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Thread: Obamacare - The Storm is Coming

  1. #1

    Obamacare - The Storm is Coming

    http://www.nationalreview.com/articl...ng-marc-siegel

    There may be a debate over whether Obamacare’s individual mandate is a penalty or a tax, but there is no debate among doctors and their patients about the fact that Obamacare will be bad for America’s health.

    The climate in my medical office is changing; my patients sense that a storm is coming. They are worried, and there is little I can do to reassure them. They are used to my office manager getting approvals for the CT scans, mammograms, PSAs, and MRIs I order, and they realize that many of these tests will no longer be covered by insurance once Obamacare’s committees — which look at so-called comparative-effectiveness research and review current guidelines — are through with them.

    Last week, with the Fourth of July looming, I was able to get a quick CT scan to rule out appendicitis for one patient, and an ultrasound of the legs to quickly diagnose a blood clot for another. Tests like these — ordered solely on the basis of my medical intuition – may not be possible in a few years. Since in both cases the symptoms weren’t “textbook,” I would probably have had to appeal to some Kafkaesque committee, wasting precious time; in an extreme instance, this could even cost a patient his or her life.

    My patients know that their premiums will be going up and that, paradoxically, they will be receiving less service for their money. This is what happens when more people enter the system and are covered with easy-to-overuse insurance. Patients who overuse services will ultimately crowd out legitimate use for the group, as more regulations are imposed by both public and private insurers to preserve their bottom lines. Unfortunately, this process jeopardizes the art of medicine and real medical treatments, as doctors are pressured to conform to guidelines and insurers refuse to cover creative solutions. Obamacare caters to the worried well by allowing anyone to use the insurance, whether he or she is sick or not, with lower co-pays and deductibles and therefore no incentive against overuse. My patients also realize that I will be paid less for seeing them — first by Medicare and Medicaid, and then the private insurers will follow suit. Patients anticipate longer waits in my office and less time to spend with me. No one is asking me any more when I will change my office carpet or paint the peeling walls.

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    My patients know that there is a doctor shortage, and that many of the doctors who are practicing medicine today are not accepting their insurance. They know that this reality applies to specialists as well as primary-care doctors. Nurse practitioners are well trained and have a focus on nutrition and prevention that many doctors lack, but my patients know they are not interchangeable with me.
    My patients are smart, and they can see into the Obamacare future, but there are a few things they may not anticipate. First, I believe our newest technology is in jeopardy because it is made for targeted, super-specialized treatment. We have been leaving the age of one-size-fits-all solutions and entering the age of personalized genetic and immunological treatments for cancer and other chronic diseases. Not only are these treatments expensive, but they also won’t work with an insurance or government-run model of care, which cannot justify a big expense for a treatment for a small group of bpatients (known as an orphan drug). This problem already exists in the current health-care world (Avastin and other targeted treatments for cancer, as well as the latest surgical techniques, are not always covered), but it will only get worse with Obamacare, which has strained to throw the insurance blanket over more and more people.

    Second, there will be fewer and fewer opportunities to pay for health care out of pocket. Flexible-spending accounts will be reduced to less than $2,500 per year beginning in 2013, and tax deductions for medical services will be harder to get. Paying out of pocket makes a patient more aware of what he or she is getting for the money and, even with the tax deduction, less likely to see a doctor unless the need is real. Reducing these options is one of Obamacare’s big mistakes.

    Third, as long as doctors practice in a climate where frivolous lawsuits are a constant threat, they will be particularly vulnerable to the whims of Obamacare. Remember, if I believe you should have a test for your prostate or your lungs or your breast but insurance won’t cover it, I am the only one liable if there is a bad outcome, not the insurance company, and not the government agency that issues guidelines insisting the test isn’t necessary. Even if I were simply following a government guideline, I could still be sued frivolously for a bad outcome.

    Of course, there will still be doctors who consider medicine a calling rather than a business, doctors who will continue to practice medicine with the same careful, caring approach, no matter how it affects their bottom lines. This may be the only way for doctors to continue to feel good about what they do, but unfortunately, it is not the most practical way to survive the Obamacare storm.

  2. #2
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    How spooky/ominous.



    Fact is, the reply will be the same as it always is.

    Yes, there is debate (Ken being example #1, also a Doctor, in total disagreement with this writer).

    Cost (to the taxpayer and responsible insurance buyer) is not something that side cares about. Coverage for everyone no matter what is the priority, not cost.

    Denials are also not an issue they care about, because they belive in the wisdom of the State to deny only what should (in their view) be denied, and approve only what should be approved. They see this system as a net positive, not a net negative, it's a lynchpin for their argument fo "savings" in such a system.

  3. #3
    Quote Originally Posted by Warfish View Post
    How spooky/ominous.



    Fact is, the reply will be the same as it always is.

    Yes, there is debate (Ken being example #1, also a Doctor, in total disagreement with this writer).

    Cost (to the taxpayer and responsible insurance buyer) is not something that side cares about. Coverage for everyone no matter what is the priority, not cost.

    Denials are also not an issue they care about, because they belive in the wisdom of the State to deny only what should (in their view) be denied, and approve only what should be approved. They see this system as a net positive, not a net negative, it's a lynchpin for their argument fo "savings" in such a system.
    When it comes to the doctor patient reltionship and quality of care issues all but the most partisan loons care deeply. This is one of the few times where most sane people put politics aside. I don't think anything anyone could say would convince Kenyo or Safety Blitz that anything Obama did wasn't completely awesome but your average person gets it. Costs more, worse care, new taxes, new deficits. The bill is a complete disaster.

  4. #4
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    Quote Originally Posted by chiefst2000 View Post
    When it comes to the doctor patient reltionship and quality of care issues all but the most partisan loons care deeply.
    You are simply mistaken. ~50% of those actively involved in Poli-Sci out there value Universla Access and Treatment over your concerns of "service quality".

    This is one of the few times where most sane people put politics aside.
    Meaningless pablum tbqg. Like "fairness". You define "sane" as everything yoru side stands for, and "partisan loons" everything the other side stands for.

    A perfect example of why nothing ever gets done, and if it does, doesn;t get done right, in our Government.

    I don't think anything anyone could say would convince Kenyo or Safety Blitz
    Becuase our Right-wing (R) posters are so much more flexable on their values and priorities?

    your average person gets it.
    You don't speak forthe average person. Nor do I.

    The election is the only speaking the "average people" will do that counts.

    Costs more, worse care, new taxes, new deficits. The bill is a complete disaster.
    Again, to you.

    To a Liberal, the small added cost to those paying isn't as important as the millions more having coverage and more State power.

    To a liberal, the "worse care", i.e longer wait times and some deinals, isn't as important as having millions more covered and more State power.

    To a liberal, new taxes are just paying your "fair share" towards the betterment of all society.

    To them, this bill is only a disaster because it doesn't unify, monopolize and universalize all healthcare under the State's authority and control.

    And ~50% of the population agree with those liberals. More, if you take the Obamacare Bill issue by issue, point by point, and ask those same "average americans" if they like/support each point in turn.

    It's interesting, the majority wants repeal, yes, but that very same majority supports almost every item IN Obamacare if asked item by item. Thats polling for you.

    With all that said, a supporter of RomneyCare has very little standing to mock ObamaCare, given how deeply similar they are. I appreciate the difference between State and Fed, but an (R) who would support RomneyCare is still more Obama-like than not.

  5. #5
    Quote Originally Posted by Warfish View Post
    You are simply mistaken. ~50% of those actively involved in Poli-Sci out there value Universla Access and Treatment over your concerns of "service quality".



    Meaningless pablum tbqg. Like "fairness". You define "sane" as everything yoru side stands for, and "partisan loons" everything the other side stands for.

    A perfect example of why nothing ever gets done, and if it does, doesn;t get done right, in our Government.



    Becuase our Right-wing (R) posters are so much more flexable on their values and priorities?



    You don't speak forthe average person. Nor do I.

    The election is the only speaking the "average people" will do that counts.



    Again, to you.

    To a Liberal, the small added cost to those paying isn't as important as the millions more having coverage and more State power.

    To a liberal, the "worse care", i.e longer wait times and some deinals, isn't as important as having millions more covered and more State power.

    To a liberal, new taxes are just paying your "fair share" towards the betterment of all society.

    To them, this bill is only a disaster because it doesn't unify, monopolize and universalize all healthcare under the State's authority and control.

    And ~50% of the population agree with those liberals. More, if you take the Obamacare Bill issue by issue, point by point, and ask those same "average americans" if they like/support each point in turn.

    It's interesting, the majority wants repeal, yes, but that very same majority supports almost every item IN Obamacare if asked item by item. Thats polling for you.

    With all that said, a supporter of RomneyCare has very little standing to mock ObamaCare, given how deeply similar they are. I appreciate the difference between State and Fed, but an (R) who would support RomneyCare is still more Obama-like than not.
    Your post would be more believable if the polls did not continue to show that by a 10+ point margin Americans favor repeal of the act. Obviously the average American does get it. I agree that liberals don't care how much it costs or how much it erodes quality of care but only 30% of the population are liberals. I think this issue decides the election. People hate Obamacare with a passion. Over 50% want it repealed. Now that the SC has fumbled the ball the voters will have to deal with it at the polls. I think this issue alone is good for a 3-4% swing in vote totals. Some that might have voted for Barry will change it up to get rid of this law.

    http://www.realclearpolitics.com/epo...pose-1947.html

  6. #6
    Quote Originally Posted by chiefst2000 View Post
    Your post would be more believable if the polls did not continue to show that by a 10+ point margin Americans favor repeal of the act. Obviously the average American does get it. I agree that liberals don't care how much it costs or how much it erodes quality of care but only 30% of the population are liberals. I think this issue decides the election. People hate Obamacare with a passion. Over 50% want it repealed. Now that the SC has fumbled the ball the voters will have to deal with it at the polls. I think this issue alone is good for a 3-4% swing in vote totals. Some that might have voted for Barry will change it up to get rid of this law.

    http://www.realclearpolitics.com/epo...pose-1947.html
    You should rethink that nonesense.

  7. #7
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    Quote Originally Posted by chiefst2000 View Post
    Your post would be more believable if the polls did not continue to show that by a 10+ point margin Americans favor repeal of the act. Obviously the average American does get it.

    People hate Obamacare with a passion.
    When taken as a whole.

    When polled on each specific item covered by Obamacare, the polls say something very different.

    Stop talking for a second and read.

    It's not nearly as strait-foward or "obvious" as your position makes out.

    I think this issue decides the election.
    We'll see.

  8. #8
    Quote Originally Posted by Winstonbiggs View Post
    You should rethink that nonesense.
    In polls only 25% self identify as liberal. I tend to think it is more like 30%. You see it differently?

  9. #9
    Quote Originally Posted by Warfish View Post
    When taken as a whole.

    When polled on each specific item covered by Obamacare, the polls say something very different.

    Stop talking for a second and read.

    It's not nearly as strait-foward or "obvious" as your position makes out.



    We'll see.
    Of course the polls say different when discussing specific items. What does that have to do with the entire bill? If you asked me if I support the provision in Obamacare that disallows insurance companies from dropping people after they become sick, I'd say sure of course. NYS already had that law on the books. If you asked a woman if they like the free pills and preventive care they get under Obamacare they'd say of course I support that.

    When you look at the bill as a whole however it is a disaster. It is all or nothing however with this bill and all in all it is a turd sandwich. Its why you don't see any of the progressives here ever arguing against the points I've made. There is no counterargument that makes sense. Just appeals to sympathy with stories of uninsured people that can finally buy insurance.

  10. #10
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    Quote Originally Posted by chiefst2000 View Post
    Of course the polls say different when discussing specific items. What does that have to do with the entire bill?
    Are you serious?

    If each item in a bill is in fact supported by a mjaority, yet the bill itself isn't.....you don't see the possible ramifications of that? The complexity involved?

    Nope, just right to......

    When you look at the bill as a whole however it is a disaster.
    Right back to talking points, eh?

    I should have expected as much from a hardcore Romeneycare Ok, Obamacare not Romney Partisan.

    Go ahead, enjoy your hurf-a-blurf. You'll excuse me if I pass on reading it, I already read each sides talking points most days, no need to re-read them verbatim here.

  11. #11
    Quote Originally Posted by chiefst2000 View Post
    In polls only 25% self identify as liberal. I tend to think it is more like 30%. You see it differently?
    Nice dodge. The idea that liberals don't care if the bill reduces the quality or cost of health care was a pretty stupid comment. Guys like Kennyo who I disagree with on many topics including health care to some extent cares deeply about the quality of care and the cost of care. The fact that he believes in universal coverage doesn't change that for must people liberal or conservative. The 25% who consider themselves liberal probably aren't that happy with Obamacare and would have preferred a payroll tax and National Health care.

  12. #12
    Quote Originally Posted by Warfish View Post
    Are you serious?

    If each item in a bill is in fact supported by a mjaority, yet the bill itself isn't.....you don't see the possible ramifications of that? The complexity involved?

    Nope, just right to......



    Right back to talking points, eh?

    I should have expected as much from a hardcore Romeneycare Ok, Obamacare not Romney Partisan.

    Go ahead, enjoy your hurf-a-blurf. You'll excuse me if I pass on reading it, I already read each sides talking points most days, no need to re-read them verbatim here.
    Each item was not polled that way. Your response is less then honest. There are a few good things in a bill mixed in with many more bad things. You say I am using talking points but you know better. You know very well that I have detailed here in many TLTR posts the specific problems with the bill. Insurance is something you buy before you have a problem not after. If car insurance could be purchased after you crash no one would own it untill they needed it. Health insurance is the same way. You can't have an insurance plan that allows people to but it after they need it.

    If I polled you and asked if you supported a mandate that allows people to purchase life insurance for loved ones after they died you'd say sure sounds great. F those evil insurance companies right. Does that mean you would support a bill that adds a new 10% payroll tax for everyone to fund a program where the bottom 10% of people get a check for $100,000 when a loved one dies?
    Last edited by chiefst2000; 07-11-2012 at 03:33 PM.

  13. #13
    Quote Originally Posted by Winstonbiggs View Post
    Nice dodge. The idea that liberals don't care if the bill reduces the quality or cost of health care was a pretty stupid comment. Guys like Kennyo who I disagree with on many topics including health care to some extent cares deeply about the quality of care and the cost of care. The fact that he believes in universal coverage doesn't change that for must people liberal or conservative. The 25% who consider themselves liberal probably aren't that happy with Obamacare and would have preferred a payroll tax and National Health care.
    Of course they don't care. I personally would have greatly preferred universal single payer coverage over Obamacare as well. At least universal care has some positive attributes. Obamacare is such a clusterfu*k of bad policy that anyone supporting it is either a loon or doesn't understand the bill. I run a business and I can tell you that the problem with our healthcare system is the costs. We have the best quality of care in the world. If they got the costs down those 20million uninsured would likely purchase it or have it provided by their employer. The reason so many are uninsured is because it costs too damn much. Obamacare drives up the price, adds new taxes and adds deficits. Simultaneously it robs the elderly of 500Billion from Medicare and speeds up the bankruptcy of that program. On top of that access to care is reduced and quality of care is reduced. Whats not to love.

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    Quote Originally Posted by chiefst2000 View Post
    Each item was not polled that way. Your response is less then honest. There are a few good things in a bill mixed in with many more bad things. You say I am using talking points but you know better. You know very well that I have detailed here in many TLTR posts the specific problems with the bill. Insurance is something you buy before you have a problem not after. If car insurance could be purchased after you crash no one would own it untill they needed it. Health insurance is the same way. You can't have an insurance plan that allows people to but it after they need it.

    If I polled you and asked if you supported a mandate that allows people to purchase life insurance for loved ones after they died you'd say sure sounds great. F those evil insurance companies right.
    You need to be honest. You know that when people were polled asking if they are happy that there are 1200+ references to "this will be decided later by some government appointed toad", if we are happy that we were sold cooked numbers that claim an impossible reduction in costs and a ton of other fairy tales, the majority of people not only agreed they like Obamacare but are really looking forward to the reach around that was promised by the government on page 978 of the ass rape I mean health care bill.

  15. #15
    Quote Originally Posted by chiefst2000 View Post
    Of course they don't care. I personally would have greatly preferred universal single payer coverage over Obamacare as well. At least universal care has some positive attributes. Obamacare is such a clusterfu*k of bad policy that anyone supporting it is either a loon or doesn't understand the bill. I run a business and I can tell you that the problem with our healthcare system is the costs. We have the best quality of care in the world. If they got the costs down those 20million uninsured would likely purchase it or have it provided by their employer. The reason so many are uninsured is because it costs too damn much. Obamacare drives up the price, adds new taxes and adds deficits. Simultaneously it robs the elderly of 500Billion from Medicare and speeds up the bankruptcy of that program. On top of that access to care is reduced and quality of care is reduced. Whats not to love.
    We don't have the best care in the world and there is a shortage of primary care doctors. There is no way you could insure 20million more people and reduce the cost without a radical change in the way care is delivered.

    I'm a free market capitalist but there is no way in hell when you have a shortage of supply and you want to add in significant demand that prices are going to go down without a major change in the way services are delivered.

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    Quote Originally Posted by Winstonbiggs View Post
    We don't have the best care in the world and there is a shortage of primary care doctors. There is no way you could insure 20million more people and reduce the cost without a radical change in the way care is delivered.

    I'm a free market capitalist but there is no way in hell when you have a shortage of supply and you want to add in significant demand that prices are going to go down without a major change in the way services are delivered.
    These statements are based on biased and flawed statistics. My favorites are the WHO score that gives points for socialized medicine (no bias there right) and the infant mortality rate with is flawed by allowing countries to define what a "live birth" is with no correlation between countries. That is like measuring a piece of wood but not defining what an inch is and letting everyone come up with their own standard.

  17. #17
    Quote Originally Posted by Winstonbiggs View Post
    We don't have the best care in the world and there is a shortage of primary care doctors. There is no way you could insure 20million more people and reduce the cost without a radical change in the way care is delivered.

    I'm a free market capitalist but there is no way in hell when you have a shortage of supply and you want to add in significant demand that prices are going to go down without a major change in the way services are delivered.
    So you are saying that there is a country you'd choose over the USA to get major surgery in? I think not. Of course our medical system is the highest quality in the world. If you choose to deny that fact please point out where the quality of care is higher.

  18. #18
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    Quote Originally Posted by chiefst2000 View Post
    So you are saying that there is a country you'd choose over the USA to get major surgery in? I think not. Of course our medical system is the highest quality in the world. If you choose to deny that fact please point out where the quality of care is higher.
    That's like saying that a sports team is the best in their sport simply because they have the best player in the league, without even regarding position. Not to mention that you're most likely wrong. Do you honestly think that the best of every type of surgeon practices in the US? Seems like a pretty naive viewpoint if you ask me.

  19. #19
    Quote Originally Posted by Sharrow View Post
    That's like saying that a sports team is the best in their sport simply because they have the best player in the league, without even regarding position. Not to mention that you're most likely wrong. Do you honestly think that the best of every type of surgeon practices in the US? Seems like a pretty naive viewpoint if you ask me.
    Huh? My contention is that our system delivers the highest quality of care in the world. I didn't say we have the best cardio thorasic surgeon in the world though I would bet that we do. Our hospitals are the cleanest most cutting edge and best equipped. News flash. Our military is also the best in the world. They have the most cutting edge weaponry and are the best trained. What about that is difficult to comprehend? What country would you choose to fly to for an operation? Cuba?

  20. #20
    Quote Originally Posted by chiefst2000 View Post
    So you are saying that there is a country you'd choose over the USA to get major surgery in? I think not. Of course our medical system is the highest quality in the world. If you choose to deny that fact please point out where the quality of care is higher.
    There are 1000's of hospitals in the US I wouldn't consider getting serious surgery in let alone having to go in for a serious illness including big name hospitals in the tri-state area.

    We have some great facilities as does most of the Western world and Japan. We also have some of the worst medical care in the world going on in hospitals that people think are wonderful until they or a loved one gets checked in.

    I have had some awful experiences with care very recently, it was a wake up call.

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