The proposed health care bill thread (merged)

[tater]

Our taxes are going up a lot.

Since the wife is mandated to see any medicaid or medicare person that goes in through the ER, even if she no longer take a either as scheduled appointments (which she no longer does), we also pay a medicaid/medicare "tax" in that we actually spend money out of the family bank account to care for these people. That is because the 2 together only pay 70% of COST (medicaid is the FAR worse of the two). Add in the lost wages and it's far worse.

BTW, the cutoff for medicaid is actually a fairly high income level. Also, I know that my old family doc in CT no longer takes ANY insurance, he has people pay an annual retainer in cash, instead.

Regardless, here's an article about something I said a few pages up someplace—doctor shortages being the REAL healthcare problem in the US.

http://online.wsj.com/article/SB1000...hatsNewsSecond

Funny thing is that article—wrongly, IMHO—concentrates on primary care. Primary care docs are who you see when you have most of your illnesses. The trouble is that the vast majority of illness is SELF LIMITED. Meaning it goes away on its own with no medical care. Yeah, they function as triage, but the reality is that the benefits of "preventative" primary care are overrated (read a recent study to that effect). When you are really sick—sick in a "get care or die" sense—you'll likely present acutely in an ER setting, or you'll go to the primary just to get a referral to a specialist (two office visits when just going to the specialist would suffice). The specialist shortage is worse.

As the article says, primary care might not be sexy, but it also has a great lifestyle, virtually nothing after hours, and little or no call, ever.

[tater]

A very short and accurate take on some of the major flaws in the new law. This is spot on, and we pay very close attention to this as it will very directly and quickly affect us.

http://healthcare.nationalreview.com...U0YTY3YzU3Njg=

The bullet point #4 is particularly concerning. The requirement that Medicaid patients get all services. Right now, doctors frequently don't take medicaid at their offices. They simply cannot do it since it pays below cost. That'd be like requiring all plumbers to do work at 20% of the actual cost to provide service—not counting the plumber's time. As a result, many people will either wait in line at low-income clinics, or only get seen when they present at the ER with conditions bad enough to get to see a specialist (and be sure, the current situation will make specialists far less cavalier about letting any medicaid get on their service, whereas now they don't even know).

Being "entitled" medicaid people means they sue more. Since this is a Democratic law, it would never think of doing anything to mitigate lawsuits—since if nothing else, they are the party of the trial lawyers. These people will sue the State any time they have to wait (they are the most likely to bitch and moan about having to wait a couple weeks to be seen for their non-emergency care as it is—sorry, lady, you've leaked pee for 20 years already, waiting an extra week because there are actual sick people to be seen and half as many docs as needed is tough luck for you.

Sigh. These idiots didn't even read this POS bill they signed.

[CaptainHaplo]

Heck - I am pissed that it included what amounts to a "white woman" tax.....

Regardless, here's an article about something I said a few pages up someplace—doctor shortages being the REAL healthcare problem in the US.

So according to that article the problem will be that as more people have coverage more people will go to doctors.
There is a simple solution, make sure as few people as possible have coverage then only a few will go to doctors so there will be no shortage of doctors

[tater]

Originally Posted by Tribesman

So according to that article the problem will be that as more people have coverage more people will go to doctors.
There is a simple solution, make sure as few people as possible have coverage then only a few will go to doctors so there will be no shortage of doctors

The is a shortage of doctors and nurses NOW.

Let me explain something to you. The US is big. Physically large. The doctor shortage is NOT in the areas of high population density—you know, the places where people are packed like sardines like Europe. Take Connecticut, where I grew up. You can lay Connecticuts in New Mexico like throw rugs and fit 20 of them. CT has more than twice the NM population, and yet has loads of docs per capita. This means that not only do you meet per capita requirements, but all those docs are physically close to everyone. Overlapping, in fact, if you set some arbitrary travel distance.

So, you need a level one trauma center. In CT, there are several, and given the fact that you can cross the state the long way in 2 hours, and the short way in one—by emergency ground vehicle in traffic. In NM, we have ONE level one trauma center. It's in the center E-W, and 2/3 the way N-S. It takes 4.5 hours to get to the South end of the State by fast moving vehicles from ABQ, so maybe 8 hours to cross the state that way, and 6 hours the other way. In small places with large population, you can get some economies of scale. Not in the middle of the US.

In the "fly over" states in the middle of the US, you need MORE healthcare infrastructure per capita (and we have less) since if you need a specialty urgently, that means you need doctors physically close. No one in CT is probably more than 20-30 minutes (including ambulances stuck in traffic) from a trauma center. In NM, the average is probably 1.5 hours BY AIR. So to have "equal protection" (if the government is responsible, I DEMAND equal travel time as someone in CT!) we'd need MANY more docs and facilities (remember that no one wants 24/7/365 call, so every facility needs 3+ people in every specialty).

Get the picture? Health care in a large country does not scale linearly with population. Area matters.

So into this, we add MORE patients—patients who get treated by a plan that pays doctors less than it costs them to care for the patients not even counting their own time. They need to make far more doctors—while letting them know that they will in fact have to pay money out of pocket to treat patients! The only way to do that is to drop standards. Foreign docs? Nope, in the US they have to do a US residency. So for a specialist, 5+ years at 100-120 hours a week for $3/hour in pay. We know a few foreign MDs who are NURSES in the US because they don't think it's worth it to do a residency when they could pass the nursing exams and instantly start making 60k a year or more for great (compared to docs) hours (this one guy is really a doc in my wife's specialty—she loves him in the OR cause he's "telepathic" and hands her the right tool before she even verbalizes it since he knows, too, lol).

So we are left with minting new docs—which REQUIRES lower standards, AND it requires TIME. If med schools magically have 30% more docs starting in 2011, then we'll see the least important kind—primary care—popping out in 2018 to start. The surgeons will not ripen til 2020. And that is only a 30% increase for one year, it will take a few decades to catch up at that rate.

If you think healthcare is simple, or that anyone in politics in favor of this pig of a bill actually understands it even a little, you're wrong.

Let me explain something to you.

So someone in New Mexico wanting to get to hospital would probably get there quicker than someone from the arse end of Mayo would even though NM is 4 times bigger than the whole of Ireland.

Foreign docs? Nope, in the US they have to do a US residency.

Do they really?
And there was me thinking the 3rd and final exam that is required for doctors who are graduates of foriegn medical schools to be granted a licence can be taken in several States without having to do the residency.

[tater]

Originally Posted by Tribesman

So someone in New Mexico wanting to get to hospital would probably get there quicker than someone from the arse end of Mayo would even though NM is 4 times bigger than the whole of Ireland.


Do they really?
And there was me thinking the 3rd and final exam that is required for doctors who are graduates of foriegn medical schools to be granted a licence can be taken in several States without having to do the residency.

No, foreign medical grads have to complete a residency in their specialty to practice.

We know a lot of docs who did med school in other countries, too. Sucked. Not sure about Canada, actually, I think they are in the same system and can come at will. <EDIT> I checked and Canadians are in the same system and can come directly, that's it, though. Also, while in some cases it sucks for docs to do a residency over again here, even european docs we know said their US Residency was far harder than their similar training abroad (jamming 10-5 years experience into 5, by working them to death, basically).

Passing the USMLE means you CAN practice medicine in the US—as a Resident, so you are sort of right (ie they are docs here, but only within the confines of being in a hospital Residency program). Part 3 is done during Residency I think. You pass the exams, and that means that your med school education is up to snuff, but you are still required to take a Residency in the US before you can practice for real. I don't know of any State where you can pass the USMLE and simply hang out a shingle. I suppose a State might chose to do this in desperation, though no medical society would Board Certify them I bet.

Boards are specialty related, and have nothing to do with license, just your ability to hang out "Board Certified."

I'm not sure where Mayo is in reference to a proper hospital, but since medical air travel is incredibly expensive (I'm talking helicopter or fixed-wing ambulance, so think in terms of many thousands of dollars per hour), most are stuck with road travel of several hours.

Regardless, while you might find that acceptable for a public system, here in the US if the system was public people would demand "equal protection" and they;d have to magically make more hospitals—that's easy, the tricky part is magically making docs and nurses (both are short here).

[tater]

The bottom line WRT this awful bill is that when the President campaigned on the need for health care reform, many of the basic goals he stated were (and remain) desired by the population over all, as well as both political parties. The bill passed into law addresses virtually none of these salient points. IMO, the bill was simply a foot in the door to try and make more people wards of the State in the hope they will then vote themselves more stuff paid for by their neighbors who actually work.

It would have been possible to pass a far simpler bill that would have worked towards the goals of: increasing access to care, "bending down the cost curve," and doing the above without negatively impacting quality of care.

There was in fact a bipartisan bill proposed to do so, but the dems killed it.

A few ideas off the top of my head:

1. Allow providers to write off care delivered below cost as a charitable contribution equal to the difference between the amount they were reimbursed, and some average reimbursement for private insurance (likely some multiple of medicare, ie: 123% of medicare or something like that). This incentivises taking people getting government care instead of the current system which pretty much requires seeing as few as is possible/legal. This should be a 100% deduction off income before any taxes, not the amount times their effective tax rate.

2. Allow insurance to cross State lines. This would vastly broaden competition.

3. The current system has the bulk of insurance sold to BUSINESS as the customer for their employees. Change this instead to individuals buying their own insurance.

4. TORT reform. No, malpractice insurance is not a huge % of medical costs. No, malpractice awards are not a huge % of medical costs. Defensive medicine to CYA, on the other hand, IS a major % of total medical costs. As a reality check, some studies have suggested that defensive medicine amounts to 20% or more of the total cost of care in the US. The insurance company profits demonized by the Democrats? 1-2% of total costs. This will not be an instant fix, docs are trained into defensive medicine. It will take some time for them to unlearn ordering every test, "just in case," as an immunization against lawsuits.

5. Allow any citizen to buy into any plan that any government employee has as if they were government employees (they are, after all the employer in that case). This doesn't matter if individuals buy plans instead of businesses, as suggested above.

6. If there are any people legitimately falling through the cracks, then expand medicaid a little. This will not hurt as much since the docs providing care can now write this off.

I'm sure other ideas are out there. Right now none of this has been done.

[Torvald Von Mansee]

Originally Posted by SteamWake

"Kids untill there 26" I dunno wether to laugh or cry.

That's funny, no where in the health care bill does it say you retain minor status until 26. Are you reading a different health care bill?