ACA Individual Mandate Struck Down! (Page 6)

Or they are dead, or the tumor has grown to inoperable size, or the bone that was broken has set incorrectly... etc...

So which is it?  Do we want people to have more access to HC or not to go as often?

So you're saying that if you tell your doctor that there is something wrong with your broken (whatever) that he is going to make you wait 2 - 3 weeks before making sure that he set it right?  Or that a tumor is going to grow to inoperable size in 2 - 3 weeks (possible, but unlikely)?  Or that you will just mysteriously die (again possible but unlikely)?  All of this in the same 2 - 3 weeks that you would have waited with the same insurance as before Obamacare?  Just want to make sure I'm understanding you correctly.

Because I don't know that any of those situations will either a) happen or b) have anything to with Obamacare.

for some reason, i can't seem to get upset about more people being able to go to the doctor....

yes the money comes from somewhere and forcing people to buy a privately competetive product is weird, yes the system is broken and aca doesn't fix it....

but ultimately, i'm OK with people trying to take better care of themselves.  again, i still don't believe that people will magically be taking better care of themselves because of this (see examples i posted a few pages ago) but the argument that the poor people shouldn't be allowed to go to the doctor...just doesn't work for me.

Until the profession of DR is no longer lucrative enough to attract sufficient talent to take care of all the patients then no one gets good care.  So crappy care for every one is better than good care for most.

Saw this on FB.  Funny...

I'm not upset about it either.  I'm just saying your wait times are going to increase...

I agree totally.  I think most people would agree with this.

It's just how we go about doing it.  Funding, access, mandate, tax, etc....  the specifics are what is always difficult to agree.

Ah yes more people demanding "free" antibiotics for a viral infection will certainly help with that whole multi-drug resistant bacterial evolution.. Yay!

You haven't been paying attention to the last 20 years, then. While it is still a good income, relative to the work put in, the indebtedness needed, and the other options available to smart people, not to mention the priority placed on income above service as a value in the US, it's already happening. Medical schools have fewer applicants per slot, and frankly the PA students I see are often of higher caliber than many of the MD/DO students that come through the same rotation.

Even when I was applying to med school in the 80's, I was told that it is not a field to go into in order to get rich. The biggest reason private practices close down and rural areas are not able to attract talent is that the burden of paperwork has increased so much, that we spend less time seeing patients and more time on documentation requirements.

Yes it is and that will accelerate.

Tell me do Medicare and Medicaid actually pay for even the basic cost of treatment where you work?  They don't where I work.  As a matter of fact they pay less than 50% of the cost of treatment.  How is that going to play out when you have more people on M/M and you are taking greater and greater losses per patient?  How do you keep a hospital open?

I agree we have made the medical profession a mess.  Maybe we should clean it up instead of just paying for more of the same.

I know the ACA is supposed to reduce paperwork, but I still have a hard time believing any government anything is going to reduce bureaucracy and paperwork.  

And this is the (evil )genius of John Robert's vote. Republicans should be dancing in the streets over his decision to vote with the liberals. He may have helped Obama win a battle but he may have helped the Republicans win the war. Many people who were undecided about the Presidential election will now swing to the right because of the overwhelming unpopularity of the ACA.

On the other hand, some are saying that he was worried about the effect on the Supreme Court itself, and the loss of trust Americans would have in a court that threw out this entire law on a 5-4 party line vote.

I tend to think neither was the case with our chief justice.  He's a thoughtful guy and he grudgingly forced himself to read the law with tunnel vision only to its constitutionality.  He even talks about that in his statement and how it isn't the court's place to protect Congress from themselves if they write a bad law.

His choice makes the court seem more impartial, or at least less political.  It's a benefit to his legacy but I don't think it factored into his decision.

It continues to amaze me how people who are against the ACA:

a) scream loudly about the individual mandate and
b) then go on to tell us how this law will bankrupt us, even though it's bringing everyone into the payment system.

It's the OLD system that was spiraling out of control with costs.  Whether the new law brings in enough additional revenue / controls enough costs remains to be seen.

It also amazes me how people scream loudly about the huge deficit this country faces, then in the same breath screams about how this bill will cut Medicare costs by $500B (which is not entirely true, just eliminating the more costly Medicare Advantage program). 

It may be a party line for you, but in reality, if the government truly ran health care, I would have 90% less paperwork, at least. Why? Because I currently have to do documentation for 10 or more different types of insurers. Some of them want this form completed, some want that. Some want to review inpatient stays every day, some want it every week. Some will only pay for drug X,  others will never pay for drug X. Some require preauthorization for drug Y, others for drug Z. Some will only pay for 90 days, some for 30. Keeping up with them all requires much more doc time and staffing. Having a single payer model would mean the rules were consistent across the board.

On the surface bringing everyone into the payment system sounds very good.  However, lets just say you take a random 20 something person today whose health insurance would cost them $500/mo. out of pocket (just making up a number).  This price is determined by the insurance company who has determined the cost is necessary for them to cover their expenses and make some profit for their shareholders.

Now you insert the government who is going to charge that same person less than $100/mo. for coverage and oh btw, because they're poor we'll give them a credit so they really don't have to pay anything.  Plus, the many hundreds (or thousands) of Dem friendly companies are getting waivers from the taxes and requirements (politics as usual) add up to what I reckon will be a huge deficit for this program.

I agree that on the surface, if you force everyone to purchase insurance (even if it were all through private insurance companies) it would reduce the overall premiums because you'd have more healthy people on the insurance.  But I think the way our politicians do math they exempt (or drastically reduce) premiums based on income levels which makes no business sense and skews the math horribly.

Its like me running my business.  If I only charge poor people half as much as I charge rich people I'm going to go out of business because my costs are the same no matter if my customer is rich, poor, or in a union.

I think the biggest complaint about many of the single payer HC systems, as far as timing goes, is how long it takes to get a procedure approved.  I am all for a single payer system.  It just makes sense, everything is so darn expensive to make up for those who can't pay now.  However, I have worked with the government before and people joke, "they work at government speed" for a reason.  Nothing could get done in a timely manner because of the chain of command that things had to follow.  This bill will be no different. 

I am in the "socially liberal, fiscally conservative" camp and feel that a government run anything is a joke, whether that be state or federal.  I want this bill to work, but feel the execution is all wrong.  I'm not going to say I'm an expert thought, because I do not know how to fix it.  The people making the rules have no idea how the system works or how it should work.  We need HC experts making these decisions, not our legislators.

Just for the record, I never scream or even raise my voice at people.  Again, we owe 16 trillion.  We as a nation had better start addressing this or this nation will see an economic collapse worse than the great depression. Time will tell who is correct on ACA saving money.  My bet and with history on my side, the government rarely has anything come in at budget or less so I doubt any promise made by politicians. 

Medicare does need to be cut.  Cut the whole damn thing as well as entitlement programs. Deep cuts in gov. spending in all areas would make me a very happy camper.

Right now, a huge number of "random 20 somethings" -- and not necessarily just those in poverty -- something like 1/4 have no insurance at all.  I was one of them for a time when I was working for myself until I finally got myself on a catastrophic insurance policy.  But I certainly wouldn't qualify for Medicaid.

Anything that group pays is more than what we're getting today.

Me too

Agree, that it will be more paid into the system.  The question is will it cover the costs associated with the new members.  I honestly don't know the answer, but my business sense tells me that it wont.  I could be totally wrong, and I hope I am, but I'm just very skeptical on the cost side of the whole ACA debate.

How about as a guidline Medicare/Medicaid pays less than half the cost of cancer treatment.  When I say cost I do not mean price I mean they pay substantially less than half of what it costs the hopital to treat them.  Now add more of those cases to the rolls.

So as someone who works in the medical field but is not a doctor, we are still not sure that the ACA will be of any benefit to us or our patients. Granted my area is pretty specialized but we see patients of all sorts and with all types of benefits. One of the problems we run into more and more these days goes to the Medicare/ Medicaid payment issue. Those payers make up the largest chunk of the patient population for most hospitals and their payments do not cover services or even close. So you have a deficit from there and try to negotiate with Private insurances to be able to make up the difference but most, if not all private insurers, are fighting to lower their reimbursments as well so you either end up with clinics which stop taking medicaid/medicare in order to survive or clinics that have to shut down because they cannot meet their repayment obligations or keep physicians on staff with a good enough salary.

whether bringing more payors into the mix will help or hurt this more is anyones guess but the next few years are going to be very interesting to sit through.

If you know what your costs are going to be, and you know how many "poor" people versus "rich" people will be using your business, and you can't figure out a pricing that accounts for all of that, then maybe you should learn more math. Frankly, that is the way healthcare has worked in this country since the middle of the last century. And it worked until the last 20 years because "rich people" (i.e. insurance and Medicare) paid enough that "poor people" could get the same care at a discounted rate (i.e. what the hospital would write off).