix your "train wreck". It will be a big change, don't worry.

The problem is that the "best" care is available to only a very, very small percent of the population. When you take the entire population and look at how we rank on the factors you note, we do not fair well at all.

Here's one you can review:

http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

[kmcrawfo]

The problem is that the "best" care is available to only a very, very small percent of the population. When you take the entire population and look at how we rank on the factors you note, we do not fair well at all.

Here's one you can review:

http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

With all due respect these comments about elite, privileged, etc. is complete Bull ^%$. Go to Wishard Memorial Hospital in Indy or Grady Hospital in Atlanta. The "dredges" of society are receiving world-class health care. Getting CT scans, MRIs, and seen by specialists, etc. The Medicaid population gets everything, and for free. They have to wait there turn, but they get it.

The Medicare population recieves elite care across the boards as well. They just don't have as long of waits.

The private insurance populatin gets great care across the board, for the most part.

You guys are quoting the same POC studies that don't study anything that really matters. Infant mortality rates and who studies? Have you actually read the study? How it was conducted, limitations, etc. Or do you go to a web site and print a pretty graph or a summary by someone else.

Contrary to a post prior in this thread, you do not just find statistics to suit your opinion in medicine. In medicine, you are trained to critically analyze studies and data so you can make good, evidence based decisions on good data. The general public should do to same when evaluating our healthcare system, but does not.

The problem with our healthcare is NOT the quality of care. If you claim this to be so, you are completely ignorant (sorry for the insult, but it is true). It is also not patient satisfaction. Good studies show over 90% of americans are very happy with their current insurance, health care, etc. The biggest problem is access to good doctors and the number of physicians that we have.

We are making drastic changes to our healthcare system to accommodate a few million people comprising 4-5% of the population. The other 90% of the population will suffer a decrease in the quality of care.

Are we increasing the number of doctors? No
Are we increasing the number of specialists? No
Are we increasing access to care? No
Are we incentivizing more people to go into medicine and decrease the doctor shortage? No
Are we increasing the number of people in an already burdened system? Yes
Are we decreasing reimbursements as costs of delivering care go up? Yes
Do we have the resources/funds to pay for this? No

We are widening the net for Medicaid, that is it. No one accepts Medicaid. I accept Medicaid because I believe it to be the right thing to do. I am the only dermatologist in all of southern Indiana to do so. I have always and will always accept it, but NOT a SINGLE other dermatologist does. The same goes for any other specialists. No GI docs accept it, No rheums, No ID, etc, etc, etc. Only 1 ophthalmologist.

Obviously, no ones mind will be changed who already thinks the ACA will make things better. This will be the end of the enviable healthcare system we have. People won't know how good they had it until it is gone.

We will have a 2-tiered system just like UK and Canada. Elite/state-of-the-art medicine will still exist for the "ELITE" who purchase extremely expensive private insurance. Everyone else will be on the public option which goes bankrupt just like the UK, Greece, Canada, Spain, Germany, etc.

This already exists. Why do people think it will be different here. Why on earth would we model a system that has failed all over the world as well as in our own country (Maine, Connecticut, Cal, etc.)

No more from me on this. Good luck to everyone regardless of what happens.

[kmcrawfo]

The problem is that the "best" care is available to only a very, very small percent of the population. When you take the entire population and look at how we rank on the factors you note, we do not fair well at all.

Here's one you can review:

http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx
One last note:

Did you even look at how that study was structured and what it actually measured?

How about cancer survival rates?
Success rate/survival after heart surgery?
Length of survival in years after organ transplants?

This is data that matters in medicine. Not feel good statistics that show to real concrete evidence of success of procedures/cures/treatments/etc.

The USA is the best in things that actual matter.

For example, cancer survival rates (link to a summary of data, please read entire manuscripts in the link if you'd like):
http://www.firstthings.com/blogs/secondhandsmoke/2009/07/21/most-cancer-survival-rates-in-usa-better-than-europe-and-canada/

Studies can be found to surgical procedures, organ transplants, sever infections. These are very specific, precise studies.

These studies show if you get sick, get cancer, need surgery, etc. where do you want to be treated for that specific problem.

The USA is the best because we have the best facilities, doctors, innovation, etc.

[GuyFawkes38]

I just don't understand, why isn't this important.

http://freemarketmojo.files.wordpress.com/2009/09/blog_oecd_healthcare_2007_0.jpg

The US has only slightly higher per capita income as the next 7 countries on that list (with the exception of luxemburg
which has much higher per captita income) . Yet, we are spending much more on health care without receiving better health care outcomes.

I have no doubt that we have the best hospitals, doctors, equiptment, etc... But I also have no doubt that the law of diminishing returns is kicking in. The US is on the wrong side of that curve. We are paying a lot of cash without the benefits.

[waggy]

As far as I'm concerned that chart points out that the entities (gov./ins./med./pharm) controlling this area, are at the very least greedy, and most likely corrupt too. I know what Bob Huggins would say. And I agree with him.

[Husketeer]

Are we increasing the number of doctors? No
Are we increasing the number of specialists? No
Are we increasing access to care? No
Are we incentivizing more people to go into medicine and decrease the doctor shortage? No
Are we increasing the number of people in an already burdened system? Yes
Are we decreasing reimbursements as costs of delivering care go up? Yes
Do we have the resources/funds to pay for this? No


The major issue with your first four questions is that no new medical schools opened in the US for over a 20 year period until Florida State in 2000. In the last decade numerous schools have opened or established schools increased enrollment. However, medical students have a couple of major issues facing them. First, though enrollments have increased (in theory, a good thing to impact the future physician shortage) residency programs have not added more spots. This leads to American students simply taking the spots of foreign medical grads in residency programs. And who pays for these residency positions - the taxpayers through the federal government.

Additionally, physician shortages in primary care will continue to grow as long as it is not incentivized. One of the PCPs with whom I worked in med school was married to another outpatient internist. They were both out of school for about 20 years and continuing to pay off their debt. The idea of going into 200k+ worth of debt and then struggling to make a dent in spite of 60 hours/week of work led a number of my classmates to pursue more lucrative specialties rather than primary care.

[kmcrawfo]

The major issue with your first four questions is that no new medical schools opened in the US for over a 20 year period until Florida State in 2000. In the last decade numerous schools have opened or established schools increased enrollment. However, medical students have a couple of major issues facing them. First, though enrollments have increased (in theory, a good thing to impact the future physician shortage) residency programs have not added more spots. This leads to American students simply taking the spots of foreign medical grads in residency programs. And who pays for these residency positions - the taxpayers through the federal government.
.

The number of residency spots in our country has little impact on the shortage of primary care physicians. There are literally thousands of unfilled pediatrics, medicine, family practice, and general surgery positions open each year. A relatively small percentage of these actually are filled by foreign grads. These are stats from the NRMP:

Among primary care specialties, family medicine programs continued to experience the strongest growth in the number of positions filled by U.S. seniors. In the 2011 Match, U.S. seniors filled nearly half of the 2,708 family medicine residency slots. Family medicine also offered 100 more positions this year.

The two other primary care specialties that increased in popularity among U.S. seniors were pediatrics and internal medicine. U.S. seniors matched to 1,768 of the 2,482 pediatric positions offered, a 3 percent increase over 2010. In internal medicine, U.S. seniors filled 2,940 of 5,121 positions, an 8 percent increase over last year.

Virtually every state offers debt/loan forgiveness to the primary care specialties now if they go to an area of need. The income gap between primary care and specialties is narrowing, but is still significant. However, there is more training/years for specialties, they are much, much harder to match into, and the procedures/surgeries that specialists do take more skill/precision/liability/etc. Increasing medical school students will increase the number of primary care docs since those residency slot are increasing/1000s available. Specialty slot are decreasing/completely full each year. This will make the specialty slots even more competitive with the top grads leaning towards those fields. As long as the USMLE boards and specialty boards to not lower their standards (ala the SAT) they quality of care should get better in the status quo system.

The problem is by increasing low paying, medicaid type patients and lower reimbursements you are actually placing an increased burden on physcians to see more patients in less time. Instead of 30 per day, it will be 45, then 55, etc. This will lead to less time/less precision/etc. If you increase physicians and increase governmental insured patients it still reciprocates the same problem.

The government can not fix this problem through regulation/adding more patients to the system and balancing the budget on decreased reimbursements. It is not a formula for success.

I started out in family practice and was in primary care for 2 years prior to specializing. My specialty training was exponentially more difficult skills/fund of knowledge to practice the specialty is more demanding.

That being said the lifestyle, income, and other benefits are more than a fair trade off.

I agree that primary care doctors have it tougher in many ways. However, we as physicians need to avoid the temptation to pit specialists vs. primary care physicians in terms of income distribution, etc. Unfortunately, when the "playing field is evened" it ends up taking 20% from one and giving 5% to the other. Then, costs go up 7%, reimbursements go down 3% and everyone is a loser. The less government intervenes often the better.

I am not saying the system is perfect. I am not saying I know all the answers. All I know is that this is glossed over way too superficially and that a complete overhaul and government take over is not likely going to solve anything.

Also.. tort reform is a huge issue and not even touched upon in this bill. That is sickening and extremely political showing the influence trial lawyers vs. physicians have in DC.

[kmcrawfo]

I just don't understand, why isn't this important.

http://freemarketmojo.files.wordpress.com/2009/09/blog_oecd_healthcare_2007_0.jpg

The US has only slightly higher per capita income as the next 7 countries on that list (with the exception of luxemburg
which has much higher per captita income) . Yet, we are spending much more on health care without receiving better health care outcomes.

I have no doubt that we have the best hospitals, doctors, equiptment, etc... But I also have no doubt that the law of diminishing returns is kicking in. The US is on the wrong side of that curve. We are paying a lot of cash without the benefits.

But.... when specific studies on very specific outcomes are done, the US is better.

I completely agree on the law of diminishing returns. The US is better, but spends way too much $$$ to get there. The US subsidizes the rest of the world when it comes to pharmaceuticals, technology, and innovation. Our system allows this to happen. Canada and Europe get the same txs and drugs at lower costs directly from the manufacturers because there systems dictate it to be so. By all means a more streamlined, less cumbersome system is needed.

The problem is this bill makes the current system more expensive, more difficult to navigate, and more cumbersome. Not the answer.

[boozehound]

I just don't understand, why isn't this important.

http://freemarketmojo.files.wordpress.com/2009/09/blog_oecd_healthcare_2007_0.jpg

The US has only slightly higher per capita income as the next 7 countries on that list (with the exception of luxemburg
which has much higher per captita income) . Yet, we are spending much more on health care without receiving better health care outcomes.

I have no doubt that we have the best hospitals, doctors, equiptment, etc... But I also have no doubt that the law of diminishing returns is kicking in. The US is on the wrong side of that curve. We are paying a lot of cash without the benefits.

Those other countries also probably have healthier overall lifestyles which could contribute to less per capita spending on healthcare for the same overall result.

We also spend an incredible amount on many people in the last 6 months of their lives when they are clearly terminal cases. My grandmother passed last year at 87 of an aggressive form of brain cancer. When she was diagnosed they gave them the option of doing nothing and letting the disease run it's course or an aggressive chemotherapy routine that they thought might give her another 6 months. My grandfather decided on the chemo. She was far too weak to handle the chemo and they had to stop shortly into the first round. She passed away about 4 months later. A lot of money and about 20% of her remaining life was wasted trying a treatment that was never going to do anything significant. We do far too much of that as a country, IMHO.

[stophorseabuse]

Km, I don't agree with you, but I do appreciate you giving real detail, and not just screaming SOCIALISM!!!

I simply think there is more than 4 or 5 percent of the population that will benefit. I am inundated with friends who have NO insurance, including myself. With my BEST insurance offered to me as a teacher, I would pay over a grand a month for my healthcare for a family of 3. I can't afford that, and it is clear I support change. I am in a spot where I prefer quantity over quality.

I own NOTHING on purpose, as I know one emergency and I would lose it all. I rent, and I spend. I hide cash in my moms accounts and in my house safe.

I KNOW my problems. They are diagnosed and have been treated successfully, but our broken system costs me thousands a year just to keep getting the meds that treat it. Required visits and blood draws=wasted money and the doctor saying yep, it's xyz, and we will treat it with abc. Just like the past 12 years.

Going to a different doctor? No easy thing. Most require insurance. Dumbest crap ever. Won't even let me pay cash.

Asshats.

In conclusion, I realize it is damaging to some, but it is very beneficial to me and many I know. And of course, THAT is what I care about most.

I am not naive enough to believe this won't be negative to some.

[bobbiemcgee]

Long Rant sorry -

1 test: 2 insurance plans: test with no insurance;

Age 64: Test ordered: Echocardigram

Venue: Denver CO

1100 a mo. ins. plan: Retail cost 1400 - ins. co would actually pay 650 (I think, who the f knows for sure?) - Co-pay 440. Didn't go.

Venue: Denver CO

No Insurance (6 mos later) same test: Walk-in price: 1550 cash -

Age 65: Medicare Advantage plan HMO -

Venue: Orlando, Fl.

Reported retail cost: 725 - ins reportedly paid 225 (again don't what they actually paid)

Co-pay = 20 bucks.

Prescriptions costs before Medicare Adv plan = 101.50 mo (purchased monthly out of FIJI, US costs triple of this) - after 65 = 0.

Monthly ins. costs - $2. - I pay 99 a mo for Part B and the Medicare Advantage Co. pays me back $96.40.

I love my HMO Doc. No BS guy. Do this or that will happen type. Cost to go see him? You guessed it. 0. Cost for 4 other referrals and tests ? 0.

Medicare Advantage Co's are PRIVATE INS Co's that take over your health care needs from Medicare. So I am dealing with the PRIVATE SECTOR.

So. Here is my question that nobody seems willing to answer. WHY is there a such HUGE decrepancy in what this test costs nationwide? Same equipment, same pretty girl adminstering it. If you check on the internet, you will see prices from $800 to 4300! ABSURD.

If Toyota ships a car to Jax and somebody drives it to Orlando or Denver, I can see why it might costs more in Denver. If a Pharm Co. makes a drug in India (all of them do for supposedly "tax reasons" ) and then sells it to the VA for $5. and the very SAME DRUG to your ins. co for $65, why the f don't we get the VA price? WHY WHY WHY WTF NOT!!!!! They are all made in the same frickin' plants by the same frickin' people. Try to find a drug made by Americans in the good 'ol US of A. It's developed and sent overseas.

We could save about a TRILLION dollars overnight. How? Pass a law that we pay what the VA PAYS. Of course, you would have to fire 3300 lobbyists who will not allow this to ever happen.

[Kahns Krazy]

The healthcare and insurance industries make most of their money by making sure the end user has no idea how much their service actually costs. Fixed co-pays, especially for medications, are freaking rediculous. Why should I pay exactly the same for a $55 medication as a $750 medication? Aren't I always going to pick the supposedly better $750 option? If I was paying 10% of my costs, and my doctor said option A was nearly as good as option B, I bet I'd try A first.

I have a cracked root in a tooth. My dentist has suggested that the long term best solution is an implant. I asked how much that might cost, and he couldn't tell me. That is f'ked up. Ultimately, to get the actual cost and out of pocket cost, we had to run through a claim for a procedure that hadn't happened yet.

Fix the pricing model, and the healthcare insurance model will fix itself. There are way too many incentives and rebates in the healthcare world to believe that providers are acting in the best interest of their patients 100% of the time.

[Snipe]

I agree with Khans. We have to get the price mechanism back into play if we want to reduce costs. It is true that Doctors and Dentists don't know what their procedures even cost.

How much is a mammogram? Ever try to figure that out? It is a routine maintenance checkup that females are supposed to have every year. If people had to pay for routine maintenance out of pocket they would be advertising their prices. It would be easy to find out. Since laws largely mandate that insurance companies should pay for mammograms, and most people are insured, you don't find competitive pricing.

Also, the United States is a high cost legal environment. Lawsuits are easy to bring and are quite profitable. When people sue doctors, hospitals, health systems or the makers of drugs, that gets factored into the cost of health care and the prices that we pay.

I wouldn't mind a law saying that we don't pay more than Canada or the UK or anyone else. Match your lowest price is you want to sell it here, maybe with a small variance for transport and marketing. Other countries mandate low prices by law and they just have to shift the cost over to someone else who will pay, and that is us.

But to pay those low prices, we would have to agree not to sue the drug makers. Also, those low cost countries don't have an FDA that makes them take over a decade to get a drug to market. It is expensive to develop drugs in the United States, and because of the litigation, it is expensive to sell them here. I want low costs drugs too, but maybe we need some tort reform or to abolish the FDA (or both) to accomplish this. If you don't like those ideas, just lay back and enjoy the rape.

[kmcrawfo]

Okay.... Here is the real question that frustrates me.

Let's chew on this:

1. The money being spent on healthcare is going through the roof
2. Reimbursements from insurance are decreasing greatly (down 20%)
3. Yet, doctors are seeing more patients.
4. Yet, doctors are making much less $$$ (30-40% less)


So... If the money spent on healthcare is going up 200-300%, yet doctors aren't making anymore money, but in fact much less. Where is all the money going? Someone is banking the $$$:

1. Insurance companies?
2. Pharmaceutical companies?
3. Hospitals?
4. HMOs and healthcare organization (Kaiser, Clarian, etc.)
5. Government agencies and departments.?

I think the biggest problem is that medicine is no longer between a physician and his/her patient. There are so many other entities (both private and public) that take there share that it drives costs through the roof.

I charge $50 to a cash patient or $100 if I do a biopsy/procedure. Blue Cross charges over $200 for the same patient. This goes up more for more complex procedures.

This bill is making the system more complex and costly and I don't think it will help.

[kmcrawfo]

Long Rant sorry -

1 test: 2 insurance plans: test with no insurance;

Age 64: Test ordered: Echocardigram

Venue: Denver CO

1100 a mo. ins. plan: Retail cost 1400 - ins. co would actually pay 650 (I think, who the f knows for sure?) - Co-pay 440. Didn't go.

Venue: Denver CO

No Insurance (6 mos later) same test: Walk-in price: 1550 cash -

Age 65: Medicare Advantage plan HMO -

Venue: Orlando, Fl.

Reported retail cost: 725 - ins reportedly paid 225 (again don't what they actually paid)

Co-pay = 20 bucks.

Prescriptions costs before Medicare Adv plan = 101.50 mo (purchased monthly out of FIJI, US costs triple of this) - after 65 = 0.

Monthly ins. costs - $2. - I pay 99 a mo for Part B and the Medicare Advantage Co. pays me back $96.40.

I love my HMO Doc. No BS guy. Do this or that will happen type. Cost to go see him? You guessed it. 0. Cost for 4 other referrals and tests ? 0.

Medicare Advantage Co's are PRIVATE INS Co's that take over your health care needs from Medicare. So I am dealing with the PRIVATE SECTOR.

So. Here is my question that nobody seems willing to answer. WHY is there a such HUGE decrepancy in what this test costs nationwide? Same equipment, same pretty girl adminstering it. If you check on the internet, you will see prices from $800 to 4300! ABSURD.

If Toyota ships a car to Jax and somebody drives it to Orlando or Denver, I can see why it might costs more in Denver. If a Pharm Co. makes a drug in India (all of them do for supposedly "tax reasons" ) and then sells it to the VA for $5. and the very SAME DRUG to your ins. co for $65, why the f don't we get the VA price? WHY WHY WHY WTF NOT!!!!! They are all made in the same frickin' plants by the same frickin' people. Try to find a drug made by Americans in the good 'ol US of A. It's developed and sent overseas.

We could save about a TRILLION dollars overnight. How? Pass a law that we pay what the VA PAYS. Of course, you would have to fire 3300 lobbyists who will not allow this to ever happen.

There actually is not a discrepancy. There are charged fees vs. negotiated reimbursements vs. fee scheduled. A physician is supposed to only have 1 fee schedule if you accept Medicare meaning you charge all insurances the same. If you have a private payer that pays $500 for a procedure and Medicare pays $100 you must send all payers a fee of $500. It not and you are audited medicare will penalize you for "discounting" and take x-percent off all your medicare collections.

I am oversimplifying it, but it is because of government regulation that this exists. The government says they will not be discounted, so you have to charge everyone more (or the "same")

[MCXU]

So. Here is my question that nobody seems willing to answer. WHY is there a such HUGE decrepancy in what this test costs nationwide? Same equipment, same pretty girl adminstering it. If you check on the internet, you will see prices from $800 to 4300! ABSURD.



Simple answer: Because there is no TRUE MARKET for Healthcare in the US. In many cases prices are "reached" by that particular offices ability to get Ins. Companies, Medicare, Medicaid etc. to pay in the past.

If Insurance or Medicare etc. pays there is little incentive for me to shop around and get the best price. I get treatment wherever is most convienent for me and let them worry about paying the cost. My deductible is the same no matter where I go. The insurance then negtiates the final payment with the office. Two procedures rarely cost the same price, what is finally paid to the Dr. is determined after the fact in many cases due to haggling between the office and the insurance company etc.

I contend that Health insurance in this country over the past 50 years has transformed from insurance to a prepaid service much like prepaid legal expenses. Insurance should only be used for situations that would bankrupt you. Anything short of that should be paid out of pocket.

If I payout of pocket, I will think twice before going to the emergency room today or deciding this can wait until tomorrow when I see my family Dr.

ER $2000 -
Something simple that my Dr. can do - possibly $250.

Big difference.

Deductible for ER $100,

deductible for family Dr. $25. MEH, I'll go to the ER $75 I can handle and I am uncomfortable now.

This has led to increased costs of medical service and insurance coverage.

If everything medical that you had done except for catastrophic events (events that would bankrupt you) were paid for out of pocket, you would see a true market emerge that would lower the price across the board. More people would "call around" for the best price when possible and it wouldn't take long for reputable Dr. offices that have a resonable price to emerge. People would then choose those offices in emergency situations when shopping around isn't possible.

This is very simplified and many other factors go into rising costs, but I believe this is the bggest factor.

[bobbiemcgee]

When there's is a cost difference of say $3500 for the same procedure, with the same equipment, then, yeah, the system is totally screwed up/broken.

Here's an idea. Fly the guy who needs this test to the $800 site in fl/ga. somewhere, pay him to take a week's vacation while there and fly him back. Savings = 1000/1500.

Or, sponsor drug trips to Mexico, nice bus, entertainment, free beer. Savings to healthcare system. Thousands.

Or, horror of horrors, offer the scripts in America at the same price! Like the VA gets. Duh. The people in Mexico are buying them from the US drug manufacturers in India at a better price, then making a nice business of selling them back to the stupid Americans at a higher price, but much, much lower than they can get in America.

If you get really sick and need heart surgery, free vacation and ticket to Thailand. Savings = hundreds of thousands. We ship out all the drug manufacturing to foreign companies, why not the patients?

My plan will save trillions over the years and everybody will be happy. The "overworked docs" will have plenty of free time and there only complaint is they wish they could stay busy.

Oh, and they might complain their jobs got shipped overseas, but that never seems to be a problem in America.

[bobbiemcgee]

BTW, after about a couple million heart surgieries in Thailand, what do you suppose would happen to the price of the same procedure in the US? It will plummet. Right now, they don't care about charging higher and higher prices, bcuz there is no incentive to lower them. They charge more, the ins co throws a profit margin on top and YOU pay it. What a wonderful business model.

My whole premise is, if you can buy a Volkwagen in Cal. for 20000 or buy one in NY for 90000, would you make the trip?

[stophorseabuse]

You know, ALL of these problems being thrown around is EXACTLY why I support this legislation. This law can be modified and adjusted, but at least there finally IS serious law. Politicians have had decades, but none REALLY CARED. They don't deal with these issues. Politicians care deeply about taxes, because it effects them.

Americans in power dont want for healthcare, but they do want for accumulating cash. I don't blame them, they never have to watch loved ones suffers, they are ignorant to real life. However, a 1% tax increas could cost them thousands or even millions.

For most of us, waiting 2 months for surgery is better than not getting it at all. I am in that boat, those who are not tend to be in a bigger, faster, much more fancy boat.

[LA Muskie]

Okay.... Here is the real question that frustrates me.

Let's chew on this:

1. The money being spent on healthcare is going through the roof
2. Reimbursements from insurance are decreasing greatly (down 20%)
3. Yet, doctors are seeing more patients.
4. Yet, doctors are making much less $$$ (30-40% less)


So... If the money spent on healthcare is going up 200-300%, yet doctors aren't making anymore money, but in fact much less. Where is all the money going? Someone is banking the $$$:

1. Insurance companies?
2. Pharmaceutical companies?
3. Hospitals?
4. HMOs and healthcare organization (Kaiser, Clarian, etc.)
5. Government agencies and departments.?

I think the biggest problem is that medicine is no longer between a physician and his/her patient. There are so many other entities (both private and public) that take there share that it drives costs through the roof.

I charge $50 to a cash patient or $100 if I do a biopsy/procedure. Blue Cross charges over $200 for the same patient. This goes up more for more complex procedures.

This bill is making the system more complex and costly and I don't think it will help.
Did I just hear you advocate for a single payer system?

[kmcrawfo]

Did I just hear you advocate for a single payer system?

Definitely not. I am an advocate for true health insurance and not prepaid healthcare which is what everyone wants.

Healthcare should go back to a cash based economy/product and people have their own policies for coverage. Just like auto insurance, home insurance, etc. You pay the doctor and if you have a policy that covers that condition/visit submit you claim.

This causes direct consumer and provider knowledge of costs, expense, etc. An educated decision can be made to purchase/not purchase/seek less expensive options/etc.

You are supposed to buy insurance and hope you never need to use it. In reality, health insurance is just prepaid healthcare which is why is so expensive. People purchase it with intent to use.

With no insurance and reduced overhead I could see a patient for around a flat $50 charge. Inexpensive, generic drugs exist to treat 95% of medical conditions.

Our insurance/healthcare system artificially inflates everything. This bill only makes it worse and will make things much more expensive.

I really don't think the people posting on here in favor the bill really understand what is in it. Heck, the people who voted for it admit to no knowing what is in it.

This is a bad deal... It will not provide what everyone on here is saying/hoping it will.

Be prepared

[bobbiemcgee]

This causes direct consumer and provider knowledge of costs, expense, etc. An educated decision can be made to purchase/not purchase/seek less expensive options/etc.


This would be great, but the insurance lobby would never go fot it. Why would they? They have all the cards now. 1. Bitch about healthcare costs. 2. Do nothing about them. 3. Charge more to the consumers, couple more percent profit for them, rest to cover the rising costs. 4. Repeat. 3300 lobbyists keep it that way.
And do you ever think they will cover a pre-existing "illness"? Forgeddaboutit.

[DC Muskie]

I really don't think the people posting on here in favor the bill really understand what is in it. Heck, the people who voted for it admit to no knowing what is in it.

I don't know about you, but I am sure glad Dr. Kevin is the incredibly small minority who understands this bill. Thank God he is here to explain it to the rest of us.

It's too bad that this bill will most likely cause him to leave medicine.

[ArizonaXUGrad]

This causes direct consumer and provider knowledge of costs, expense, etc. An educated decision can be made to purchase/not purchase/seek less expensive options/etc.

You are supposed to buy insurance and hope you never need to use it. In reality, health insurance is just prepaid healthcare which is why is so expensive. People purchase it with intent to use.

Although, I certainly believe what you say. The European born part of me believes that healthcare/insurance whatever you want to call it should never have to be shopped around. The big difference between auto/home insurance and health insurance is that most of us may never have to deal with auto/home insurance. We float through life accident free.

However, a vast percentage of us have to deal with heath insurance. When you need it, you should never have to shop around for services to find the best price.

The US system fails for one simple reason....greed. Greedy doctors and greedy Insurance providors.

[XU 87]

I don't know about you, but I am sure glad Dr. Kevin is the incredibly small minority who understands this bill. Thank God he is here to explain it to the rest of us.



Based on what he has written, and because he's actually in the business, he does know more than you (and me) and just about everyone else about this bill and the effects it will have.

It's not a secret that the democrats who voted for this bill had no idea what was in it. Nancy Pelosi admitted as much.

He said that the current system drives up costs. He says Obamacare will make things worse. Instead of attacking Crawford, prove him wrong.

P.S. I've tried but have failed to get rid of the dumb "angry face" up top.

[XU 87]

The US system fails for one simple reason....greed. Greedy doctors and greedy Insurance providors.

So I suppose we should get rid of all other private industries (steel, cars, airlines, hotels, chemicals, entertainment etc, etc) since they are all based on greed- the desire to earn money. After that, get rid of all those greedy pharmaceutical companies and medical device companies. The government will do a much better job developing these products.

Let's get rid of all private industry. The old Soviet Union tried that and it worked out really well.

[RealDeal]

greed- the desire to earn money.

I don't think that is the correct definition.

[XUOWNSUC]

Greedy doctors

That is a bunch of bull crap.

My wife is a physician. She went to Xavier and studied hard for 4 YEARS so that she could get the required grades necessary to get into medical school. She certainly didn't have the typical (or what people think of as typical) college experience of partying, drinking, etc. Once in medical school, she studied hard for ANOTHER 4 YEARS to earn her medical degree. After obtaining her MD, she was $130,000+ in debt due to her educational loans. She then went into residency for ANOTHER 3 YEARS for her training. During residency, she worked 60 to 80 hours per week and made roughly $39,000 per year during residency. After residency she decided to specialize and did a fellowship for ANOTHER 3 YEARS - 60-80 hours per week for $40 to 45K per year. After her fellowship, she was then able to go out and pursue "real" job.

So let's sum things up:

14 years of education (all post high school) and study (working her ass off while having little or no social life)
$130,000+ debt (student loans)
60-80 hour work weeks while being paid little (no overtime here folks)

That's one reason why there is such a shortage of PCP in this country. Why anybody would want to go through that if there isn't a nice reward at the end?

Don't you think somebody that has worked so hard for so long deserves a decent salary? Please.

I haven't even got into what she deals with as a doctor day to day. For example, people read WebMD and automatically think they are experts on a particular medical topic and question her every move like she is trying to kill them or make an insane profit over them. There is a reason why she studied 14+ years (post high school). Don't get me wrong - people should absolutely have questions about their health care and related costs - but the length that a lot of them take it to would surprise a lot of you.

kmcrawfo is right - somebody is making a ton of money from the health care system - but it isn't the doctors - I can assure you that.

For some reason everybody bitches about what doctors make but they barely complain about what CEOs make (or rather do anything about it). I'm sorry but no CEO is worth $10 million+ a year. Hell, cut their salary in half and you could provide 100 $50,000 paying jobs.

[LA Muskie]

I am an advocate for true health insurance and not prepaid healthcare which is what everyone wants.

Healthcare should go back to a cash based economy/product and people have their own policies for coverage. Just like auto insurance, home insurance, etc. You pay the doctor and if you have a policy that covers that condition/visit submit you claim.
...

This is a bad deal... It will not provide what everyone on here is saying/hoping it will.

Be prepared
So healthcare should be like cars and iPhones -- you can have it if you can afford it; if not, you are SOL. As we prepare to celebrate our independence, that's the America I endear.

I'm sorry, but the notion that healthcare (or healthcare insurance, if you prefer) is comparable to -- and should be operated like -- other market segments is one of the most inhumane concepts that politicians have ever spun. I will never understand how conservatives can support the spending of billions (if not trillions) of dollars trying to save banks, auto makers and unborn children, but let the poor living perish.

[UCGRAD4X]

I'm sorry, but the notion that healthcare (or healthcare insurance, if you prefer) is comparable to -- and should be operated like -- other market segments is one of the most inhumane concepts that politicians have ever spun. I will never understand how conservatives can support the spending of billions (if not trillions) of dollars trying to save banks, auto makers and unborn children, but let the poor living perish.

I'm not sure where you get the notion that conservatives support bailing out the banks and auto industry - some Republicans may have but they are less conservative and more RINO. I'm also not sure how we are spending billions (if not trillions) on unborn children. I think we are spending a whole lot more getting rid of the unborn than allowing them to fulfill their God-given and constitutional right to life, liberty and the pursuit of happiness.

[DC Muskie]

Based on what he has written, and because he's actually in the business, he does know more than you (and me) and just about everyone else about this bill and the effects it will have.

He can certainly have an opinion. But the pedantic (my new favorite word) manner in which he demonstrates that opinion is a bit grating.

You happen to agree with him, so it probably doesn't grate you at all.




It's not a secret that the democrats who voted for this bill had no idea what was in it. Nancy Pelosi admitted as much.

Where do you get this?



He said that the current system drives up costs. He says Obamacare will make things worse. Instead of attacking Crawford, prove him wrong.

Come on you know me better than that. If I was attacking him, I'd get real personal and say things like. Kevin is a skin doctor, not a real one. Or for a guy who hates Medicaid, he even admits he tolerates it because he feels it the right thing to do.

I'm never going to "prove him wrong" since it's just opinions.

But here are some links from other professionals who disagree with him...

http://npalliance.org/wp-content/uploads/NPA-ACA.Quick_.Guide_.for_.Physicians.041311.pdf

http://www.amsa.org/AMSA/Homepage/About/News/062812.aspx

http://www.cleveland.com/opinion/index.ssf/2012/06/why_cleveland-area_doctors_sup.html

http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Commends-Supreme-Court-Decision-to-Uphold-the-Affordable-Care-Act.aspx

http://www.medpagetoday.com/Washington-Watch/Reform/33563

[DC Muskie]

I'm not sure where you get the notion that conservatives support bailing out the banks and auto industry - some Republicans may have but they are less conservative and more RINO.

I love the term "RINO." Tossed out there when people don't like it when a Republican votes for something they hate.

Here's a list of Republicans who voted for TARP. They are now RINO's.

In the House...one big name...

Paul Ryan

In the Senate, I'll just highlight the RINO's...

Chambliss
Coburn
Cornyn
Craig
Ensign
Graham
Grassley
Hatch
Kyl
McCain
McConnell
Stevens
Thune
Warner

Here's the rest of the list. (http://www.rinolist.org/2010/08/list-of-republicans-who-voted-for-tarp/)..

[bjf123]

Couple of things. First, regarding "greedy" doctors. My wife used to work for an orthopedic practice. The doctor who did their back surgeries paid over $150,000 PER YEAR for his malpractice insurance. He'd never had a malpractice claim filed against him. This was a number years ago. I'm sure that cost has gone up since then.

Second, regarding the variances in pricing. One big reason is how hospitals negotiate their rates with the insurance companies. Let's say hospital A just built a brand new, state of the art, maternity ward. They need to recover those costs, so they'll want a much higher rate for procedures there to show the board of trustees that all that money spent was worthwhile. If the same hospital has an older cardiac care unit, they'll discount the heck out of that. The insurance companies only want to have an overall discount rate with the hospital of X. How they get there is not that important.

A friend recently needed an MRI. Through our insurance company's web site, we could search for providers and their approximate cost. Since it was a high deductible plan, she wanted the lowest price since it would be out of pocket. The prices ranged from $400 to almost $2000 for the same procedure. That's just plain nuts.


Sent from my iPhone using Tapatalk

[bobbiemcgee]

That is a bunch of bull crap.
For some reason everybody bitches about what doctors make but they barely complain about what CEOs make (or rather do anything about it). I'm sorry but no CEO is worth $10 million+ a year. Hell, cut their salary in half and you could provide 100 $50,000 paying jobs.

No, it's not the Docs. Getting screwed like everyone else. GSK just paid 3 BILLION Dollars in damages and pled guilty to FRAUD, not the usual "admits to no wrongdoing" BS, they pled absolutely 100% guilty. What happened to the perps? Nothing. They are all living it up in their beachfront mansions with the enormous payouts from the fraud. WTF aren't they in jail and stripped of all assets? "Different times" the CEO sez. What a frickin' corrupt moron. He can't wait to get his piece.

These fraud's will continue until they put away a few ceo's for fraud for maybe 10+ yrs. and take all the money back. In China, they may have got a bullet in the head.

One company. 3 frickin' billion in fraud. Nothing happens to those responsible. Unfrickin' believable. Keep buying our drugs, suckers.

[bobbiemcgee]

A friend recently needed an MRI. Through our insurance company's web site, we could search for providers and their approximate cost. Since it was a high deductible plan, she wanted the lowest price since it would be out of pocket. The prices ranged from $400 to almost $2000 for the same procedure. That's just plain nuts.


Exactly my point. WHY? Are there illegal aliens giving the $400 MRI? Why can someone charge 500% more for the same frickin' test. It is NUTS!

And pls. lose the "negotiated" contract bs. Negotiate better!!!!!! You are a terrible negotiator if you pay 90 grand for a VW!!!!

[boozehound]

For some reason everybody bitches about what doctors make but they barely complain about what CEOs make (or rather do anything about it). I'm sorry but no CEO is worth $10 million+ a year. Hell, cut their salary in half and you could provide 100 $50,000 paying jobs.

People rarely complain about what CEO's make? What America have you been living in?

[XUOWNSUC]

People rarely complain about what CEO's make? What America have you been living in?

It's pretty disproportionate to how often people complain about doctor salaries. Everytime yahoo puts up a freakin top salaried jobs article, doctors lead the way. Or, how often do you hear a comment about "rich" doctors and the cars they drive?

Edit: Here's a yahoo.com article that was JUST POSTED TODAY:

http://finance.yahoo.com/news/highest-paying-jobs-in-the-u-s-.html

Any guess to who leads the way?

I realize there has been a debate about CEOs recently. I'm not stupid.

[GoMuskies]

Alan Mullaly is worth whatever Ford is paying him, I promise you that. That's all I have to add.

[GuyFawkes38]

For some reason everybody bitches about what doctors make but they barely complain about what CEOs make (or rather do anything about it). I'm sorry but no CEO is worth $10 million+ a year. Hell, cut their salary in half and you could provide 100 $50,000 paying jobs.

yikes.

You might disagree with those critiquing physician salaries. But your not really addressing their primary arguments. Physician salaries, on average, are much higher in the US than other countries and that is, in part, contributing to the high expense of health care in the US. Reducing physician salaries would require a system set up to make it easier to become a physician, which might reduce the quality of your average physcian. But that's a risk many are willing to make to lower costs.

In contrast, most major corporations in the US have large profits, despite the sluggish economy, and can easily afford paying their CEO’s multimillion dollar salaries, for better or for worse.

[UCGRAD4X]

I love the term "RINO." Tossed out there when people don't like it when a Republican votes for something they hate.

Here's a list of Republicans who voted for TARP. They are now RINO's.

In the House...one big name...

Paul Ryan

In the Senate, I'll just highlight the RINO's...

Chambliss
Coburn
Cornyn
Craig
Ensign
Graham
Grassley
Hatch
Kyl
McCain
McConnell
Stevens
Thune
Warner

Here's the rest of the list. (http://www.rinolist.org/2010/08/list-of-republicans-who-voted-for-tarp/)..

I think the original statement referring to something akin to "all you conservatives" not necessarily the political idiots in washington.

In any case, voting for TARP was not a "conservative" move.
GW was not a "conservative"
Three senators and zero house members voted for the stimulus.

The most recent midterm elections informed many of those RINOs to come to their senses by demonstrating what conservatives among the electorate stand for.

That was my point.

[kmcrawfo]

yikes.

You might disagree with those critiquing physician salaries. But your not really addressing their primary arguments. Physician salaries, on average, are much higher in the US than other countries and that is, in part, contributing to the high expense of health care in the US. Reducing physician salaries would require a system set up to make it easier to become a physician, which might reduce the quality of your average physcian. But that's a risk many are willing to make to lower costs.

In contrast, most major corporations in the US have large profits, despite the sluggish economy, and can easily afford paying their CEO’s multimillion dollar salaries, for better or for worse.

Wow... So the average salaries of these docs:

Pediatrics: $135,000
Family Practice: $140, 000
Internal medicine: $154,000

How on earth are these people overpaid?

More importantly there are 209,000 of these physicians in the United States. So... why don't you just cut the salaries in half and make them all earn the same as accountants and less than engineers.

That would saved $14,630,000,000 per year. (less than that actually since a large percentage of income may come from cash payers, elective/cosmetic procedures, and private insurance).

The annual healthcare budget is $882,000,000,000.

For the sake of debate lets say somehow through cuts to all physicians you are able to save 14 billion per year from the healthcare budget for cutting physician reimbursement. So, your plan would save a whopping 1.65% from federal healthcare spending. Additionally, no one can live off of $75,000 per year and pay back the average medical school debt of $142,000 (that does not include undergrad debt, just medical school). So, to make your plan work the government would have to subsidize medical school. Oops... there goes most of the 14 billion in savings.

That would be brilliant move to:
1. have no impact on the costs of healthcare what-so-ever
2. Disincentive people from going into medicine even more
3. Thereby actually decreasing the quantity and quality of docs.

Physician salaries/earning have essentially zero impact on the cost of healthcare. The majority of the $882,000,000,000 is being wasted by the government, pocketed by beurocrats/politicians/government workers, earned by medical device/pharma companies, etc.

I don't know how/why thoughts like this are even enternained or where they come from. For the ammount of time, education, work hours, liability, etc. Physicians are underpaid when compared to other professions. Physicians deserve every penny they make and most should probably be making more.

[kmcrawfo]

Wow... So the average salaries of these docs:

Pediatrics: $135,000
Family Practice: $140, 000
Internal medicine: $154,000

How on earth are these people overpaid?

More importantly there are 209,000 of these physicians in the United States. So... why don't you just cut the salaries in half and make them all earn the same as accountants and less than engineers.

That would saved $14,630,000,000 per year. (less than that actually since a large percentage of income may come from cash payers, elective/cosmetic procedures, and private insurance).

The annual healthcare budget is $882,000,000,000.

For the sake of debate lets say somehow through cuts to all physicians you are able to save 14 billion per year from the healthcare budget for cutting physician reimbursement. So, your plan would save a whopping 1.65% from federal healthcare spending. Additionally, no one can live off of $75,000 per year and pay back the average medical school debt of $142,000 (that does not include undergrad debt, just medical school). So, to make your plan work the government would have to subsidize medical school. Oops... there goes most of the 14 billion in savings.

That would be brilliant move to:
1. have no impact on the costs of healthcare what-so-ever
2. Disincentive people from going into medicine even more
3. Thereby actually decreasing the quantity and quality of docs.

Physician salaries/earning have essentially zero impact on the cost of healthcare. The majority of the $882,000,000,000 is being wasted by the government, pocketed by beurocrats/politicians/government workers, earned by medical device/pharma companies, etc.

I don't know how/why thoughts like this are even enternained or where they come from. For the ammount of time, education, work hours, liability, etc. Physicians are underpaid when compared to other professions. Physicians deserve every penny they make and most should probably be making more.

Better yet... Let's have all doctors work for free and not get paid at all. That would save us whopping $30 billion, maybe even $60 or $70 billion.

Wow... even docs for free would still not even touch 10% of healthcare costs.

[GuyFawkes38]

You might not agree with it. But it's very reasonable in the next 50 years to increase the supply of docs to meet the demands of an aging population and to keep salaries under control or even reduced.

Cost cutting. It's going to have to happen.

[kmcrawfo]

You might not agree with it. But it's very reasonable in the next 50 years to increase the supply of docs to meet the demands of an aging population and to keep salaries under control or even reduced.

Cost cutting. It's going to have to happen.

You miss the point. The problem is not the $$$ docs make. Look at the numbers and what is going on in the world. Do a google search on doctors striking in Europe, etc. and their healthcare systems are still going bankrupt.

How can you really save money?

Well... people need to first ask the question of what they really want:
1. Universal Healthcare

or

2. Decrease in Healthcare costs/spending.

You cannot get both. It is not possible. Period.

If you want universal healthcare, which is what the current law entails then this will happen:
1. Decrease access to care
2. Decrease access to elective procedures (hip replacements, knee replacements, rotator cuff surgery). These won't kill you, so you don't really need them.
3. Decreased access to expensive/new drugs (cost too much)
4. Despite the basic level of care to all, overall quality of care goes down.
5. Despite overall quality of care going down, costs go way up...

This is the European model.

If you want to decrease costs of healthcare you must:
1. Decrease the number of people receiving it by increasing medicare age to 67 or 70 and making it harder to qualify for medicaid. (oposite of Obamacare).
2. Increase the costshare of medicare to 25% (rather than 20%)
3. Increase the medicare deductible to $1000 (rather than $250)
4. Pass tort reform controlling law suits
5. Remove some of the burdening regulations that exist on docs in terms of documentation, paperwork, costs, etc. These are extremely expensive (My overhead to just keep my doors open was over $700,000 in 2011. This is for a single provider office).

People would scream bloody murder for this.

But... The fact is you can not get both. You can not increase access to care and cut costs. It is not possible. Also, we do not have the resources to give universal care even if the new law is now demanding it.

People need to wake up and see the reality of limited resources, etc.

As much as I would like to provide state or the art healthcare to everyone it the country, it can not happen. No possible no matter how much our hearts demand it.

[GuyFawkes38]

If you want universal healthcare, which is what the current law entails then this will happen:
1. Decrease access to care
2. Decrease access to elective procedures (hip replacements, knee replacements, rotator cuff surgery). These won't kill you, so you don't really need them.
3. Decreased access to expensive/new drugs (cost too much)
4. Despite the basic level of care to all, overall quality of care goes down.
5. Despite overall quality of care going down, costs go way up...

This is the European model.

That's sounds like the British public health care system (NHS). Yes, provide a safety net for all Americans like that.

I've never been to a hospital in Britain. So maybe my view would change if I did. But I like the idea behind it. The British government offers every one (poor and rich) a workable but admittedly cheap health care safety net. They run on a strict budget. Yes, they often have to deny care. But it its, after all, a safety net.

Unlike in Canada, if anyone does want to spend additional cash on their health care in Britain, they are free to do so. Outside of the crude safety net, people have the freedom to spend as much money on their health care as they want. If they don't trust the public system, they work hard and save and can splurge on the private system.

[stophorseabuse]

I think doctors should make a great deal of money. However, lots of professionals are taking paycupts annually, and for years now. My income is going down substantially, and cost of living is skyrocketing. I don't have a problem with docs making more than me, but I sure wish they would have to deal with the types of cuts we are.

I simply wish it was government run, just like education. Like education, I see healthcare as a fundamental right. I do think docs should be public employees, or at least got the option of having student loans forgiven to be a public employee.

In NOOO way do I think dr. Competence is a major problem with all this, it is just more class warfare.

[kmcrawfo]

That's sounds like the British public health care system (NHS). Yes, provide a safety net for all Americans like that.

I've never been to a hospital in Britain. So maybe my view would change if I did. But I like the idea behind it. The British government offers every one (poor and rich) a workable but admittedly cheap health care safety net. They run on a strict budget. Yes, they often have to deny care. But it its, after all, a safety net.

Unlike in Canada, if anyone does want to spend additional cash on their health care in Britain, they are free to do so. Outside of the crude safety net, people have the freedom to spend as much money on their health care as they want. If they don't trust the public system, they work hard and save and can splurge on the private system.

The problem is the british system in bankrupt and unsustainable. Thanks to Brian Day, the Canadian system also has a private sector now, which is flourishing, while the government run system also is bankrupt and unsustainable.

You end up with a 2 class system. The extremely wealthy will get pristine care; everyone else, a much lower standard than what we have in the US today.

Canada, Great Britain, Germany, and other countries are trying to back-track from the socialized/goverment run model. The problem is once it is implemented in society it is extremely difficult to remove.

I don't understand why our country is going down a path that other countries are now trying to reverse as it has proven an unsustainable, economic disaster in every single situation it has every been implemented.

[X Factor]

I simply wish it was government run, just like education. Like education, I see healthcare as a fundamental right. I do think docs should be public employees, or at least got the option of having student loans forgiven to be a public employee.

Yeah, because our public government run education system is so wonderful. I'm talking about the institution, not every individual teacher.

Doctors public employees? Wow.

Why doesn't the government just make everyone a public employee? That way everyone would have a job and the government can take care of everyone.

kmcrawfo has been spot on this entire thread.

edit: I hate talking politics on here. I love talking Xavier basketball with a bunch of other Xavier basketball fans. That's what unites us here.

[kmcrawfo]

I think doctors should make a great deal of money. However, lots of professionals are taking paycupts annually, and for years now. My income is going down substantially, and cost of living is skyrocketing. I don't have a problem with docs making more than me, but I sure wish they would have to deal with the types of cuts we are.

I simply wish it was government run, just like education. Like education, I see healthcare as a fundamental right. I do think docs should be public employees, or at least got the option of having student loans forgiven to be a public employee.

In NOOO way do I think dr. Competence is a major problem with all this, it is just more class warfare.

Do you not realize that doctors have taken huge cuts in pay already during last decade?

The implementation of Multiple Reduction Rules and Bundling resulted in a 40-50% cut in resimbursements. Mohs surgery took a reduction exemption hit 3 years ago which was another 30% hit. Reimbursments decreased by 4% in 2012. Numerous surgeries are expected to be cut about 20-30% in 2013.

Despite this, medmal rates go up, staff continue to expect raises/benefits, costs of medical equipment and supplies are going up.

Doctors continue to get kicked in the groin in terms of cuts in salary more than any other profession in this country. They just started out at a higher base and could absorb these cuts thus far.

However, we are now at a breaking point. It is simply not possible to absorb any more cuts and still provide good care. Why on earth would I go through all the training/15 years post high school education/100 hours of work per week/debt/liability/etc to make $100,000. I can make more than that being an engineer, businessman, or taking a faculty position at a local university.

I know some pediatricians that already make less than 100k. A couple have quit and gone to work for labs/pharma companies to make the same/more salaries but only work a 9-5 job with no risk of being sued.

[XUOWNSUC]

Do you not realize that doctors have taken huge cuts in pay already during last decade?

The implementation of Multiple Reduction Rules and Bundling resulted in a 40-50% cut in resimbursements. Mohs surgery took a reduction exemption hit 3 years ago which was another 30% hit. Reimbursments decreased by 4% in 2012. Numerous surgeries are expected to be cut about 20-30% in 2013.

Despite this, medmal rates go up, staff continue to expect raises/benefits, costs of medical equipment and supplies are going up.

Doctors continue to get kicked in the groin in terms of cuts in salary more than any other profession in this country. They just started out at a higher base and could absorb these cuts thus far.

However, we are now at a breaking point. It is simply not possible to absorb any more cuts and still provide good care. Why on earth would I go through all the training/15 years post high school education/100 hours of work per week/debt/liability/etc to make $100,000. I can make more than that being an engineer, businessman, or taking a faculty position at a local university.

I know some pediatricians that already make less than 100k. A couple have quit and gone to work for labs/pharma companies to make the same/more salaries but only work a 9-5 job with no risk of being sued.

Spot on correct - again.

[stophorseabuse]

Guys, I don't doubt many of you won't get much out public insurance. But I am real close to buying street drugs to avoid high costs. I can do that for me, I can't do it for my kid.

I am Just low middle class enough to not have 1200/mo to afford getting protected from death, but to middle class to get welfare assistance.

In my position average healthcare is better than none. Just like average education systems are better than none. If education wasn't over half the kids in this country would have zero education.

Making me wait 2 months to be seen is better than never being seen at all.

Again, people homeschool. I want the right to home med. most docs I have seen look symptoms up in booklet then write a script based on their cheat sheets. I can do that shit, and I would be happy.

[stophorseabuse]

My healthcare is held hostage by drug laws. If I HAVE to go to the doctor for access to medicine, I am essentially being forced to go. If I can have access to getting my own Xanax and the other stuff I need, I would NOT demand affordable healthcare. As long as my well being is held hostage by regulation, I am going to demand access to see those doctors.

[stophorseabuse]

And I too want to say I love this board for hoops. I also don't mind it for politics. It's just politics, no one should ever be getting butthurt over this. I certainly wouldn't hold you guys in some regard based on your political beliefs. A low socio-economic guy like myself will always have different interests from those making 4 times me. It doesn't mean we don't all love X, just where we view them from.

I am not ashamed to be poor, but I have to fight for my families well being.

[joebba]

Sorry, but part of the problem is that everyone thinks all dotors are super wealthy. 150k-200k salary is not outragous for someone who has gone to school several years beyond undergraduate studies, gone through the toture or residency training and is srtapped with huge debt for their education. You take away the finacial incentive you will degrade the pool of medical candidates. As it is now more and more are shying away for medicine for all the bs insurance companies and medicare do to ditacte what physicians can charge for their services.

[stophorseabuse]

Sorry, but part of the problem is that everyone thinks all dotors are super wealthy. 150k-200k salary is not outragous for someone who has gone to school several years beyond undergraduate studies, gone through the toture or residency training and is srtapped with huge debt for their education. You take away the finacial incentive you will degrade the pool of medical candidates. As it is now more and more are shying away for medicine for all the bs insurance companies and medicare do to ditacte what physicians can carge for their services.

I don't think they make too much.

I just want the right to home med myself, just like homeschool.

Give me access to a computer and a scrip. Pad and I will handle 90% of my medical Needs.

If there was ever something I wouldn't try myself, I could then pay the professional doctor to do it.

[Snipe]

I simply wish it was government run, just like education. Like education, I see healthcare as a fundamental right. I do think docs should be public employees, or at least got the option of having student loans forgiven to be a public employee.



I wish George Bush was in charge of my health care. What a great idea. After the great things that government has done with government schools and government housing, I can't wait for government health care.

You see healthcare as a fundamental right. So does every emergency room, because they never turn anyone away.

If healthcare is a right, then we have several other rights. In Maslow's hierarchy of needs, food and shelter are the first on the list. If you think everyone should have healthcare, then everyone should be given a home and free food. We already do much of that.

But we do pay a price for it. The Welfare State since the 60s has basically spent the same equivalent amount of our national debt. And giving money to the poor surprisingly doesn't decrease poverty, though it does give us a stunningly obese number of poor children.

More people are dependent on the government today than at any time in our nation's history.

In Greece it didn't last forever. If it doesn't last forever here, than the next big thing is going to be spectacular. To put it in the terms well liked by my progressive friends, our system is unsustainable.

I have a theory. "Things that can't go on forever, don't."

[Snipe]

The Fascist party in Greece has won gains unthought of just a few years or even a couple of decades ago.

One of the radical things that people have proposed is dragging immigrants out of hospitals.

Think about that here. It would never happen. You can't drag a free-loader out of a hospital just because they are a free-loader. In fact, in our system, you are a bigot if you call them a free-loader. Not kidding.

But in Greece, things are tight. Medication is now scarce, and that has never happened. They have a genuine shortage, and it won't break soon. In a shortage, some people get medication, and some people don't because resources are scares. It isn't just that this immigrant is taking medication that costs the state, it is the fact that the immigrant is getting health care and perhaps your father or grandmother can no longer get the meds that they need. To some it is seen as a zero-sum game, where giving to one means that the other has to go to bed hungry.

In economics, they have two concepts called Scarcity and Opportunity Cost. Scarcity is upfront and explicit. Resources are scarce. They are not unlimited. Opportunity Cost chimes in with Scarcity to tell you that if you choose one course of action, than the real cost of that isn't dollars or debt. The real cost is what you could have done with those same resources. You don't have unlimited resources. What you choose has consequences.

Five or Ten years ago nobody could win political seats in Greece by talking about dragging immigrants out of hospitals and deporting them.

Overton Window

Joseph Overton was an economist at the Mackinac Center for Public Policy. He came up with a theory that is now attributed to him.

Her is the wiki:



At any given moment, the “window” includes a range of policies considered to be politically acceptable in the current climate of public opinion, which a politician can recommend without being considered too “extreme” or outside the mainstream to gain or keep public office. Overton arranged the spectrum on a vertical axis of “more free” and “less free” in regard to government intervention. When the window moves or expands, ideas can accordingly become more or less politically acceptable. The degrees of acceptance[3] of public ideas can be described roughly as:


Unthinkable
Radical
Acceptable
Sensible
Popular
Policy


The Overton Window is a means of visualizing which ideas define that range of acceptance by where they fall in it. Proponents of policies outside the window seek to persuade or educate the public so that the window either “moves” or expands to encompass them. Opponents of current policies, or similar ones currently within the window, likewise seek to convince people that these should be considered unacceptable.

It appears that the Overton Window in Greece has shifted, and that it has shifted quite rapidly. Now they are electing politicians from a party that advocates dragging immigrants out of hospital rooms and deporting them from the country. Many people would think this is just the flaw of those swarthy Greeks (they do have many flaws, but I don't think that is one of them).

If your Mom or Dad could no longer get medication, or if your nanna or gramps couldn't get their meds, and you knew that immigrants were still accessing the system, the same thing would happen here. Things that were unthinkable in polite society become speakable policy for politics in an instant. Economic collapse produces a sea change in the Overton Window.

Questions:

So what does our new Obamacare plan do for illegal immigrants, or even legal immigrants? 75% of first generation Mexican immigrants are on at least one welfare program. The get right on the dole, and you aren't allowed to complain about it, because that is racist. You are probably racist just for reading this.

The great cost savings from Obamacare come partly from making everyone insured. But we are not insuring illegals (or are we?). They will still just walk right up to the emergency room and get free health care.

From what I have heard, anyone Hispanic can walk right up and get free emergency health care and say that they are an undocumented immigrant. Because they are undocumented, they don't have to show any papers. You can do that right here at Christ Hospital in Cincinnati, but not if you are White. They would laugh at you if you were White.

I think that our government ran out of money years ago, and nobody realized it. Obamacare is going to put 30 million more people on the rolls by their own projections. I can't see how this all ends well. I can't see how costs come down. I think that costs will go up, and we couldn't afford the system that we already had. At some point the system will break.

And then some people will see the wisdom of the Greek Fascists. I am not advocating dragging immigrants out of hospitals to deport them, but I can see a future where that could be a popular notion. Nothing lasts forever, and our current delusions of spending and more spending will one day be broken by reality. So enjoy your government health care while you have it, and get ready for the next big thing.

[DC Muskie]

Do you not realize that doctors have taken huge cuts in pay already during last decade?

The implementation of Multiple Reduction Rules and Bundling resulted in a 40-50% cut in resimbursements. Mohs surgery took a reduction exemption hit 3 years ago which was another 30% hit. Reimbursments decreased by 4% in 2012. Numerous surgeries are expected to be cut about 20-30% in 2013.

Despite this, medmal rates go up, staff continue to expect raises/benefits, costs of medical equipment and supplies are going up.

Doctors continue to get kicked in the groin in terms of cuts in salary more than any other profession in this country. They just started out at a higher base and could absorb these cuts thus far.

However, we are now at a breaking point. It is simply not possible to absorb any more cuts and still provide good care. Why on earth would I go through all the training/15 years post high school education/100 hours of work per week/debt/liability/etc to make $100,000. I can make more than that being an engineer, businessman, or taking a faculty position at a local university.

I'm just curious where do you get your information from about decreasing salary numbers for the past decade?

According to a medscape survey in 2011 out of the 150,000 doctors they questioned, 27% said they saw an increase in pay from 2009 vs 2010.

Over 50% said their salary stayed the same.

In the same survey over 50% in both specialty and primary care felt they were compensated fairly.

Anyway, it sucks that the the process of being a doctor is so difficult and I mean that. I have a sister who is a nurse, and I have no earthly idea why anyone does it.

It's too bad that it looks like you will be leaving medicine and I think at the end of the day, that's not a good thing.

[UCGRAD4X]

My healthcare is held hostage by drug laws. As long as my well being is held hostage by regulation, I am going to demand access to see those doctors.

And you think this new law is going to make all that go away?

Have you seen the bill?

Of course not, no one has, but you have seen the size of it.

Little by little we are earning about the tidal wave of new regulations, restrictions and costs.

We are also hearing about who will be allowed to bypass the regulations.

News flash: It won't be the tweeners like us.

[kmcrawfo]

I'm just curious where do you get your information from about decreasing salary numbers for the past decade?

According to a medscape survey in 2011 out of the 150,000 doctors they questioned, 27% said they saw an increase in pay from 2009 vs 2010.

Over 50% said their salary stayed the same.

In the same survey over 50% in both specialty and primary care felt they were compensated fairly.

Anyway, it sucks that the the process of being a doctor is so difficult and I mean that. I have a sister who is a nurse, and I have no earthly idea why anyone does it.

It's too bad that it looks like you will be leaving medicine and I think at the end of the day, that's not a good thing.

Muskie, I typically ignore your posts because, quite frankly, you come across as a demeaning, classless jerk. Your endless disrespect and sarcasm get a little old.

However, you can do a little real research and see that for the exact reasons I have already given you doctor's reimbursements have taken huge cuts.

Why do their actual earning stay the same or go up slightly? It is because contrary to popular belief most docs are actually very good businessmen and are very smart.

To make things very simple, you do the following:
1. Stop taking Medicaid and low paying insurances (hurts access)
2. Do more cash/elective proceedures (hurts access)
3. See more patients and give each patient less time and less care
4. Perform clinical trials to supplement income
5. Fire employees or cut benefits
6. Several other things.

The problem is these avenues are pretty much maxed out now. Not much more wiggle room.

Also, those compensation reviews are extremely inaccurate. They basically send a letter/email to a bunch of docs and ask them to disclose financial numbers. Few actually response, few give accurate data, and and large percentage that do respond are in academic/HMO type healthcare groups which for various reasons earnings are affected differently by cuts. These groups are based more on salary than actual earnings. The profit margins of these groups are shrinking, but they are buffered by various other fees and often self contained insurance policies, labs, etc.

By the way, please quit putting words in my mouth. I have not intention of changing professions anytime soon. I know of many who have recently and will shortly, however.

[Xavier Bluehairs]

Don't you get it kmcraw? DC Muskie is brilliant. He knows big people in the non-profit sectior in DC. He is so important that he spends hours upon hours on a basketball chatboard debating health care.

[boozehound]

My healthcare is held hostage by drug laws. If I HAVE to go to the doctor for access to medicine, I am essentially being forced to go. If I can have access to getting my own Xanax and the other stuff I need, I would NOT demand affordable healthcare. As long as my well being is held hostage by regulation, I am going to demand access to see those doctors.


I don't think they make too much.

I just want the right to home med myself, just like homeschool.

Give me access to a computer and a scrip. Pad and I will handle 90% of my medical Needs.

If there was ever something I wouldn't try myself, I could then pay the professional doctor to do it.

Seriously? You want them to just turn people loose with a computer and a prescription pad? Half of this country would be on drugs unnecessarily and the other half would be abusing opiates recreationally. Not to mention that there are numerous public health risks to over-medication. One such example would be people over-using antibiotics to treat minor illnesses which results in drug-resistant 'super bugs'. I would consider myself to be fairly libertarian, but I think that is crazy.


Sorry, but part of the problem is that everyone thinks all dotors are super wealthy. 150k-200k salary is not outragous for someone who has gone to school several years beyond undergraduate studies, gone through the toture or residency training and is srtapped with huge debt for their education. You take away the finacial incentive you will degrade the pool of medical candidates. As it is now more and more are shying away for medicine for all the bs insurance companies and medicare do to ditacte what physicians can charge for their services.

I agree with this wholeheartedly. I was surprised at how low the average Doctor salaries posted were, particularly when you consider the amount of debt that many people graduate from medical school with. $150K isn't a lot of money when you have $250K in student loans to pay on. $150K is a good salary, but many people is business and other fields earn that kind of money and don't have endure anywhere near the amount of schooling doctors do.

The thing is that $150K does seem like a crapload of money to guys making $40K-$50K per year though, which makes it easy to demonize doctors as being overpaid. The guys making $45K and complaining about doctor (and CEO) salaries couldn't do their jobs for even a day, but that doesn't stop them from complaining.

[blueblob06]

If you have $250K in debt and make $150K/yr, you can get out of debt fairly quickly if you aren't wasting money. Once the debt is paid off, $150K/yr is a lot of money IMO.

And yes, no one making $45K could do their job for a day because those people aren't doctors...they didn't study pre-med + med school + residency for 8 to 10 years.

[GoMuskies]

If you have $250K in debt and make $150K/yr, you can get out of debt fairly quickly if you aren't wasting money.

And if you don't want to buy a house. Or have kids.

[DC Muskie]

Muskie, I typically ignore your posts because, quite frankly, you come across as a demeaning, classless jerk. Your endless disrespect and sarcasm get a little old.

You know, you really don't get the upper hand here when you preface this with this nonsense. Put me on ignore you "classless jerk" and be done with it. I'm not sure what you hoped to accomplish by beginning your statement like this. I'm sure you feel better.



However, you can do a little real research and see that for the exact reasons I have already given you doctor's reimbursements have taken huge cuts.

Why do their actual earning stay the same or go up slightly? It is because contrary to popular belief most docs are actually very good businessmen and are very smart.

To make things very simple, you do the following:
1. Stop taking Medicaid and low paying insurances (hurts access)
2. Do more cash/elective proceedures (hurts access)
3. See more patients and give each patient less time and less care
4. Perform clinical trials to supplement income
5. Fire employees or cut benefits
6. Several other things.

The problem is these avenues are pretty much maxed out now. Not much more wiggle room.

Also, those compensation reviews are extremely inaccurate. They basically send a letter/email to a bunch of docs and ask them to disclose financial numbers. Few actually response, few give accurate data, and and large percentage that do respond are in academic/HMO type healthcare groups which for various reasons earnings are affected differently by cuts. These groups are based more on salary than actual earnings. The profit margins of these groups are shrinking, but they are buffered by various other fees and often self contained insurance policies, labs, etc.

By the way, please quit putting words in my mouth. I have not intention of changing professions anytime soon. I know of many who have recently and will shortly, however.

I did do a little research, in fact I even sighted the survey to ask. So basically I put out a list of medical associations who support the new law, throw out a survey and basically your response is this..

They are wrong.

Okay, cool, I can dig that.

Also, if things are such doomsday and you have seen so many people who will stop practicing because of these new devastating regulations, that only you seem to be able to view correctly, it's not that leap to suggest that maybe you will be leaving too.

Because if not, then are the people who are leaving just stupid business people, compared to you?

Anyway, just put me on ignore.

[stophorseabuse]

Booze,

It is no more insane than having to see the doc every 3 months for 3 minutes so she will re up the scripts (after sending me for bloodwork). Same for my wife. We pay 1000 a year in dr. visits. 5000 a year in meds, plus about a grand in blood draws. We have no choice. She charges us money to let us be healthy, while providing no extra services. They are ALL like this.

My costs on healthcare are about 8 grand a year out of pocket. We have zero protection from major event (outside of hidden cash assets).

To get insurance, my yearly costs would be about 14000. How is 14000 okay when essentially we just need the same meds that prob. Cost only about 200 dollars to produce for a year.

Those in 6 figures simply can't be in touch with what people in my position deal with.

I would never act like I know what it is like to be in 6 figures.

[boozehound]

If you have $250K in debt and make $150K/yr, you can get out of debt fairly quickly if you aren't wasting money. Once the debt is paid off, $150K/yr is a lot of money IMO.

And yes, no one making $45K could do their job for a day because those people aren't doctors...they didn't study pre-med + med school + residency for 8 to 10 years.


And if you don't want to buy a house. Or have kids.

I agree with Go Muskies.

You are basically in school for 7 years followed by a solid 2 years of residency. That is a minimum of about 10 years in which you aren't making money. So doctors that don't specialize are basically 29-30 years old before they start earning.

Let's say they make the average at $150K starting at 30, but they have $250K in debt.

$150K nets to a take home of about $8K per month most likely by the time you pay taxes and health insurance and aggressively contribute to your 401(k) since you weren't putting anything in during your early and mid 20's.

If you want to pay off your $250K loans in 10 years you need to be paying between $2300-$2500 per month (probably on the low side since I'm not sure what the interest rates for those are). Then you are down to $5500 per month effective take home pay. That's like making around $90K per year. Not terrible, but not great money. You do that for 10 more years while paying off your student loans. Then you are in your 40's. Finally you start having some money.

Doctors aren't starving, but it can often take a long time before they are really 'wealthy'.

[stophorseabuse]

I agree with Go Muskies.

You are basically in school for 7 years followed by a solid 2 years of residency. That is a minimum of about 10 years in which you aren't making money. So doctors that don't specialize are basically 29-30 years old before they start earning.

Let's say they make the average at $150K starting at 30, but they have $250K in debt.

$150K nets to a take home of about $8K per month most likely by the time you pay taxes and health insurance and aggressively contribute to your 401(k) since you weren't putting anything in during your early and mid 20's.

If you want to pay off your $250K loans in 10 years you need to be paying between $2300-$2500 per month (probably on the low side since I'm not sure what the interest rates for those are). Then you are down to $5500 per month effective take home pay. That's like making around $90K per year. Not terrible, but not great money. You do that for 10 more years while paying off your student loans. Then you are in your 40's. Finally you start having some money.

Doctors aren't starving, but it can often take a long time before they are really 'wealthy'.

And the effects of assanine healthcare costs does the exact same thing to a much greater number of Americans.

I wonder if those college loans were tax funded. Damn handouts.

[blueblob06]

If you have $250K in debt and make $150K/yr, you can get out of debt fairly quickly if you aren't wasting money. Once the debt is paid off, $150K/yr is a lot of money IMO.

And yes, no one making $45K could do their job for a day because those people aren't doctors...they didn't study pre-med + med school + residency for 8 to 10 years.


And if you don't want to buy a house. Or have kids.

Most of the guys I know from Xavier who are doctors (age 28-30) have a kid and all of them have a house and they are doing well. From my and my friends experiences, you can live modestly off $50k for a few years until debts are paid off.

[GuyFawkes38]

This is simple stuff. Doctors rightly (I blelieve) claim that they deserve every penny they receive because it's a really expensive and lenghty process to become a doctor and earn a full salary. So make it easier to become a doctor. Open many more med schools. Reduce time length of med schools and training, etc....

It's all about the entire "diminishing returns" arguement. Would it really make much of a difference to shorten the process. If doctors could start earning their full salaries at 26 instead of 30, that would save a lot of cash for the system as a whole.

I think it's going to happen.

[stophorseabuse]

This is simple stuff. Doctors rightly claim that they deserve every penny they receive because it's a really expensive and lenghty process to become a doctor and earn a full salary. So make it easier to become a doctor. Open many more med schools. Reduce time length of med schools and training, etc....

I think it's going to happen.

I think that would be AWESOME.

I am NOT worried about high quality. Below average sounds REALLY good compared to none.

[Snipe]

I think that would be AWESOME.

I am NOT worried about high quality. Below average sounds REALLY good compared to none.

Life is about tradeoffs. So is capitalism. Lower the standards and we can flood the market with doctors. I would support that.

[stophorseabuse]

Life is about tradeoffs. So is capitalism. Lower the standards and we can flood the market with doctors. I would support that.

Common Ground!!!!!!!!!!

That is rare, but it appears to have happened.

[GuyFawkes38]

I think that would be AWESOME.

I am NOT worried about high quality. Below average sounds REALLY good compared to none.

exactly. Not everyone can afford a Harvard lawyer at a big firm. Some retain a University of Datyon lawyer at a smaller firm. All joking aside, I'm sure UD trained attourneys are more than capable lawyers.

[boozehound]

And the effects of assanine healthcare costs does the exact same thing to a much greater number of Americans.

I wonder if those college loans were tax funded. Damn handouts.


I think that would be AWESOME.

I am NOT worried about high quality. Below average sounds REALLY good compared to none.

I am worried about quality, but I am open to the idea of lowering standards for doctors to drive health care costs down, although I'm not sure how much doctor's salaries are the problem. I think health care costs are too high but I think other factors play a much greater role in medical costs than doctor's salaries do.

In theory I'm not opposed to a market in which people could pay different amounts for different standards to care, similar to hiring a lawyer, as guyfawkes pointed out. If I want to pay more to see a doctor that graduated at the top of his class from a Tier 1 school, I can. If I can't (or choose not to) pay for that then I can pursue lower cost options.

[kmcrawfo]

You know, you really don't get the upper hand here when you preface this with this nonsense. Put me on ignore you "classless jerk" and be done with it. I'm not sure what you hoped to accomplish by beginning your statement like this. I'm sure you feel better.




I did do a little research, in fact I even sighted the survey to ask. So basically I put out a list of medical associations who support the new law, throw out a survey and basically your response is this..

They are wrong.

Okay, cool, I can dig that.

Also, if things are such doomsday and you have seen so many people who will stop practicing because of these new devastating regulations, that only you seem to be able to view correctly, it's not that leap to suggest that maybe you will be leaving too.

Because if not, then are the people who are leaving just stupid business people, compared to you?

Anyway, just put me on ignore.

Thank you for proving my point with your typical reaction and response.

why so angry at everyone in the world (or those who don't agree with you).

Everyone else here has discussions. We may not agree, but remain civil. You excel in attacks and personal insults.

[kmcrawfo]

Most of the guys I know from Xavier who are doctors (age 28-30) have a kid and all of them have a house and they are doing well. From my and my friends experiences, you can live modestly off $50k for a few years until debts are paid off.

The question is why go to school for 8 years, plus 4-10 years of residency/fellowship (all of which are beyond stressful/hard) and not earn your first paycheck until your mid thirties if you are going to "live modestly" until you pay your debt is paid off.

Why not just start and engineering or business job at age 21, make $75,000 for those 10 years, and be several hundred of thousands of dollars ahead in the game with a much better lifestyle?

[blueblob06]

Most of the guys I know from Xavier who are doctors (age 28-30) have a kid and all of them have a house and they are doing well. From my and my friends experiences, you can live modestly off $50k for a few years until debts are paid off.


The question is why go to school for 8 years, plus 4-10 years of residency/fellowship (all of which are beyond stressful/hard) and not earn your first paycheck until your mid thirties if you are going to "live modestly" until you pay your debt is paid off.

Why not just start and engineering or business job at age 21, make $75,000 for those 10 years, and be several hundred of thousands of dollars ahead in the game with a much better lifestyle?
I didn't know such business jobs existed and I guess those people don't like engineering. I don't think living modestly from age say 27 to 31 and then being fairly wealthy from 31 til death would be a bad deal. Plus they are improving lives every day which probably makes them feel good.

[stophorseabuse]

Km, people would still be doctors for the same reason smart people become teachers, social workers, clergy, etc.

A call to help society.

Teachers could choose much more lucrative careers, but hundreds of thousands don't, because we know what we do is positive, and we can look ourselves in the mirror despite being underpaid and not respected. There would surely be plenty of doctors do the same, they aren't all in it for the money.

[stophorseabuse]

If you are a doctor you will get work, there is absolutely no guarantee of finding work as an engineer, and especially in business.

[kmcrawfo]

Km, people would still be doctors for the same reason smart people become teachers, social workers, clergy, etc.

A call to help society.

Teachers could choose much more lucrative careers, but hundreds of thousands don't, because we know what we do is positive, and we can look ourselves in the mirror despite being underpaid. There would surely be plenty of doctors do the same.

The problem of comparing teachers/social workers/etc. to docs is what it takes to get there. You can get a teaching/social work/etc. degree in 3-4 years. Curriculum during school does not compare in terms of difficulty. Regular hours, etc.

Just a whole different ball game.....

If an MD and residency training could be obtained in 3-4 years after high school with the same courses as the above, I'd agree with you.

However, today you can only go into medicine if you are doing to help people. Doing it to "get rich" will cause you much grief and disappointment.

[kmcrawfo]

If you are a doctor you will get work, there is absolutely no guarantee of finding work as an engineer, and especially in business.

The difference is, in general, these are the people graduating in the to 2-5% of their classes and have down research/internships/etc to get accepted. An person graduating from Purdue, for example, in the top 5% of their class with an engineering degree with a good internship will not have a problem finding a good job somewhere in that salary range.

However, those were just 2 examples:

How about:
Pharmacist
Physical Therapist
Physician Assistant

All of which may require and additional couple years, but immediately will get good jobs of $75,000 or more.

[DC Muskie]

Thank you for proving my point with your typical reaction and response.

why so angry at everyone in the world (or those who don't agree with you).

Everyone else here has discussions. We may not agree, but remain civil. You excel in attacks and personal insults.

Jesus, where in the world do you get this crap from? You are the one who needed to preface a response to me how much of a prick you find me. Look back at what I have been saying and tell me what a personal attacks I have thrown at you. Where I have ever called you a "classless jerk." You're the one posting on this thread and have been since the beginning that people don't know what they are voting for. It's been that way for the past three years.

Get a grip.

Look I even laid out other medical associations who disagree with your idea and opinion that this law is terrible.

But here are some links from other professionals who disagree with you...

http://npalliance.org/wp-content/upl...ans.041311.pdf

http://www.amsa.org/AMSA/Homepage/Ab...ws/062812.aspx


http://www.aap.org/en-us/about-the-a...-Care-Act.aspx

http://www.medpagetoday.com/Washingt...h/Reform/33563

Are these people are dumb as well?

Or is that not a civil question?

What is your response to this article, just out yesterday? (http://www.washingtonpost.com/opinions/fareed-zakaria-curbing-the-cost-of-health-care/2012/07/04/gJQAxkr7NW_story.html)

I tried to look to see where the associations you are members with I couldn't find their position concerning ACA. Does the ABD, the AAD,and the ASDS have a position on this new law?

Can you answer that, or do you need to call me a "classless jerk" before you do?

[DC Muskie]

Just a interesting tidbit to throw out there, in 2009 there were 11% fewer engineering jobs in the country than 25 years ago according to the National Center for Education Statistics.

[XUOWNSUC]

Life is about tradeoffs. So is capitalism. Lower the standards and we can flood the market with doctors. I would support that.

For those who think they should lower the standards to allow more docs, what do you do about malpractice insurance then? I would assume the more docs we have (by lowering standards - I'm not sure what that really means btw) would mean more errors and more malpractice. Malpractice costs are ridiculous now, what would they be in that scenario?


Km, people would still be doctors for the same reason smart people become teachers, social workers, clergy, etc.

A call to help society.



My wife once cited "a call to help society" or something similar to that as a reason for entering medical school. However, with all the crap she has to deal with on a day to day basis, so hardly feels like she is helping society.


Most of the guys I know from Xavier who are doctors (age 28-30) have a kid and all of them have a house and they are doing well. From my and my friends experiences, you can live modestly off $50k for a few years until debts are paid off.

From my experience (my wife being a physician), it's not that way at all. Her debt is a long way from being paid off. It doesn't go away in a "few years" like you think. Boozehound has the general idea below. Although, I'd change the school years to 8 and residency to 3 (in my wife's case it was 5 because she specialized).


I agree with Go Muskies.

You are basically in school for 7 years followed by a solid 2 years of residency. That is a minimum of about 10 years in which you aren't making money. So doctors that don't specialize are basically 29-30 years old before they start earning.

Let's say they make the average at $150K starting at 30, but they have $250K in debt.

$150K nets to a take home of about $8K per month most likely by the time you pay taxes and health insurance and aggressively contribute to your 401(k) since you weren't putting anything in during your early and mid 20's.

If you want to pay off your $250K loans in 10 years you need to be paying between $2300-$2500 per month (probably on the low side since I'm not sure what the interest rates for those are). Then you are down to $5500 per month effective take home pay. That's like making around $90K per year. Not terrible, but not great money. You do that for 10 more years while paying off your student loans. Then you are in your 40's. Finally you start having some money.

Doctors aren't starving, but it can often take a long time before they are really 'wealthy'.

Another thing sort of off topic - those "Top Docs In Cincinnati" magazine articles are a load of crap. Don't go to a doctor based off of reading one of those articles. Do your research, talk to friends, etc. Some of the stories my wife has told me about some of the so-called "Top Docs" would surprise you.

[DC Muskie]

I agree with Go Muskies.

You are basically in school for 7 years followed by a solid 2 years of residency. That is a minimum of about 10 years in which you aren't making money. So doctors that don't specialize are basically 29-30 years old before they start earning.

Let's say they make the average at $150K starting at 30, but they have $250K in debt.

$150K nets to a take home of about $8K per month most likely by the time you pay taxes and health insurance and aggressively contribute to your 401(k) since you weren't putting anything in during your early and mid 20's.

If you want to pay off your $250K loans in 10 years you need to be paying between $2300-$2500 per month (probably on the low side since I'm not sure what the interest rates for those are). Then you are down to $5500 per month effective take home pay. That's like making around $90K per year. Not terrible, but not great money. You do that for 10 more years while paying off your student loans. Then you are in your 40's. Finally you start having some money.

Doctors aren't starving, but it can often take a long time before they are really 'wealthy'.

Where are you living and making $90,000? That's makes a huge difference.

[blueblob06]

From my experience (my wife being a physician), it's not that way at all. Her debt is a long way from being paid off. It doesn't go away in a "few years" like you think. Boozehound has the general idea below. Although, I'd change the school years to 8 and resideny to 3 (in my wife's case it was 5 because she specialized).


Agreed, sorry for confusion...I was just trying to respond to the point of 'doctors making $150K is not a lot'. Those that are could pay off their debt in a few years if they live modestly for a bit. Most aren't making that and have to pay it off over 10+ years like us non-doctors of the world.

Good notes in your other points as well.

[boozehound]

Where are you living and making $90,000? That's makes a huge difference.

Agree. If the average for a doctor (posted earlier in this thread) was around $150K I would say my example would take place in a city with a cost of living similar to the national average. In which case $90K would be decent (but not necessarily great) money. You are living a pretty comfortable lifestyle but you are far from rich.

[DC Muskie]

Agree. If the average for a doctor (posted earlier in this thread) was around $150K I would say my example would take place in a city with a cost of living similar to the national average. In which case $90K would be decent (but not necessarily great) money. You are living a pretty comfortable lifestyle but you are far from rich.

Because with $90k you can live pretty well on your own here in DC. Which I believe is the 6th most expensive city in the country.

I always think this types of arguments come down to taste and tolerance. If you have expensive taste, then living on $90K will be difficult if you live in Chicago, have a place in Wrigleyville, and shop at Whole Foods.

But if you can tolerate living in Groveport, OH you can have a nice house for around $129K and have more materials that can make your life livable.

[LA Muskie]

To me it is (or should be) like just about any other profession. The top doctors should make plenty. Others should earn a living wage, considering all factors (including student loans and lost years of income). I think $150k per year, on average, is low.

[kmcrawfo]

Jesus, where in the world do you get this crap from? You are the one who needed to preface a response to me how much of a prick you find me. Look back at what I have been saying and tell me what a personal attacks I have thrown at you. Where I have ever called you a "classless jerk." You're the one posting on this thread and have been since the beginning that people don't know what they are voting for. It's been that way for the past three years.

Get a grip.

Look I even laid out other medical associations who disagree with your idea and opinion that this law is terrible.

But here are some links from other professionals who disagree with you...

http://npalliance.org/wp-content/upl...ans.041311.pdf

http://www.amsa.org/AMSA/Homepage/Ab...ws/062812.aspx


http://www.aap.org/en-us/about-the-a...-Care-Act.aspx

http://www.medpagetoday.com/Washingt...h/Reform/33563

Are these people are dumb as well?

Or is that not a civil question?

What is your response to this article, just out yesterday? (http://www.washingtonpost.com/opinions/fareed-zakaria-curbing-the-cost-of-health-care/2012/07/04/gJQAxkr7NW_story.html)

I tried to look to see where the associations you are members with I couldn't find their position concerning ACA. Does the ABD, the AAD,and the ASDS have a position on this new law?

Can you answer that, or do you need to call me a "classless jerk" before you do?

DC, I have no idea who you are, nor do I care. You clearly get some satisfaction of showing that you know who I am and make derogatory and disrespectful remarks towards to myself and my profession.

I do not make personal attacks on anyone with perhaps of the exception of my remarks to you saying your remarks come across (again in this previous comment your made) as simply put, crass and classless. You may not agree, not problem. Keep on keepin on.

4 of your links did not work. The only I could get open was an op-ed piece of someone who clearly has not read the bill in question here and did little research of what this bill actually contains and has in it.

People need to understand what this bill actually does and what it will change. Virtually every representative and senator who voted for it admitted they had not read it. It took me weeks to get through it. I provided a link to it for everyone to read at the beginning of this or another thread.

This is a nasty bill that will have great impact beyond what people expect. I think STOPHORSEABUSE has pretty reasonable expectations from what it will provide actually after reading his responses and what he wants from his healthcare. Otherwise, I am not sure people really understand what they are getting.

That is how I see things. Why don't you just read the bill or review and article from someone who has actually read the bill and then form an educated opinion. Most of the pieces I am reading are groups/organizations that are pointing out a few parts of the bill that suit their means. Then, I am sure we'll have a more civil discussion.

[GuyFawkes38]

To me it is (or should be) like just about any other profession. The top doctors should make plenty. Others should earn a living wage, considering all factors (including student loans and lost years of income). I think $150k per year, on average, is low.

Being a lawyer, I believe, you probably know more about this than I do. I bring it up because some commentators have noted that they wished the medical field would be more like the law field.

In the past 50 years, many new law schools have opened up. It has become easier to become a lawyer. The supply of lawyers has risen dramatically. That doesn't mean that lawyers from top law schools have seen their salaries drop. They are still in demand. But it is easier for a consumer on a budget to retain the services of a capable lawyer (maybe not a Harvard grad, but still a good lawyer).

That's all many people are asking for the medical field. Make it easier and less costly to become a doctor. We need more doctors.

[kmcrawfo]

Being a lawyer, I believe, you probably know more about this than I do. I bring it up because some commentators have noted that they wished the medical field would be more like the law field.

In the past 50 years, many new law schools have opened up. It has become easier to become a lawyer. The supply of lawyers has risen dramatically. That doesn't mean that lawyers from top law schools have seen their salaries drop. They are still in demand. But it is easier for a consumer on a budget to retain the services of a capable lawyer (maybe not a Harvard grad, but still a good lawyer).

That's all many people are asking for the medical field. Make it easier and less costly to become a doctor. We need more doctors.

Good point. But what is the real reason you can find a lawyer at a reasonable price?

There is no law insurance. Lawyers are a direct to consumer product. You pay for what you want.

The government has no, and never will, infiltrate the legal field like it has medicine. Lawyers run/hold to many influential positions and know how damaging that would be to their profession.

Lawyers also don't have to worry as much about every increasing cost of medical supplies. Sure they have supplies and staff, but it is not the same as healthcare overhead.

All that being said, I would love it if medicine would go down this road and be direct to consumer relationship between the physician and patient. The same as lawyer and his client. It would be better and more affordable care.

[GoMuskies]

There is no law insurance.

That's not exactly true. The cost of your lawyer is part of a liability insurance policy. There's a reason why a huge branch of law firm work is called insurance defense.

[X Factor]

This is going to be just great!

It’s a lawyer’s dream!
Officials have already drafted 13,000 pages of new regulations for the new ObamaTax law.
FOX News reported:

With the Supreme Court giving President Obama’s new health care law a green light, federal and state officials are turning to implementation of the law — a lengthy and massive undertaking still in its early stages, but already costing money and expanding the government.

The Health and Human Services Department “was given a billion dollars implementation money,” Republican Rep. Denny Rehberg of Montana said. “That money is gone already on additional bureaucrats and IT programs, computerization for the implementation.”

“Oh boy,” Stan Dorn of the Urban Institute said. “HHS has a huge amount of work to do and the states do, too. There will be new health insurance marketplaces in every state in the country, places you can go online, compare health plans.”

The IRS, Health and Human Services and many other agencies will now write thousands of pages of regulations — an effort well under way:

“There’s already 13,000 pages of regulations, and they’re not even done yet,” Rehberg said.

“It’s a delegation of extensive authority from Congress to the Department of Health and Human Services and a lot of boards and commissions and bureaus throughout the bureaucracy,” Matt Spalding of the Heritage Foundation said. “We counted about 180 or so.”

There has been much focus on the mandate that all Americans obtain health insurance, but analysts say that’s just a small part of the law — covering only a few pages out of the law’s 2700.

“The fact of the matter is the mandate is about two percent of the whole piece of the legislation,” Spalding said. “It’s a minor part.”

Much bigger than the mandate itself are the insurance exchanges that will administer $681 billion in subsidies over 10 years, which will require a lot of new federal workers at the IRS and health department.

“They are asking for several hundred new employees,” Dorn said. “You have rules you need to write and you need lawyers, so there are lots of things you need to do when you are standing up a new enterprise.”

For some, though, the bottom line is clear and troubling: The federal government is about to assume massive new powers.

13,000 Pages of Regulations (http://www.thegatewaypundit.com/2012/07/lawyers-have-already-drafted-13000-pages-of-regulations-for-new-obamatax-law/)

[LA Muskie]

Being a lawyer, I believe, you probably know more about this than I do. I bring it up because some commentators have noted that they wished the medical field would be more like the law field.

In the past 50 years, many new law schools have opened up. It has become easier to become a lawyer. The supply of lawyers has risen dramatically. That doesn't mean that lawyers from top law schools have seen their salaries drop. They are still in demand. But it is easier for a consumer on a budget to retain the services of a capable lawyer (maybe not a Harvard grad, but still a good lawyer).

That's all many people are asking for the medical field. Make it easier and less costly to become a doctor. We need more doctors.
I won't pretend to know the inner workings of the medical field, but you are right about the legal profession. Aand I too believe that many would consider a similar progression to be a vast improvement of the healthcare system.

[LA Muskie]

That's not exactly true. The cost of your lawyer is part of a liability insurance policy. There's a reason why a huge branch of law firm work is called insurance defense.
Exactly. There are also pre-paid legal services products (which are nearly literally "law insurance").

[kmcrawfo]

That's not exactly true. The cost of your lawyer is part of a liability insurance policy. There's a reason why a huge branch of law firm work is called insurance defense.

True. I certainly have a ton of "law insurance" with my medmal, business liability, etc. However, I view these more as true insurance in that I never plan on using them.

When I say law insurance I am referring to how people view "health insurance" today, which is, prepaid and entitled healthcare. Can you imagine how often the general public would run to a lawyer to solve every little problem if they only had a $40 or zero copay and could then expect you to submit their bill to a 3rd party who would then be expected to foot the rest of the bill. Imagine if starting at age 65, you could also get as much legal advise and services as you want from a lawyer in any speciality free of charge (or 80% covered as in Medicare). Also, if you were at the poverty level could get it all for free (Medicaid).

No catastrophic or other event preceding this use. Instead of covering true "legal emergencies" you then would get all the "colds" and "runny noses" too. Would place much more of a burden on the system.

I know the 2 scenarios are not exactly comparable, but I hope that makes more sense.

[LadyMuskie]

True. I certainly have a ton of "law insurance" with my medmal, business liability, etc. However, I view these more as true insurance in that I never plan on using the.

When I say law insurance I am referring to how people view "health insurance" today, which is, prepaid and entitled healthcare. Can you imagine how often the general public would run to a lawyer to solve every little problem if they only had a $40 or zero copay and could then expect you to submit their bill to a 3rd party who would then be expected to foot the rest of the bill. No catastrophic or other event preceding this use. Instead of covering true "legal emergencies" you then would get all the "colds" and "runny noses" too. Would place much more of a burden on the system.

I know the 2 scenarios are not exactly comparable, but I hope that makes more sense.

People do this anyway. Why do you think people make so many lawyer jokes and hate lawyers? People want lawyers to sue other people and make the client a lot of money, without charging the client a lot of money. 9 times out of 10, it doesn't work that way.

You'd be surprised the phone calls you get from people wanting a lawyer so that they can sue someone for something frivolous. When you explain to them that lawyers aren't free, and that the cost associated with bringing a case to trial isn't worth it when you consider the cost of the attorneys, the paralegals, filing fees, etc. and a possibility that you won't win if you go to trial and don't settle, people get upset and think you're being unhelpful. After all, everyone claims to know someone who sued someone else and left the courthouse with millions of dollars in their pockets after they fell at Kroger. Sure, there are all kinds of attorneys and the ambulance chasers will take on any and all cases, but the discerning attorneys will caution their clients that the probability of walking away with a windfall judgment is slim to none. Very few cases are rainmakers, but everyone thinks they can get an Erin Brokovich settlement, and everyone thinks they're entitled to their day in court to get their millions.

[kmcrawfo]

People do this anyway. Why do you think people make so many lawyer jokes and hate lawyers? People want lawyers to sue other people and make the client a lot of money, without charging the client a lot of money. 9 times out of 10, it doesn't work that way.

You'd be surprised the phone calls you get from people wanting a lawyer so that they can sue someone for something frivolous. When you explain to them that lawyers aren't free, and that the cost associated with bringing a case to trial isn't worth it when you consider the cost of the attorneys, the paralegals, filing fees, etc. and a possibility that you won't win if you go to trial and don't settle, people get upset and think you're being unhelpful. After all, everyone claims to know someone who sued someone else and left the courthouse with millions of dollars in their pockets after they fell at Kroger. Sure, there are all kinds of attorneys and the ambulance chasers will take on any and all cases, but the discerning attorneys will caution their clients that the probability of walking away with a windfall judgment is slim to none. Very few cases are rainmakers, but everyone thinks they can get an Erin Brokovich settlement, and everyone thinks they're entitled to their day in court to get their millions.

The difference is you choose to not take the case or tell people that they will have to pay for your services since it is not likely to pay out.

Take it a step further that if people had legal entitlements similar to medical entitlements. It would matter what your analysis of the situation was they would still be able to take it to trial, etc. You would just then have to come up with the best medication (err.. legal strategy) to get them the desired results regardless of the low likelihood or success (i.e. nearly certain fatal disease/cancer/etc) or how frivolous (i.e. I don't like this faint, barely visible pink spot on my left butt cheek) the case may be.

Once again it seems so foreign in the legal world for the reasons you just described. In the end each lawyer/firm decides what cases they want to take (I know this is actually NOT 100% true due to insurance contracts/etc), but you get the drift.

[bobbiemcgee]

I know Docs complain a lot about Medicare, but they don't have to take it. So don't.
You can kiss your retirement money goodbye paying co-pays, deductibles, daily hospital expenses, etc,etc. if you have a long term illness of any kind. Someone is gladly accepting these referrals, and they wouldn't be, if they weren't making money off them.

I have a neighbor who paid for $67,000. for drugs in one year. Sadly, his wife is a vegetable, but he told me he will be on Medicaid next yr. (broke).There are lots of people who don't take their drugs cuz they can't afford them. They can eat or take the drugs but not both.

I got referred to the "Ass" Doc. He got $125 from from Medicare Adv plan and 20 bucks from me. 1 hour wait. 3 minute appt. "You ever had a colonoscopy?" No. "You need one. We'll do it Friday." Next.
Wondered how he could see a room full of people in an hour. Now I know.

[kmcrawfo]

I know Docs complain a lot about Medicare, but they don't have to take it. So don't.
You can kiss your retirement money goodbye paying co-pays, deductibles, daily hospital expenses, etc,etc. if you have a long term illness of any kind. Someone is gladly accepting these referrals, and they wouldn't be, if they weren't making money off them.

I have a neighbor who paid for $67,000. for drugs in one year. Sadly, his wife is a vegetable, but he told me he will be on Medicaid next yr. (broke).There are lots of people who don't take their drugs cuz they can't afford them. They can eat or take the drugs but not both.

I got referred to the "Ass" Doc. He got $125 from from Medicare Adv plan and 20 bucks from me. 1 hour wait. 3 minute appt. "You ever had a colonoscopy?" No. "You need one. We'll do it Friday." Next.
Wondered how he could see a room full of people in an hour. Now I know.

I don't complain about Medicare and have not problem with accepting their patients. Now a new, level 3 (which is what most new visits are) from Medicare only pays $99.32. A level 4 visit pays $152.23, but requires a very extensive exam and history. Not possible for you to have qualified for a level 4 visit from what you are describing. The problem is from that $99 most is gobbled up on overhead (nurses, staff, rent, supplies, etc.). The only profitable thing that doc is going to do for you is the scope. Thus, to make end meet, so to speak, he has to see 10 people in an hour.

I work at a relatively lower volume and spend more time with my patients. I never leave the room without sitting down next to the patient and asking if they have any questions or if there is anything else I can help them with. It takes another 3 or 4 minutes per patient and I sacrifice income from it, but it provides better care and relationships with my patients. I have the benefit of buffering the general loss of income with regular office visits with elective and cosmetic procedures that I perform. This is also why I can "afford" to accept Medicaid, which is charity work. So, in the end everyone gets good care. Unfortunately, at some point if cuts become enough I will eventually not be able to continue such service.

[Emp]

The difference is you choose to not take the case or tell people that they will have to pay for your services since it is not likely to pay out. You have absolutely no clue how medmal cases get evaluated and taken, or not; and the economics of risk taking. At trial, doctors win far more than other groups of defendants. Suffice it to say, anyone practicing plaintiff's medmal cases will not take the "faint, barely visible pink spot on even the most glamorous butt. People TALK about making all sorts of claims, not just against doctors and Huge Corporation. In the end 99.99% of it is just talk.

Take it a step further that if people had legal entitlements similar to medical entitlements. It would matter what your analysis of the situation was they would still be able to take it to trial, etc. and if successful, would be required to reimburse medicade from the proceeds of any settlement or judgment. EVERYONE is subrogated now, Doc, as I am sure you are aware.. So IF there was malpractice, the federal goverment gets reimbursed,

You would just then have to come up with the best medication (err.. legal strategy) to get them the desired results regardless of the low likelihood or success (i.e. nearly certain fatal disease/cancer/etc) or how frivolous (i.e. I don't like this faint, barely visible pink spot on my left butt cheek) the case may be.

Once again it seems so foreign in the legal world for the reasons you just described. In the end each lawyer/firm decides what cases they want to take (I know this is actually 100% true due to insurance contracts/etc), but you get the drift.
Gosh, what a revelation...lawyers decide what kind of cases they want to take. You're sure your not 110% certain. Insurance contracts have little to do with case analysis prior to accepting representation with a client. Insurance CLIENTS, yes that has a lot to do with whether a practitioner can accept plaintiff's cases. Doh!

Stick to the medicare beef, Doc. It's territory you know.

[kmcrawfo]

Gosh, what a revelation...lawyers decide what kind of cases they want to take. You're sure your not 110% certain. Insurance contracts have little to do with case analysis prior to accepting representation with a client. Insurance CLIENTS, yes that has a lot to do with whether a practitioner can accept plaintiff's cases. Doh!

Stick to the medicare beef, Doc. It's territory you know.

Chill out killer.... You clearly misread and misunderstood my post. Take a step back and reread it, relax, take a deep breath, and then repost. I am actually excluding the insurance based medical-legal and liability insurance situations from my discussion as those are insurances in the true sense (i.e. purchased without intent to use) for the very reason you extolling. I am stating exactly what you are stating in that most cases are just talk, but that if people had a free ticket like they do with healthcare and could force attorneys to accepts there cases for frivolous things then it would place a burden on the legal system.

I am referring more to the fact that a person can hire an attorney to resolve most any issue or debate and there are laws pertaining to almost everything. I have spoken to the attorney I retain for many things some people would consider trivial because I value his analytical advice and how he views things from a different perspective than I do. I have no problem paying him for this time. This does not mean I am suing somebody as it is typically an ivestment purchase, contract analysis, lease, business proposal, insurance risk analysis, etc. My point was that if people could go to an attorney for anything they wanted under the parameters that I discussed (not just law suits) it would clearly make a difference on how law services are provided. People would seek legal advice for things that are trivial such as "please closely review my Direct TV contract," since it was free. The was my comparison to the equally trivial case that I might come in contact with such as, "please look at the barely visible spot." Both seem trivial and are a burden on the system. The difference is that one is completely free, covered, and paid for by our system. The other no one would consider because why would they pay an attorney a few hundred dollars to review a contract from a cable company. I may say the spot is fine and you may the contract looks good, but then the patient/client demands more to be done. Since it is and entitled service I would try some treatment to make it fade (waste of time/money). You might try some small change in the contract (waste of time/money). But since the patient/client is not directly paying for it it drives costs/burden up.

Clearly, as I said before, it is such a foreign concept and not directly comparable. It will never happen. It really doesn't matter...... Just quickly typed something up that clearly was not clearly written and likely still is not.

Also, I very much understand how the medmal process works and how cases are selected for representation. I have been subject to threats from patients just like every other doctor and had to chat with my carrier about what to do. I have been asked to testify as an expert witness in cases and have numerous conversations/case reviews with attorneys over the years representing both physicians and patients. I know more than you apparently think I do, but we are broaching this from completely different perspectives as I stated this was supposed to be excluding such cases.

[kmcrawfo]

Gosh, what a revelation...lawyers decide what kind of cases they want to take. You're sure your not 110% certain. Insurance contracts have little to do with case analysis prior to accepting representation with a client. Insurance CLIENTS, yes that has a lot to do with whether a practitioner can accept plaintiff's cases. Doh!

Stick to the medicare beef, Doc. It's territory you know.

FYI it was supposed to say I know this is NOT 100% true with insurance contracts, etc.

It was a typo.....

[DC Muskie]

DC, I have no idea who you are, nor do I care. You clearly get some satisfaction of showing that you know who I am and make derogatory and disrespectful remarks towards to myself and my profession.

I do not make personal attacks on anyone with perhaps of the exception of my remarks to you saying your remarks come across (again in this previous comment your made) as simply put, crass and classless. You may not agree, not problem. Keep on keepin on.

4 of your links did not work. The only I could get open was an op-ed piece of someone who clearly has not read the bill in question here and did little research of what this bill actually contains and has in it.

People need to understand what this bill actually does and what it will change. Virtually every representative and senator who voted for it admitted they had not read it. It took me weeks to get through it. I provided a link to it for everyone to read at the beginning of this or another thread.

This is a nasty bill that will have great impact beyond what people expect. I think STOPHORSEABUSE has pretty reasonable expectations from what it will provide actually after reading his responses and what he wants from his healthcare. Otherwise, I am not sure people really understand what they are getting.

That is how I see things. Why don't you just read the bill or review and article from someone who has actually read the bill and then form an educated opinion. Most of the pieces I am reading are groups/organizations that are pointing out a few parts of the bill that suit their means. Then, I am sure we'll have a more civil discussion.

See here's the thing Kevin. I have never once made fun of your profession. Not once. You are the one who in fact has used personal insults. Since you are good at reading things, go back and read what you have written to me, and what I have written.

You seem to be incapable of not using the word "classless." Stop. For someone who claims to be able to read a bill and come to a conclusion that everyone else is incapable of understanding, using the word "classless" constantly makes you look like a teenager trying to sound grown up. At best you sound like Dayton fan. There, that's my direct insult to you.

Now can we move on?

I'm not sure why the links don't work. But basically The National Physicians Alliance, the American Academy of Pediatrics and the American Medical Student Association all have come out in support of ACA.

You never did answer why your own professional associations don't seem to have a position either way on the new law. I was interested as to why that is, if you knew, or what. But since you seem more interested in taking twenty minutes making sure I know that you think I'm classless, and crass, or whatever. So I'm guessing I won't get an answer.

But your entire position, like saying everyone who voted to the law admitting to not reading it, (which I would like to see where you get that information) is based on this simple fact...

I read the bill, I'm a doctor, no one else understands it.

Well, I merely pointed out that other professionals in the medical field seem to disagree with you. I'm not sure how much of the bill they have read, but I will not assume that they haven't simply because their opinion is different than yours.

I've seen a lot of arguments and discussions on this board on a wide variety of topics. I have never once seen someone so...what word to use here..."crass" as to suggest that no one else could possibly understand the bill. We can have disagreements as the specifics and even on the possible outcomes. I'm not sure what you hope to accomplish by telling people they simply don't understand what they are getting into. You sound like some sort of prophet, damning all the nonbelievers to hell.

So I'm not sure if you will answer my question about the associations you are apart of and their position on ACA. Because I'm pretty sure I wrote a lot of classless things in this reply that will occupy your attention.

[GoMuskies]

Someone's totally getting a dead hooker in their trunk.

[DC Muskie]

Someone's totally getting a dead hooker in their trunk.

Bitch didn't read the bill.

[UCGRAD4X]

But basically The National Physicians Alliance, the American Academy of Pediatrics and the American Medical Student Association all have come out in support of ACA.

I never know how much stock to put into opinions from some of these professional organizations. The hierarchy deciding to endorse something doesn't always mean the rank and file members do. I'm not saying this is the case here - but check into it. (I haven't but I think I will in my spare time).

I just think of the times the AARP backed something that most old people I know would never agree with or equating union bosses' opinions to members.

Just sayin'!

[DC Muskie]

I never know how much stock to put into opinions from some of these professional organizations. The hierarchy deciding to endorse something doesn't always mean the rank and file members do. I'm not saying this is the case here - but check into it. (I haven't but I think I will in my spare time).

I just think of the times the AARP backed something that most old people I know would never agree with or equating union bosses' opinions to members.

Just sayin'!

I think it's just like anyone else opinion. Take it for whatever you want really. Just like Dr. Kevin. No more, no less.

The point I was making is there are other professionals out there who disagree with our resident dermatologist. (That was a joke Kevin.)

[kmcrawfo]

See here's the thing Kevin. I have never once made fun of your profession. Not once. You are the one who in fact has used personal insults. Since you are good at reading things, go back and read what you have written to me, and what I have written.

You seem to be incapable of not using the word "classless." Stop. For someone who claims to be able to read a bill and come to a conclusion that everyone else is incapable of understanding, using the word "classless" constantly makes you look like a teenager trying to sound grown up. At best you sound like Dayton fan. There, that's my direct insult to you.

Now can we move on?

I'm not sure why the links don't work. But basically The National Physicians Alliance, the American Academy of Pediatrics and the American Medical Student Association all have come out in support of ACA.

You never did answer why your own professional associations don't seem to have a position either way on the new law. I was interested as to why that is, if you knew, or what. But since you seem more interested in taking twenty minutes making sure I know that you think I'm classless, and crass, or whatever. So I'm guessing I won't get an answer.

But your entire position, like saying everyone who voted to the law admitting to not reading it, (which I would like to see where you get that information) is based on this simple fact...

I read the bill, I'm a doctor, no one else understands it.

Well, I merely pointed out that other professionals in the medical field seem to disagree with you. I'm not sure how much of the bill they have read, but I will not assume that they haven't simply because their opinion is different than yours.

I've seen a lot of arguments and discussions on this board on a wide variety of topics. I have never once seen someone so...what word to use here..."crass" as to suggest that no one else could possibly understand the bill. We can have disagreements as the specifics and even on the possible outcomes. I'm not sure what you hope to accomplish by telling people they simply don't understand what they are getting into. You sound like some sort of prophet, damning all the nonbelievers to hell.

So I'm not sure if you will answer my question about the associations you are apart of and their position on ACA. Because I'm pretty sure I wrote a lot of classless things in this reply that will occupy your attention.

Ok... maybe I misunderstand your posts DC. But... In my opinion (whatever that is worth) you come across as highly sarcastic and combative in your posts. Just read the first 2 pages on this post and people responses (not mine) to your initials posts.

Then read the last couple pages of this post and read other people response (not mine) to your replies/comments. I am not the only one who says you come across as extremely combative and at times insulting. Maybe you are just trying to be funny/joking. It does not come across like that.

Regardless... Organizational opinions are that, generally, of a few people at the top of that organization. In medicine these are most usually physcians at academic institutions, etc. They do not share the opinions/thoughts of the vast majority of doctors actually in small groups/private practice. Only a small fraction of physicians (a small minority) actually belong to the AMA, etc. The reason is because most docs do not agree with the opinions you have posted. Therefore, they do not join/participate in those societies.

The flaw in your argument is that you are posting organizations views and not actual physicians' views. There is a big difference. If you can come up with groups of docs who are actually in private practice or group practice (this is the majority of docs in this country) then they would be more convinving. That is not what you are showing.

Of all the docs that I know across the country from either training, my speaking events, previous faculty positions, etc. I have met only 2 physicians who are in private/group practice that actually support this bill.

Now... I have met several in academic, institutional, and government type medicine that do support it. That is because it is emulating the systems that they are in. I get that.

The bill will clearly decrease the quality and access of care in the private setting. It will emulate the care in the institutional setting, which is more expensive and wasteful. If this is what you want, great. If not, then you should not support this bill.

As I said if someone understands what this bill does and still supports it, great. If they don't understand and think they are all going to get great and free healthcare without adding an enourmous economic burden on the country, that is where I have a problem understand.

In the end, this bill will actually personally affect me, my healthcare, and my livlihood much less than it will the rest of the people on this board and in this country. I am looking out for others interest more than my own as I truly will be fine either way.

Also, in the end, I truly mean you no disrespect and really would like to have less heated/more civil discussions with you. We can point fingers at who is mean/classeless, etc. Why not both of us get over it and try to move forward in a more friendly mannner?

Everyone have a great weekend. It is time for me to go home.

[stophorseabuse]

Maybe I am one of the few that gets DC's persona. Remember, these handles make up rather fictional personalities, with a bit of our real personality in there. DC just comes across dry and snide to get his point across. I have to be honest too, I struggle to accept the view of doctors or anyone that stands to lose profit from this bill. Frankly, I just really don't accept anything that comes from the upper middle class and above.

I absolutely understand all of that group is not evil, but I also know those groups have the money to influence public opinion, are NOT in the same position as most Americans, and are clever enough to do it or wouldn't be in that financial position to start with.

KM, you are in a tough position to influence opinion on this as you don't represent those who need improved healthcare. In addition to that, I don't think people greatly trust doctors right now. It is ABSOLUTELY not personal, but it is how the rest of us have to protect ourselves. Be wary of those who stand to gain or lose financially.

[kmcrawfo]

Maybe I am one of the few that gets DC's persona. Remember, these handles make up rather fictional personalities, with a bit of our real personality in there. DC just comes across dry and snide to get his point across. I have to be honest too, I struggle to accept the view of doctors or anyone that stands to lose profit from this bill. Frankly, I just really don't accept anything that comes from the upper middle class and above.

I absolutely understand all of that group is not evil, but I also know those groups have the money to influence public opinion, are NOT in the same position as most Americans, and are clever enough to do it or wouldn't be in that financial position to start with.

KM, you are in a tough position to influence opinion on this as you don't represent those who need improved healthcare. In addition to that, I don't think people greatly trust doctors right now. It is ABSOLUTELY not personal, but it is how the rest of us have to protect ourselves. Be wary of those who stand to gain or lose financially.

As I said in my last post, I stand to lose far less and will affected far less than the vast majority of Americans with this bill. Doctors are not the enemy, they give more in terms of time/money/charity than most any other profession. You can not balance the budget on the backs of docs, or provide good healthcare by undermining them.

Docs will be fine, it is the quality and quantity of care that will suffer. Wait and see.

[ArizonaXUGrad]

It is ABSOLUTELY not personal, but it is how the rest of us have to protect ourselves. Be wary of those who stand to gain or lose financially.

It is difficult to get a man to understand something when his salary depends upon his not understand it - Upton Sinclair

That said, I spent probably 5 years at PricewaterhouseCoopers and you would not believe how many partners totally disagreed with the creation of the PCAOB (basically government oversight over audits) in the aftermath of the Enron scandal and Anderson's demise.

The same goes for regulating the derivative market after the 2008 financial collapse. Even though we haven't done nearly enough there you should be getting my point.

[stophorseabuse]

Arizona grad, I have NO IDEA what you just said. I understand all the words, but together they make no sense to me. I think I appreciate your insight?

Sincerely,

Guy not into money or material things with no background in business.

[LadyMuskie]

Arizona grad, I have NO IDEA what you just said. I understand all the words, but together they make no sense to me. I think I appreciate your insight?

Sincerely,

Guy not into money or material things with no background in business.

He's saying that those people who are going to be dealing with the regulations and/or changes and/or upheaval the most are (in general) those most opposed to the law (like how some Wall Street types hate the new regulations post 2008 or how some IT professionals loathe Sarbanes-Oxley). In other words, in this case, doctors and insurance companies will try and scare you into believing that this new health care law is going to be the end of western medicine and maybe western civilization as we know it. But, in reality, it won't be. It's really just that everyone is scared of the unknown, including physicians who don't want the status quo disrupted in any way.

[stophorseabuse]

Basically just confirmation of what I suggested a few posts ago about km being in a poor position to shape this issue. I pretty well got the gist, just not the specific language of the business field.

[kmcrawfo]

Basically just confirmation of what I suggested a few posts ago about km being in a poor position to shape this issue. I pretty well got the gist, just not the specific language of the business field.

I am telling each of your to actually research the law and not what others tell you it says. It will be the end of modern western medicine. Research it, read it, and educate yourselves. This law will transform western medicine into a European style healthcare system. If that is what you want, then great.

I have no problem with the status quo changing, if it is for the better. Unfortunately, this only will make things worse for everyone.

[stophorseabuse]

I'm not reading 2000 pages, but anything that eliminates prejudice against the sick by rich corporations I support. I agree it's not the plan I want, but at least it gets everybody the opportunity for health insurance. My wife and I are getting a divorce this month so she can get treatment for her endometriosis.

The American Dream

[GoMuskies]

What about prejudice against the sick by poor corporations?

[LadyMuskie]

I am telling each of your to actually research the law and not what others tell you it says. It will be the end of modern western medicine. Research it, read it, and educate yourselves. This law will transform western medicine into a European style healthcare system. If that is what you want, then great.

I have no problem with the status quo changing, if it is for the better. Unfortunately, this only will make things worse for everyone.

Hmmmm . . . I have quite a few friends who are doctors. They range in practice from primary care physician to radiologist. Most are for the law, and a few are against, but none of them are building a bunker the way you are.

Also, most people consider Europe part of the "west". America is not the center of the universe, or "western" anything.

[Porkopolis]

It will be the end of modern western medicine.

If you believe that the United States and our dysfunctional system contains the entirety of "western medicine" then I suppose you are right.

[ArizonaXUGrad]

I am telling each of your to actually research the law and not what others tell you it says. It will be the end of modern western medicine. Research it, read it, and educate yourselves. This law will transform western medicine into a European style healthcare system. If that is what you want, then great.

I have no problem with the status quo changing, if it is for the better. Unfortunately, this only will make things worse for everyone.

Last time I checked, Europeans still got great healthcare.

http://www.photius.com/rankings/healthranks.html

WHO ranked this last time in 2000, but don't plan on doing it again.

#1 was France and Europe was well represented. I was born in Germany which was 25th and a full 12 spots higher than USA at 37th.

I honestly think the US has the best healthcare as long as you are uber-rich. I think it starts to dramatically decrease with your level of wealth.

[Snipe]

It is difficult to get a man to understand something when his salary depends upon his not understand it - Upton Sinclair

That said, I spent probably 5 years at PricewaterhouseCoopers and you would not believe how many partners totally disagreed with the creation of the PCAOB (basically government oversight over audits) in the aftermath of the Enron scandal and Anderson's demise.

The same goes for regulating the derivative market after the 2008 financial collapse. Even though we haven't done nearly enough there you should be getting my point.

The Government didn't catch Enron, the market did. It is important to remember that. Enron's price plummeted way before the government came in. Then we put in regulations, but those regulations didn't catch other companies or prevent the last crisis. We have had a banking crisis around once a decade going back for awhile. We keep bailing them out, and we keep getting another crisis. What happened with Solyndra or the others than recently went bankrupt? How do we stop those? We funded those and we knew that they weren't financially viable.


He's saying that those people who are going to be dealing with the regulations and/or changes and/or upheaval the most are (in general) those most opposed to the law (like how some Wall Street types hate the new regulations post 2008 or how some IT professionals loathe Sarbanes-Oxley). In other words, in this case, doctors and insurance companies will try and scare you into believing that this new health care law is going to be the end of western medicine and maybe western civilization as we know it. But, in reality, it won't be. It's really just that everyone is scared of the unknown, including physicians who don't want the status quo disrupted in any way.

Where has government regulation worked the best? Honestly? Our government over a hundred people that were regulators who worked on site at AIG. They got up and went to AIG in the morning, and went home from AIG to eat and go to bed. They were not AIG employees, but government regulators. They didn't see the collapse of AIG coming. So I guess we need a hundred more regulators. Maybe we should have let AIG collapse.

The real regulation is that a fool and his money are soon parted. Let people fail.

The worst part of it is crony capitalism, because government regulation is a two way street. You can't have one without the other. The more government regulates businesses, the more it is in the best interests of the business sector to regulate government. You see that today. Our government has a large role in the private sector, and likewise our private sector has a large role in government. These two things are not unrelated.

Bill Gates once joked that he was "from the other Washington". Then he came under fire and had to testify before the Senate under anti-trust investigations. Now he has one of the largest lobbies in Washington. Wal Mart prided themselves on not having a thing to do with government, until people figured out if they couldn't beat them in the market they would lobby against the way that they do business. Now WalMart has one of the largest and well funded private business lobbies in DC. Our system is set up so that everyone has to pay, and everyone has to pay. So if you don't like businesses running your government, perhaps you should stop the government from running your businesses. You will never have one without the other.

[boozehound]

Last time I checked, Europeans still got great healthcare.

http://www.photius.com/rankings/healthranks.html

WHO ranked this last time in 2000, but don't plan on doing it again.

#1 was France and Europe was well represented. I was born in Germany which was 25th and a full 12 spots higher than USA at 37th.

I honestly think the US has the best healthcare as long as you are uber-rich. I think it starts to dramatically decrease with your level of wealth.

The top 20 of that list reads like a "Who's Who" of countries with crappy economies and lots of debt. Just sayin'.

[stophorseabuse]

The top 20 of that list reads like a "Who's Who" of countries with crappy economies and lots of debt. Just sayin'.

Rather have a crappy economy and lots of debt with top 20 healthcare than a crappy economy with lots of debt and #37 healthcare.

[Pete Delkus]

You can argue the benefit of health insurance coverage for people who currently aren’t enrolled….You can argue the positives in $0 coverage for procedures deemed mandatory by the Government.

However, I will argue until I die about the massive increase of cost heaped onto the private sector, and who will bear the brunt of the cost. I am sickened at the USA Today and their misleading, political headline they ran on the front page yesterday.

These authors claimed to have studied federal data arriving at this conclusion. ASK THE F’ING EMPLOYERS WHERE THE INCREASED COST WILL END UP!

I got ill, seriously, when I read that. When I tried to have a very civil discussion with a left leaning associate, his response was: “Well, why won’t Romney release his taxes”

There is state of our political debate at this very moment!


............


Few pay more taxes under health care law


By Kelly Kennedy and Richard Wolf, USA TODAY

WASHINGTON – President Obama's health care law is constitutional as a tax — but only a small percentage of Americans will pay more, a USA TODAY analysis of federal data shows.


President Obama discusses the health care law on June 28 following the announcement that the Supreme Court had upheld the legislation.


Though the law is projected to raise more than $800 billion in taxes, fees and penalties over a decade, 40% comes from about 3.5 million households with adjusted gross incomes above $200,000. Employers, insurers and health care providers are slated to fork over much of the rest.
That leaves only a few taxes that will fall partially on middle-income taxpayers:


•About 7 million people could pay more because the law makes it more difficult to deduct medical expenses. People with lower incomes are less likely to itemize deductions.

•About 4 million workers could pay more because of a new $2,500 limit on flexible spending accounts, which can be used to shield medical expenses from taxation.

•The tax that rendered the law constitutional, to be assessed on those who fail to buy mandated health insurance, could hit about 4 million people across all income brackets.

Several small taxes, such as one on indoor tanning salons, also could reach average taxpayers. Still, fewer than 10% of the nation's 140 million tax filers are likely to pay more.

The law's impact on middle-income taxpayers "is on average going to be relatively small," says Donald Marron, director of the non-partisan Tax Policy Center. "The bulk of the taxes are aimed at corporations and high-income folks."

•Tax on high-cost health insurance plans paid by health insurance companies.

•Annual fee on health insurance providers paid by health insurance companies.

•Increased Medicare tax paid by individuals making more than $200,000 a year or couples making more than $250,000 a year.

•Limited deductions for health expenses paid by individuals claiming $7,500 or more in health expenses.

•10% tax on tanning salon visits paid by people who use tanning salons.

•2.3% tax on medical devices that cost more than $100 paid by manufacturers and importers of medical devices.

•Higher tax on home sales for individuals who make more than $250,000 and couples who make more than $500,000 in profit on the sale of their homes.

Source: Joint Committee on Taxation


Republicans insist much of the tax burden will get passed along to middle-income taxpayers. Sen. Orrin Hatch, R-Utah, top Republican on the Senate Finance Committee, notes one in 10 of those taxed for failing to buy health insurance will be below the federal poverty level.

"Twelve of the 21 taxes in the Democrats' health care law will hit middle-class families," says House Ways and Means Committee Chairman Dave Camp, R-Mich. "That's a double-hit on both families and job creators already struggling with the high cost of health care."

On the other hand, about 18 million people will get tax credits if they buy health insurance plans through new federal or state exchanges.

"The Affordable Care Act is the largest health care tax cut in history," says Jason Furman, deputy director of the White House National Economic Council. "It will provide a significant net tax cut for middle-class families and the millions of Americans who will seek affordable insurance in the years ahead."

[LA Muskie]

You can argue the benefit of health insurance coverage for people who currently aren’t enrolled….You can argue the positives in $0 coverage for procedures deemed mandatory by the Government.

However, I will argue until I die about the massive increase of cost heaped onto the private sector, and who will bear the brunt of the cost.
Pete,

If the only thing you're interested in debating is which of our pockets the money comes out of, then it's a pretty meaningless debate. The private sector will bear the brunt of healthcare insurance, because the private sector needs healthcare. The government has taken money out of our pockets to fund healthcare for decades, under both left and right administrations and Congresses. This isn't something that President Obama and "leftists" suddenly sprung on us...

[Pete Delkus]

1) My overriding point was the fallacious headline and story, instigated by politics and Not by facts.

2) You say, " the private sector will bear the brunt of healthcare insurance, because the private sector needs healthcare."

I really don't understand what you mean. Isn't this administration's contention that healthcare is a right, and thus all should receive equal healthcare? Wouldn't this make every segment responsible for cost? I just don't understand what you are saying.

If you mean the private sector will continue to bear even MORE of the brunt, because of these seemingly jaw dropping new sets of taxes and fines (if you want examples, I'm in this business, I am working with clients daily, I can tell you what HHS has lent guidance on so far, and what is expected) then I agree. Yes, the % is shifting even more to everyday employee of "ABC Service Co.".

Bottom line is that there is strong probability, that if you work for private company, that you will either be released to the exchanges and your employer will pay the small per-person fine (which is low to encourage more people reliant on Govt' Healthcare - but will creep up for employers), OR experience more cost sharing in increased premiums and decreased benefits.

[LA Muskie]

I really don't understand what you mean. Isn't this administration's contention that healthcare is a right, and thus all should receive equal healthcare?
No. That's not the point. The point is that everyone should have access to healthcare insurance, and so the government is going to help allow individuals to purchase their own by negotiating the removal of private insurer exclusions, allowing the creation of exchanges (where pools for individual insureds can take advantage of volume pricing), and expanding the provision of government-insured healthcare for many of those who cannot afford either of those options.


If you mean the private sector will continue to bear even MORE of the brunt, because of these seemingly jaw dropping new sets of taxes and fines (if you want examples, I'm in this business, I am working with clients daily, I can tell you what HHS has lent guidance on so far, and what is expected) then I agree. Yes, the % is shifting even more to everyday employee of "ABC Service Co.".
Yes, I think we will pay more for healthcare insurance in the near term. But I don't think it will exceed the increases that the insurers otherwise would have pushed through. In fact, I believe the net increase will be less. The notion that the law is causing drastic increases in the cost of healthcare insurance is belied by the huge increases the industry has seen, year over year, for nearly 10 years now.


Bottom line is that there is strong probability, that if you work for private company, that you will either be released to the exchanges and your employer will pay the small per-person fine (which is low to encourage more people reliant on Govt' Healthcare - but will creep up for employers), OR experience more cost sharing in increased premiums and decreased benefits.
I see you have bought into the "sky is falling" mantra of the conservatives. As if everything is just hunky-dory with the current system.

Most large employers have been providing healthcare benefits for decades (if not longer), without any legal requirement to do so. It is not an altruistic endeavor on their part. They provide benefits because they want to recruit and retain employees. For that reason, I very much doubt this "prediction" will prove to be true. That is, unless you believe that the government can manage healthcare so much better than the for-profit insurers that they simply can't compete on access, price or quality. In which case, perhaps the for-profit insurers are in the wrong line of business in the first place.

[Pete Delkus]

1) Again, Point # 1 was about the article and Politics vs. Reality.

2) "Pay more but won't exceed". Wrong, Wrong already. Trend of typical increases for small group alone have shot from 8-12% to 16-18% in the last year or so... if you are telling me they will swing to single digits soon, to even out current increases, well maybe we should end this conversation. Not reality.

3) "Bought the Conservative Line"

No. This is direct conversations I have with groups on a day to day basis. Some of which pay $100 mill in claims a year, let alone admin and insurance cost. When the alternative is releasing all employees to exchanges and recouping 80% of that cost annually, answer me this question, do you think they are bluffing or just reciting the "conservative" line?

These are not financial firms and oil companies. These are true midwestern-based manufacturing and service companies, where these $ are substantial.

[GuyFawkes38]

Completely unrelated, but if you type in "Pete Delkus" into google, you receive a profile for him from google on the right side of the page.

http://www.google.com/#hl=en&output=search&sclient=psy-ab&q=pete+delkus&oq=pete+delkus&gs_l=hp.3..0l4.441.3779.0.3983.13.10.1.2.2.0.252.1 703.0j7j3.10.0...0.0...1c.eweA-LDujyI&pbx=1&bav=on.2,or.r_gc.r_pw.r_qf.,cf.osb&fp=2cf25f040aba1e2c&biw=1600&bih=734

Google just started doing this. It's a new status symbol to get a profile. Pete is a big shot. Very cool.

[blueblob06]

Completely unrelated, but if you type in "Pete Delkus" into google, you receive a profile for him from google on the right side of the page.

http://www.google.com/#hl=en&output=search&sclient=psy-ab&q=pete+delkus&oq=pete+delkus&gs_l=hp.3..0l4.441.3779.0.3983.13.10.1.2.2.0.252.1 703.0j7j3.10.0...0.0...1c.eweA-LDujyI&pbx=1&bav=on.2,or.r_gc.r_pw.r_qf.,cf.osb&fp=2cf25f040aba1e2c&biw=1600&bih=734

Google just started doing this. It's a new status symbol to get a profile. Pete is a big shot. Very cool.

Tu has one....Kenny Frease and Will Caudle do not...(sad face)

[LA Muskie]

1) Again, Point # 1 was about the article and Politics vs. Reality.
I agree it was a horrible headline. But that puts it in a class of about 90% of headlines. They almost universally suck.


2) "Pay more but won't exceed". Wrong, Wrong already. Trend of typical increases for small group alone have shot from 8-12% to 16-18% in the last year or so... if you are telling me they will swing to single digits soon, to even out current increases, well maybe we should end this conversation. Not reality.
I'm saying that insurance rates would have increased without PPACA even more than they will increase with PPACA. I say this because healthcare insurance rates have been increasing at unprecedented levels for the last decade without PPACA, and at least with PPACA there will be limits on the extent to which insurers can jack up rates.


3) "Bought the Conservative Line"

No. This is direct conversations I have with groups on a day to day basis. Some of which pay $100 mill in claims a year, let alone admin and insurance cost. When the alternative is releasing all employees to exchanges and recouping 80% of that cost annually, answer me this question, do you think they are bluffing or just reciting the "conservative" line?

These are not financial firms and oil companies. These are true midwestern-based manufacturing and service companies, where these $ are substantial.
If they are true midwestern-based manufacturing and service companies, then they are most likely unionized. And I very much doubt the unions will stand for dumping benefits, which are typically more aggressively negotiated than even wages. Add to that the tax advantages for small businesses to provide healthcare insurance benefits to their employees, and I really don't think we'll see a significant reduction. In fact, I think we may well see an increase in employer-sponsored healthcare insurance benefits given that small businesses finally will be able to provide cost-effective coverage, and they will be incentivized to provide provide it.

But even if there were wholesale benefits cuts at the employer level , that should just make the exchanges more cost competitive, because they will have an even greater critical mass on behalf of which to negotiate rates.

[waggy]

CintasCEO Scott Farmer sent an email to employees earlier this month detailing his concerns about Obamacare and the potential of the election to result in higher taxes and regulation for businesses, a company spokeswoman has confirmed.


It’s important for each of our voices to be heard this Election because the decisions that are made and the policies that are set by our government impact each of us personally as individuals. These decisions and policies could also have a significant impact on Cintas – on our ability to run our business effectively and efficiently, on our ability to attract and retain customers and on our ability to provide the level of benefits, opportunities, and development we believe our partners want, need and deserve.

http://cincinnati.com/blogs/politics/2012/10/29/cintas-ceo-rails-against-obamacare-in-email/

[Frambo]

In addition to Farmer's email, my brother-in-law is a doctor who was a huge Obama supporter four years ago. He is now voting for Romney. When I asked him why, his response was obamacare.

[paulxu]

Well, that all makes sense. Vote for the first guy to have universal health care coverage...not the second.

[DC Muskie]

In addition to Farmer's email, my brother-in-law is a doctor who was a huge Obama supporter four years ago. He is now voting for Romney. When I asked him why, his response was obamacare.

It's funny, I have a buddy who owns a private practice in Colorado who supported Obama in 2008 and is voting for Obama again. His primary reason, Obamacare.

I certainly didn't read that email as intimidation, just sorta funny. I wonder what Romney's opinion would be if the state of Ohio decided to keep Obamacare if he was elected president.

[bobbiemcgee]

It's funny, I have a buddy who owns a private practice in Colorado who supported Obama in 2008 and is voting for Obama again. His primary reason, Obamacare.

I certainly didn't read that email as intimidation, just sorta funny. I wonder what Romney's opinion would be if the state of Ohio decided to keep Obamacare if he was elected president.

I see another 400 posts coming....

[waggy]

It's funny, I have a buddy who owns a private practice in Colorado who supported Obama in 2008 and is voting for Obama again. His primary reason, Obamacare.

I certainly didn't read that email as intimidation, just sorta funny. I wonder what Romney's opinion would be if the state of Ohio decided to keep Obamacare if he was elected president.

What's your buddys name? Does he have a website? Farmer is quoted, and I gave a link. Cintas Corp is a pretty big endeavor.

[DC Muskie]

What's your buddys name? Does he have a website? Farmer is quoted, and I gave a link. Cintas Corp is a pretty big endeavor.

Yes and Yes.

What's your point? What's Farmer's point? Why did he pick Obamacare? Why now? Since Cintas is a pretty big endeavor, what's Famrer's opinion on Cintas's position on the Liddy Ledbetter Act? How will that affect Cintas and their customers do business?

That's why it's so funny. Famer can do whatever he wants, that's fine. I just find the humor.

[waggy]

Your buddys name is Yes?

That IS funny.

[DC Muskie]

It's even funnier when you tell him no.

[waggy]

I wonder if Cintas employees are laughing? Actually I'm pretty sure they're not.


According to the Supreme Court, the new health care law amounts to the single largest tax on Americans and business in history. We have spent a lot of time over the past months trying to understand the impact that the new law will have on our company. Currently, Cintas spends $130 million providing competitive healthcare benefits for our partners. Under the new law, we estimate that our health care costs will increase by over $50 million, taking the total we would need to spend to provide the same level of coverage we are currently providing to $188 million.

While one of the original intents of the new health care law was to provide broader access to health care for all people, the law is actually set up to allow companies to eliminate their health care coverage and instead pay a penalty of $2,000 per employee.

Cintas understands the importance of competitive, comprehensive health care coverage to the health, well-being, and engagement of our partners and has no intention of dropping coverage at this time. For perspective, consider that this penalty would cost Cintas about $50 million – that’s about 30% of what Cintas’ health care costs ($188 million) would be if we continue to offer health care coverage to our partners. Now consider the potential impact that the law could have on the many smaller and/or less fiscally solvent companies that make up our communities. These businesses are our customers and they employ our friends and family.


The reason I asked about Yes' business is because, well, it may not actually exist. ....Doctors often work for various health care providers, and don't actually run a business.

[DC Muskie]

What's really funny is how my response to Frambro's post of why his doctor friend was voting for Romney has you questioning my if doctor friend actually runs a business.

Actually what's even funnier is how you seem to completely miss the point of why it's funny Farmer even sent the email.

I'm not sure what your point is, or where you are going with this...but if I had to guess you approve of the email, which I could care less about. Doesn't change my opinion that the email was pretty funny on its premise.

As for the Cintas employees, I'm sure they are laughing at the idea that their employer while laying out their strong feelings about the new health care law, have no intentions to drop their coverage.

Which again leads us right back to how funny the email is in the first place.

[waggy]

What's really funny is how my response to Frambro's post of why his doctor friend was voting for Romney has you questioning my if doctor friend actually runs a business.

Actually what's even funnier is how you seem to completely miss the point of why it's funny Farmer even sent the email.

I'm not sure what your point is, or where you are going with this...but if I had to guess you approve of the email, which I could care less about. Doesn't change my opinion that the email was pretty funny on its premise.

As for the Cintas employees, I'm sure they are laughing at the idea that their employer while laying out their strong feelings about the new health care law, have no intentions to drop their coverage.

Which again leads us right back to how funny the email is in the first place.

Let's clear up what's funny and what is not. Your buddy the doctor is funny; Farmers email is not.

Frambo related something from close family. Your goofy doctor buddy lives all the way in Colorado, clearly doesn't run a business, and is probably a chiropractor.

[Frambo]

Let's clear up what's funny and what is not. Your buddy the doctor is funny; Farmers email is not.

Frambo related something from close family. Your goofy doctor buddy lives all the way in Colorado, clearly doesn't run a business, and is probably a chiropractor.

I'll see him saturday for the Breeder's Cup party and verify his position, although that is what he told me a few weeks ago. Hopefully his older brother (also an MD) will be there too for his opinion.

[XU-PA]

thanks so much for resurrecting a long dead thread,,,,,, zzzzzzzz.
actually, the doctor claim (working for romney because of obamacare) reminds me of so many claims we heard back in 2009. a very close friend, on his return from the doctors office back then, said that his doctor was ready to hang it up, quit practicing medicine alltogether, because the affordable care act would require him to spend tens of thousands of dollars for a new billing system that it required. Remember hearing how many physicians were going to quit? I don't recall hearing much about that, not sure that any have decided to give up a 6 figure income and hit the streets as a sign waver for the local gold buyer.
and yes, i put as much stock in those claims from ceo's about how tough it will be to do business when the act takes full effect. it's always best to avoid talking politics at work, that advice especially for bosses and owners. initially you look like an ass, then after the fact the workers consider you a big liar.

[paulxu]

I tried to find out where the "Supreme Court" (per the Cintas letter) actually said the health care law was the largest tax increase ever. I couldn't find that. It is not the "largest" but that makes for good reading.

Today's WSJ has an interesting article about the impact of the law, especially on small businesses and individuals who might decide to opt for part time work to get medical subsidy, vs. full time, with employee sponsored that would less beneficial. Not sure how many people/businesses it would affect, but there are some things that need to be worked out in that area. Really a good read, although WSJ has a paywall so linking doesn't help.

It also points out a very large effective subsidy from the government that is often overlooked...the favorable tax treatment that employers who offer health care (the sort of traditional American model) get, versus employers who do not offer that as a benefit. In a simple example, you might choose to work for an employer who offers the same wage with health care coverage...over an employer who offers the same wage without it. All taxpayers support the "subsidy" the government offers the first employer through the tax treatment of that expense.

[DC Muskie]

Let's clear up what's funny and what is not. Your buddy the doctor is funny; Farmers email is not.

Frambo related something from close family. Your goofy doctor buddy lives all the way in Colorado, clearly doesn't run a business, and is probably a chiropractor.

What? Are you trying to be funny because you, unlike your friend Farmer, are falling flat.

[waggy]

thanks so much for resurrecting a long dead thread,,,,,, zzzzzzzz.


LOL. Sorry if you read the entire thread again, but if you'd learn how to work the forum tools it wouldn't be necessary.

[waggy]

What? Are you trying to be funny because you, unlike your friend Farmer, are falling flat.

No, I highlighted the fact that your make believe chiropractor friend, with his make believe business, isn't analogous to the CEO of Cintas.

[DC Muskie]

No, I highlighted the fact that your make believe chiropractor friend, with his make believe business, isn't analogous to the CEO of Cintas.

Okay. Not sure why you connected those two, because I brought up Yes in response to Frambro's post about why his doctor friend was voting for Romney.

Your connection makes about as much sense as Farmer's email to his employees.

[waggy]

Obamacare Dramatically Increases The Cost of Insurance for Young Workers
(http://www.forbes.com/sites/theapothecary/2012/03/22/how-obamacare-dramatically-increases-the-cost-of-insurance-for-young-workers/)

Before the Patient Protection and Affordable Care Act became law, Gruber published a widely-cited analysis (http://voices.washingtonpost.com/ezra-klein/Gruber%20sfc%20nongroup%20premium%20analysis%2010-12-09.doc), using his Gruber Microsimulation Model, in which he asserted that in 2016, young people would save 13 percent, and older people 31 percent, on their insurance premiums. Gruber’s numbers were used to rebut an October 2009 analysis (http://blogs-images.forbes.com/aroy/files/2012/02/PWC-Report-on-Costs-Final.pdf) from PriceWaterhouseCoopers, which projected that non-group (a.k.a. individual-market) premiums would increase by 47 percent over the same period.

Ezra called the PwC report “deceptive (http://voices.washingtonpost.com/ezra-klein/2009/10/the_insurance_industrys_decept.html).” Jonathan Cohn, noting that the report was commissioned by the insurer trade group, AHIP, described it as “the insurance industry declaring war (http://www.tnr.com/blog/the-treatment/breaking-the-insurance-industry-declares-war).” After Obamacare was signed into law, Cohn described the Gruber-led counterattack against PwC as a turning point (http://www.tnr.com/blog/the-treatment/finishing-the-treatment) in the fight to get the bill passed:

I think the costs are going up for everyone, not just young people. Just another fleecing at the hands of Washington scumbags.

[bobbiemcgee]

Less than 4 months until the 1st enrollee signs up and nobody knows shit.

[waggy]

Democrats' New Argument: It's A Good Thing That Obamacare Doubles Individual Health Insurance Premiums


Experts in the economics of health insurance understand that this has been Obamacare’s central flaw from the beginning. The law’s heavy-handed approach to the health insurance market massively drives up premiums for the average person.

http://www.forbes.com/sites/theapothecary/2013/06/03/democrats-new-argument-its-a-good-thing-that-obamacare-doubles-individual-health-insurance-premiums/#comment-7460

[ArizonaXUGrad]

Democrats' New Argument: It's A Good Thing That Obamacare Doubles Individual Health Insurance Premiums



http://www.forbes.com/sites/theapothecary/2013/06/03/democrats-new-argument-its-a-good-thing-that-obamacare-doubles-individual-health-insurance-premiums/#comment-7460

Or instead of freaking out, we can just wait and see what happens. I can assure you as a former PwC long time employee that they cater to whomever is paying the bill.

[LA Muskie]

The CA exchange rates were released last week. Overall increase over average individual policies pre-mandate, but the increase was about 50% less than the "estimates".

[Pete Delkus]

So you are measuring cost of insurance based on the California exchange pricing?

Boy, what a measure of the effectiveness of the ACA!

45% of folks receive their health benefits from their employer, and I bet the eyes on this board amount to an even greater percentage. So when ALL Obamacare employer mandates are running fill throttle at the same time, will you come here an imply "Hey, it's working, individual policies in CA are cheaper than expected?"

Say when the FINES AND TAXES are levied AGAINST employers by the IRS for noncompliance for look-back calculation & benefit eligibility, Auto-Enrollemt, State Exchange Notifications, Wait Periods, Employer Shared Responsibility, Grandfather Plans, Employee Opt-Out Survey, tons of Expanded Coverages, Affordability fines = 9.5%, Employer Reporting, SBC … PLUS taxes on Health Insurers, Cadillac Tax, Rx Tax, Medical device tax, hospitals re-admittance and MLR…will you use "Adjusted" CA exchange as your measure?


Kathleen Sebelius and crew, slicing the neck of employers and employees in the business world, small and large...uttering to business owners, "The Obama's send their regards"
The Real Red Wedding!

[paulxu]

Pretty easy to see why single payer works so much better at about 1/2 the cost when I read that list.

[Pete Delkus]

Oh, One Payer! I love the incentive of...GETTING WHAT THE NEXT GUY GETS, to really propel Doctors and Medical innovators to design the technology and efficiencies of the future.

Remember this, the next time you are in a hospital and the nurse says "This new machine allows me scan you from the outside, and doesn't make me enter through an artery in your upper thigh".

Profit has a big part in creating our current crop of life saving Rx and procedures.

[waggy]

A Reason for Conservatives to Love Obamacare (http://www.cnbc.com/id/100791774?__source=xfinity|mod&ticket=ST-54113-uDPvn71nLjXgK4geGx6XkwLdBQugtjpacqS-20&rememberMe=null)


"This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges, where many will pay higher costs for poorer insurance with a more limited network of providers," wrote UFCW president Joe Hansen in an opinion piece on the union's web site (http://www.ufcwaction.org/2013/05/21/ufcw-president-joe-hansen-in-the-hill-treat-nonprofit-healthcare-fairly/). "In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab."

That channeling may already be happening, even before the law goes into full effect next year.

"I just ended negotiations between a union and a company over health care benefits," said Marc Bloch, a labor and employment lawyer at Walter & Haverfield in Cleveland, Ohio.

"The union didn't like the plan the company offered, but the company said it would rather drop the plan, and pay the fine that comes with Obamacare," Bloch explained. "They determined it was cheaper to pay the fine than continue with the coverage. I think you're going to see more of that in the future."

[waggy]

Union Calls for Repeal of Obamacare (http://www.unionroofers.com/political/issue.aspx/49775)


Washington, DC – United Union of Roofers, Waterproofers and Allied Workers International President Kinsey M. Robinson issued the following statement on April 16, 2013, calling for a repeal or complete reform of President Obama's Affordable Care Act (ACA).

Our Union and its members have supported President Obama and his Administration for both of his terms in office.

But regrettably, our concerns over certain provisions in the ACA have not been addressed, or in some instances, totally ignored. In the rush to achieve its passage, many of the Act's provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer sponsored coverage could keep it.

These provisions jeopardize our multi-employer health plans, have the potential to cause a loss of work for our members, create an unfair bidding advantage for those contractors who do not provide health coverage to their workers, and in the worst case, may cause our members and their families to lose the benefits they currently enjoy as participants in multi-employer health plans.

For decades, our multi-employer health and welfare plans have provided the necessary medical coverage for our members and their families to protect them in times of illness and medical needs. This collaboration between labor and management has been a model of success that should be emulated rather than ignored. I refuse to remain silent, or idly watch as the ACA destroys those protections.

I am therefore calling for repeal or complete reform of the Affordable Care Act to protect our employers, our industry, and our most important asset: our members and their families.

:tonguewag:

[waggy]

Less than 4 months until the 1st enrollee signs up and nobody knows shit.

Linda Blumberg, health economist at the Urban Institute:


It's premature right now for people to be figuring out whether they can afford this

:pointandlaugh:

[waggy]

Liberty Hospital laying off 129

LIBERTY, Mo. —Liberty Hospital is laying off 129 workers, citing upcoming federal changes in health care. Hospital points to federally mandated healthcare changes in 2014:


"In 2014 the Affordable Care Act will reduce payments to hospitals from Medicare. Hospitals also will experience reduced payments due to the lack of an expansion to the Medicaid program and growing bad debt due to patients being forced to manage increased out-of-pocket costs in the form of deductibles, co-pays and insurance premiums. The healthcare reforms, which began affecting hospitals in 2010, already have encouraged hospitals to focus on fiscal responsibility and to find ways to balance revenue loss with patient care," according to a statement from the hospital.

The hospital said that the cutbacks are occurring through May 24. In addition to staff reductions, the hospital said a task force recommended eliminating the hospital-funded transportation program and closing its wound clinic.

http://www.kmbc.com/news/kansas-city/liberty-hospital-laying-off-129-workers/-/11664182/20140022/-/10eslapz/-/index.html#ixzz2THuK3IoT

[waggy]

Insurers predict 100% to 400% Obamacare rate explosion


Internal cost estimates from 17 of the nation's largest insurance companies (http://energycommerce.house.gov/letter/letters-health-insurance-companies-regarding-ppacas-effect-health-insurance-premiums) indicate that health insurance premiums will grow an average of 100 percent under Obamacare, and that some will soar more than 400 percent, crushing the administration's goal of affordability.

New regulations, policies, taxes, fees and mandates are the reason for the unexpected "rate shock," according to the House Energy and Commerce Committee, which released a report Monday (http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/analysis/insurancepremiums/FinalReport.pdf) based on internal documents provided by the insurance companies. The 17 companies include Aetna, Blue Cross Blue Shield and Kaiser Foundation.

http://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523

[bjf123]

And after the 100-400% increase, those on the left will use that as a reason to bring up a one payer system so they can control costs.


Sent from my iPhone using Tapatalk

[Pete Delkus]

It's time for some Obamacare Fun Math. I am going to make up a "large" group and show the penalty for a company that violates 1 of the "Employer Responsibility Provisions".

Who: Musketeer Gameday Trinkets


200 employees
$1,957,335 in annual medical plan payment
Sally in HR, knows she isn't an Obamacare expert, but has told Jane, the CFO, that she thinks they are "OK because they offer a 'good' plan through Anthem."


Lets say 190 of the employees are clearly full-time (Over 30 hours). However, they hire about 10 drivers to deliver these trinkets during basketball season. If they don't offer these 10 health insurance, yet because of increased business, these folks start working over 30 hours, this company is still compliant because of the 5% error factor "allowed" by Obamacare.

However, if they make 1 more 'error' and it jumps to 5%+, they pay a fine of….

$2,000 X 170 = $340,000

$340K on top of the $2,000,000 they just paid in medical plan payment

This is JUST ONE OF MANY "Gotcha" provisions in this law.

[boozehound]

Insurers predict 100% to 400% Obamacare rate explosion



http://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523

All the (justified) angst around Obamacare makes me wonder if we aren't heading toward a single payer system. I'm also not sure that it would be have to be the worst thing in the world, if executed properly. I also have no faith that it would be executed properly.

Here is why (I think) we end up with a single payer system:

We seem to have determined that we are going to provide medical care to all people regardless of there ability to pay. We don't refuse medical care just because someone has no insurance or means to pay. We can argue whether that is the right thing to do, but it probably isn't going away.

The other factor in all this is the post-pension retirement era that we are just now starting to see. In the past you worked for a company for 30 years and they provided you with a pension and healthcare benefits on their group plan for life. Some companies paid your premiums while other companies asked you to pay the premiums after retirement but you still had access to group health care rates. Now more and more companies are not providing health benefits to retirees which is going to push more people to Medicare.

Medicare is a bad deal for the government and the taxpayers because people start receiving benefits after retirement age when (statistically) most of their health care problems occur. If you tried to run an insurance company that only insured people over the age of 65 your monthly premiums would be through the roof. If we reach a point where the typical worker has group health insurance through an employer from 25-65 and pays 40 years of premiums to a private company that is making a profit then switches over to Medicare we are going to have a major problem funding Medicare.

I'm not a huge fan of a single payer system for reasons cited above (medical innovation, losing doctors to other countries, etc.) but I also don't know how sustainable Medicare will be without a massive influx of funds. One possible way to generate those funds would be a singler payer system in which the government, who is picking up the tab after 65 anyways, gets the benefits of the premiums the young and healthy are paying. Like a giant group health care plan.

For me, in a perfect world, I would look at a single payer system upon which people can either pay out of pocket or purchase supplemental insurance to increase their standard of care. I do believe that the wealthy are entitled to better health care if they are willing and able to pay for it. There can be a 'baseline' standard of care for everyone and the option for the wealthy to purchase 'premium care'.

[waggy]

My view is the big problem with healthcare in the US is the cost. Pretty sure some other posters have posted graphs and links in this thread about this. But just google it if in doubt. We spend way more money. Like a whole lot more. These dollars are going somewhere....

To me if the government really wanted to help the people, they'd get into the price fixing business. Let's determine what a reasonable cost is for a procedure and only permit a certain percentage of variance. This wouldn't be that hard (or costly) because trust me the insurance companies pretty much already have a handle on it.

And I'm not saying being the medical field shouldn't be financially rewarding. The numbers for the US vs. the rest of world are stupid.

[waggy]

"Health Insurance Costs to Increase Significantly Under Affordable Care Act"

http://www.insurance.ohio.gov/Newsroom/Pages/06062013ACAProposedRates.aspx

[boozehound]

My view is the big problem with healthcare in the US is the cost. Pretty sure some other posters have posted graphs and links in this thread about this. But just google it if in doubt. We spend way more money. Like a whole lot more. These dollars are going somewhere....

To me if the government really wanted to help the people, they'd get into the price fixing business. Let's determine what a reasonable cost is for a procedure and only permit a certain percentage of variance. This wouldn't be that hard (or costly) because trust me the insurance companies pretty much already have a handle on it.

And I'm not saying being the medical field shouldn't be financially rewarding. The numbers for the US vs. the rest of world are stupid.

I believe that reduced costs through price fixing is exactly what proponents of a single payer system tout as one of the core advantages of that healthcare system. The medical field doesn't like it at all because it will reduce their profits. The insurance industry really doesn't like it. Advocates of little government don't like it either, for obvious reasons.

I understand where both sides are coming from on this issue, I'm just not sure we are going to be able to avoid eventually ending up at a single payer system.

[Pete Delkus]

Why stop at Medical? One payer for life insurance too, guarantee issue?
I demand Long and Short Term Obama-Dis-O-Bility!
Dental?
Sure, why not?
Cell Phones ...
Already Done!

What else ya got ?

ummm...Critical Illness and Accident?
DONE annnnnnnnnnnd DONE

Happiness Expert?
I have a buddy in the IRS who's got that number for you...COMPED!

Love to be in the fox hole with you folks!

Love this One-Payer system.

[GuyFawkes38]

For me, in a perfect world, I would look at a single payer system upon which people can either pay out of pocket or purchase supplemental insurance to increase their standard of care. I do believe that the wealthy are entitled to better health care if they are willing and able to pay for it. There can be a 'baseline' standard of care for everyone and the option for the wealthy to purchase 'premium care'.

This would be illegal with Canada's single payer system (and most others). What you are describing is closer to the English system which, IMHO, is ideal (a basic, crude free safety net for everyone, but it's legal to purchase additional care). Some comlain that England has 2 tiered, classist system. But we have to accecpt that not everyone will receive the same level of care. Some people will make more money than others and will want to spend more on health care and that should be ok.

[boozehound]

Why stop at Medical? One payer for life insurance too, guarantee issue?
I demand Long and Short Term Obama-Dis-O-Bility!
Dental?
Sure, why not?
Cell Phones ...
Already Done!

What else ya got ?

ummm...Critical Illness and Accident?
DONE annnnnnnnnnnd DONE

Happiness Expert?
I have a buddy in the IRS who's got that number for you...COMPED!

Love to be in the fox hole with you folks!

Love this One-Payer system.

I have no idea what you are trying to say here, other than that you hate Obama and everything he does. To the point that you can't even talk about healthcare without bringing up phones and and bunch of other shit that has nothing to do with health care. I get that you don't like entitlements. I don't like them either. I think that the wealthy should be able to buy anything they want, and that they should have better lives than the poor. They earned it. I also realize that we live in a country in which we simply are not going to let poor people die because they don't have medical insurance. We are going to provide care for these people, so we have to find a way to pay for it.

What is your (realistic) solution? Keep paying for poor and elderly people's health care anyways out of taxpayer coffers while insurance companies profit on the 25-65 working crowd?


This would be illegal with Canada's single payer system (and most others). What you are describing is closer to the English system which, IMHO, is ideal (a basic, crude free safety net for everyone, but it's legal to purchase additional care). Some comlain that England has 2 tiered, classist system. But we have to accecpt that not everyone will receive the same level of care. Some people will make more money than others and will want to spend more on health care and that should be ok.

Exactly. Baseline care for everybody with the option to purchase better care. What is the point of being rich if you can't pay for better things than if you were poor? What is more important than medical care? If you are rich and want better care you should absolutely be allowed to pay for it.

I wouldn't really have a problem with our current system if we still lived in an environment in which companies provided healthcare for retirees, but that is rapidly being phased out. I just don't see why we should allow insurance companies to profit on people during their working years and then have the government pick up the tab once they retire. At least with some type of single payer system we can use the premiums from the healthy people pay to offset the healthcare costs of the elderly. Medicare costs are going to spiral out of control over the next 10-20 years. We need to have some kind of plan to pay for that.

[Pete Delkus]

"I also realize that we live in a country in which we simply are not going to let poor people die because they don't have medical insurance. We are going to provide care for these people, so we have to find a way to pay for it.

What is your (realistic) solution? Keep paying for poor and elderly people's health care anyways out of taxpayer coffers while insurance companies profit on the 25-65 working crowd?"

We have to find a way to pay for it?
-Obama's way - GIVE (in some way, up to 400% of poverty line) people full blown heath insurance policies. Stacked with mandated, and pre-paid coverages that can't be to rich (Cadillac Tax) or to lean (Mandated benefit penalty). So magically everyone is closing in on some type of semi-robust policy with only a few variances. Businesses, Rx, Medical Innovation, Hospitals getting killed.

-Single Payer - Taxes SKY-ROCKET on everyone to pay for some type of equal plan for all. Doc's & Hospitals run the for the hills as Medicare reimbursement is AWFUL!

-Current - Some have insurance, some don't. The folks who don't, only utilize care when they are in an emergency or sick. Our Premiums are higher to offset the hospitals right-off of these folks.

My contention is that it is cheaper to account for the "Sunk Cost" of emergency poor care, than it is for us to pay for Full-Blown health care policies for all! Yes, we pay for it in more expensive premiums, but at of less of a cost than a single payer or Obamacare.


Almost last. Insurance companies are not philanthropic by any means. However, an insurance company is essentially a 'buying association' that drives down cost for it's policy holders. If you think your Carrier isn't providing you the buying power you need, than competition should supply you alternatives that you can shop. Now, there is little competition in the market because of both over-regualtion and Crony Capitalism...both awful to the free market.

Lastly - People wreck insurance companies. However, I dare you to find entities, outside of hospital systems, that invest more money into general population "wellness". The BILLION$$ of dollars that have been invested in Disease Management, Wellness Programs, Predictive Modeling (alerting an employee of gaps in care) is mind-boggling.

Insurance companies and your Employer really, really don't want you to be a catastrophic claim. That's why Wellness programs and Disease Management mean so much to these groups.

A one-payer system (government bureaucracy) would never produce the type of Wellness that the private market has generated.

[paulxu]

-Single Payer[/U] - Taxes SKY-ROCKET on everyone to pay for some type of equal plan for all. Doc's & Hospitals run the for the hills as Medicare reimbursement is AWFUL!

A one-payer system (government bureaucracy) would never produce the type of Wellness that the private market has generated.

Just for the record, a couple of items:

- The majority (60%) of doctors surveyed by the University of Indiana favored a single payer system
- Single payer systems are not government bureaucracies; only in England is that the case. The rest of the developed world uses private, nonprofit companies to process claims
- Single payer systems measured across Wellness provided far exceed our private coverages...if for no other reason than they cover everyone with primary care and prevent problems from skyrocketing with resultant costs
- The US pays on average twice what the rest of the world pays, for care that is, for the whole population, not better (sure Mayo Clinic is good if you are one of the few treated there)

We have a complicated, dysfunctional system. I hope we figure it out in time for my grandkids.

[Strange Brew]

(a basic, crude free safety net for everyone, but it's legal to purchase additional care).

Wow guy, you must be the sole American privy to the vote in Congress and the Presidential signature that eliminated Medicare and Medicaid. For are they not the the crude, free safety net you are longing for this country to adopt?

[boozehound]

"I also realize that we live in a country in which we simply are not going to let poor people die because they don't have medical insurance. We are going to provide care for these people, so we have to find a way to pay for it.

What is your (realistic) solution? Keep paying for poor and elderly people's health care anyways out of taxpayer coffers while insurance companies profit on the 25-65 working crowd?"

We have to find a way to pay for it?
-Obama's way - GIVE (in some way, up to 400% of poverty line) people full blown heath insurance policies. Stacked with mandated, and pre-paid coverages that can't be to rich (Cadillac Tax) or to lean (Mandated benefit penalty). So magically everyone is closing in on some type of semi-robust policy with only a few variances. Businesses, Rx, Medical Innovation, Hospitals getting killed.

-Single Payer - Taxes SKY-ROCKET on everyone to pay for some type of equal plan for all. Doc's & Hospitals run the for the hills as Medicare reimbursement is AWFUL!

-Current - Some have insurance, some don't. The folks who don't, only utilize care when they are in an emergency or sick. Our Premiums are higher to offset the hospitals right-off of these folks.

Taxes would definitely skyrocket in a single payer system, but have you ever looked at what you pay for health insurance? Not just the amount you pay, but the premium your employer pays as well. It can easily get above $1K per month for you and a spouse.


My contention is that it is cheaper to account for the "Sunk Cost" of emergency poor care, than it is for us to pay for Full-Blown health care policies for all! Yes, we pay for it in more expensive premiums, but at of less of a cost than a single payer or Obamacare.


I don't know about that. I would think that if it was cheaper to eschew preventative care in favor of emergency care if necessary then my insurance provider wouldn't be pushing people so hard to keep up on preventative care. The bills for preventative care are quite reasonable, IMO. The emergency service bills are the ones that can get insanely expensive. My guess is that my insurance company is pushing me to keep up on preventative care because their actuaries have determined it to be cheaper. I could be wrong, though.


Almost last. Insurance companies are not philanthropic by any means. However, an insurance company is essentially a 'buying association' that drives down cost for it's policy holders. If you think your Carrier isn't providing you the buying power you need, than competition should supply you alternatives that you can shop. Now, there is little competition in the market because of both over-regualtion and Crony Capitalism...both awful to the free market.

Most people who have health insurance have it through their companies. I don't have a lot of options. I have an option for 3 different plans administered by the same company.


Lastly - People wreck insurance companies. However, I dare you to find entities, outside of hospital systems, that invest more money into general population "wellness". The BILLION$$ of dollars that have been invested in Disease Management, Wellness Programs, Predictive Modeling (alerting an employee of gaps in care) is mind-boggling.

Insurance companies and your Employer really, really don't want you to be a catastrophic claim. That's why Wellness programs and Disease Management mean so much to these groups.

A one-payer system (government bureaucracy) would never produce the type of Wellness that the private market has generated.

The government has invested tons of money in space research. Too much in fact. I'm sure if we had a single payer system they would invest stupid amounts of money in medical research.

I also don't get why my insurance company doesn't want me to be a catastrophic claim, but earlier you say that you think it is cheaper for the country if poor people don't get preventative care and wait until they have a catastrophic event requiring emergency care.

My major beef with a single payer system is that I don't trust our government to administer it. I'm not sure we are going to have other realistic options in 20 years.

[waggy]

L.A. schools use your tax dollars teaching students to sell ObamaCare at home


...the Los Angeles Unified School District has designed a nearly $1 million program to train teenagers to promote the glories of ObamaCare to parents, relatives and friends at home.

The state's health insurance exchange, Covered California, is handing $990,000 to LA schools, along with federal grants totaling 36-million more U.S. taxpayer dollars to districts around the most populous state.

The goal is to train millions of student messengers statewide to sell the idea of government-subsidized health insurance to parents and relatives at home and to get more people enrolled in ObamaCare.

http://news.investors.com/politics-andrew-malcolm/062813-661774-los-angeles-schools-teach-students-to-enroll-parents-in-obamacare.htm

[coasterville95]

Pete - and my hunch down the road is the Maximum Benefits (Caddilac Tax Rule) and the minimum benfiets (Mandated Benefits Penalty) wil keep getting closer and closer together. The only question is how agressive will they be in this goal. The end result is "Sure, you can sell health insurance, but if you do your plan design has to be (insert official plan design specs here). Insurance comapnies then realize they all have to sell essentially the same exact product, the exchanges make their prices transparent, the "afforrdable" clause keeps the maximum rates down, and eventually the insureers say "screw it, we're not making the kind of money we used to - lets the government do it.

Employers - who are slated to be hit with a slew of taxes for every soul covered on their plans, burdonsome regulations on how to adminsiter their plans, which cut all the way dow to how they schedule their workforce, look at the "pennies on the dollar" penalty for not offering insurace, say "screw it, let's just give our staff an allowance and send them to the exchanges"

You end up with a single payer system - when you were sold a bill of goods that said the exact opposite - "we're going to force your employer to offer you a real, meaningful, and affordable health plan"

Then it's Run for the Hills time.

I only wonder - who will be the first major big time employer to ditch benefits and send their massive workforce out to the exchanges. Right now benefits is still a big incenctive in luring a person to a job/keeping a person in a job. I don't know how "Greedy Employer drops all their associates health plans" will play in the media, and what employer will be the first to risk the PR battle in doing so. Face it - even if said Employer gave each associate a $10,000 allowance to go to the exchanges, they would still be pilloried for not offering a traditional plan themsevles.

[paulxu]

You guys are laying out real well why the rest of the developed world (for the most part) disengaged health care from whether or not you are employed, made it single payer, and for the most part let nonprofit admin groups handle the unified paperwork for everyone. Some have added Cadillac insurance for a few things...but basically they get everyone covered with primary care and reduce expenses in the long run. (roughly 1/2 of what we spend)

[waggy]

roughly 1/2 of what we spend

What's this "we" shit? What do you spend?

[paulxu]

What's this "we" shit? What do you spend?

Too damn much...and I'm already a senior. (but certainly at this point in my life not getting screwed as much as others)

[waggy]

This really deserve it's own thread, but the liberals around here don't care about anything conservative, even privacy, so whatever.

Move over NSA, here comes the Obamacare Big Brother database



Would you trust thousands of low-level Federal bureaucrats and contractors with one-touch access to your private financial and medical information? Under Obamacare you won’t have any choice.

As the Obamacare train-wreck begins to gather steam, there is increasing concern in Congress over something called the Federal Data Services Hub. The Data Hub is a comprehensive database of personal information being established by the Department of Health and Human Services (HHS) to implement the federally facilitated health insurance exchanges. The purpose of the Data Hub, according to a June 2013 Government Accountability Office (GAO) report, is to provide “electronic, near real-time access to federal data” and “access to state and third party data sources needed to verify consumer-eligibility information.” In these days of secret domestic surveillance by the intelligence community, rogue IRS officials and state tax agencies using private information for political purposes, and police electronically logging every license plate that passes by, the idea of the centralized Data Hub is making lawmakers and citizens nervous.


http://rare.us/story/move-over-nsa-here-comes-the-obamacare-big-brother-database/

[waggy]

Curious if there is anyone that reads this forum that can relate a positive experience because of Obamacare?



At a rally in Virginia in June 2008, Obama said: “In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year.”

“We’ll do it by investing in disease prevention, not just disease management; by investing in a paperless health care system to reduce administrative costs; and by covering every single American and making sure that they can take their health care with them if they lose their job,” he said at the time. “We’ll also reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses.

“We won’t do all this twenty years from now, or ten years from now,” he said. “We’ll do it by the end of my first term as President of the United States.”


http://abcnews.go.com/blogs/politics/2012/09/rising-health-costs-undermine-obama-pledge-to-curb-trend/

[smileyy]

Obamacare required my insurance company to cover my wife's breast pump.

[bobbiemcgee]

Obamacare explained BY CARTOON PEOPLE:

http://kff.org/health-reform/video/youtoons-obamacare-video/

[XUglow]

For helvede...

My health insurance is up 44.74% per single employee in one year. It is up over 25% for families. My bill... the one that I pay... out of my pocket... is going up by a ridiculous number. I don't have any room to pass along increased costs to my customers in this economy. I will see what I can do to cut costs in other areas, but the easiest (and maybe only solution) is for my company to do more with fewer people. This really sucks.

[waggy]

White House told insurance execs to keep quiet on Obamacare



"The White House is exerting massive pressure on the industry, including the trade associations, to keep quiet," he said.

Laszewski, who's been a vocal critic of Obamacare, said he's been asked by insurance executives to speak out because they feel defenseless against an administration that is regulating their business -- and a big customer.

Government-backed plans accounted for about half of health care policies last year, a number that is expected to grow over the years.

http://www.cnn.com/2013/10/30/politics/obamacare-white-house-pressure/?iref=obinsite

[GuyFawkes38]

Yikes. What a disaster. What on earth is the Obama administration thinking when they developed "The Fix". Let's get a little bit of political capital in exchange for something that will cause major harm to the insurance marketplaces and help no one. Unbelievable.