In the last several years, a lot of people have huffily told me that they were never going to read my blog again. I guess they meant it as a diss, but frankly, I see it as a blessing. Honestly, I think the people who read this blog are a great group of people. Most of the comments I get are intelligent, thoughtful, respectful, and/or humorous. So I thank you readers for being awesome.
In light of the recent disastrous government shutdown, I'm dying to ask my readers:
What do you think of Obamacare? Love it or hate it?
I presume that you will give me intelligent answers and not just say you're afraid of being raped by a scary puppet.
Personally, I am in favor of it. I believe people using the ER for their medical needs is costing the taxpayers a bundle... unless we are heartless people who will turn away uninsured patients whose lives are in danger, it doesn't make sense to allow people to be uninsured. And there are other countries and even states within this country (e.g. Romneycare) who use a similar system and have good healthcare. Definitely no puppet rape.
Now your turn.
I am also very optimistic about Obamacare. I mean all the people who hate Obamacare...do they think the current system is better? I do not.ReplyDelete
People fear change. The next generation won't understand the concept of not having health insurance...I don't see how that is a bad thing. :shrug:
I think it's also important to note that a lot of the "changes" we're expecting with obamacare were industry trends that were happening regardless - ie decreased physician autonomy, needing approval before physicians can order a test, pay based on results rather than services, etc.ReplyDelete
Love it! It makes sense to have a "health connector" for Health INsurance so people can shop around for the product that suits their needs.ReplyDelete
However, the "marketplace" is a fictional concept when it comes to Health ASSURance (everyone should have coverage to see a PCP, thanks to EMTALA the culture is go to the ED to see a doctor for anything, which we can hopefully change).
Disclosure: I am a Primary Care Physician benefiting from RomneyCare who is planning for Accountable Care Organizational cost control.
Here's the thing. I'm a do-er. It's part of why I'm in medical school for crying out loud. Regardless of the potential negatives of the ACA (there will be some, it's legislation for crying out loud), implementing it is far preferable to a) leaving the American health care system the way it is and b) the conservative plan for healthcare [for clarity on this plan, see letter (a)]. We can't fix things when we don't even pick up the tools.ReplyDelete
"Disasterous Government shutdown?" Excuse me? Katrina was a disaster. Hurricane Sandy was a disaster. The government running out of money is not a disaster.ReplyDelete
Obamacare is a disaster looking for a place to happen. I agree that the healthcare system needs reform, but Obamacare is like curing a head cold with a bullet between the eyes. It will inevitably punish the very class it's intended to help. It's already cost me my job, as the medical device manufacturer I work for is shutting down a design/production line because of the Obamacare surtax on medical devices. Now I will be unemployed/self-employed, and I will be subject to punitive fines if I don't acquire a health plan. I doubt I will be able to afford the fines or the insurance. unemployment will go up, as companies will be less inclined to take on the extra expenses that will accrue to each employee. Many companies are cutting their full-time staff to 28 hours a week or less to avoid having to buy insurance. How is any of this a good thing? Do you think doctors will be more available, or emergency rooms will magically empty out? This is a classic case of good intentions meeting unexpected consequences.
Fair enough. But if you have no insurance and no money, and you fall down a flight of stairs and break both your legs, what should be done? Who will pay?Delete
I'm sorry that you're experiencing hardship over it, but I wonder why you're blaming the Affordable Care Act and not the companies. There are companies that truly can't afford what might be coming their way, but there are also many companies that are posting record profits and awarding their management class wonderful bonuses and salaries. They blame the ACA for reducing their workers' hours and wages, all while continuing with their profits and bonuses. People buy it, so they get away with it.Delete
It's interesting to me that there has been a growing divide between the average salary of the worker and the managers of companies over the past 20-30 years. The divide is now far, far greater than you see in Europe, and it's closer to what you'd find in third-world countries.
The ACA isn't perfect, for sure, but people being greedy should be called out for what it is.
As for my own opinion, I think that a lot of the complaints about the ACA seem pretty silly because they're valid complaints about the current healthcare system. "I don't want people getting things for free" applies now, as does "I don't want someone telling my doctor what they can or can't do." I don't know enough about the ACA to say whether it's a better thing or a worse thing, but based on the big points that I've heard about, it's a step in the right direction.
Good news! If you're unemployed and need health insurance then you probably qualify for Obamacare's subsidies for anyone making less than 400% over the poverty line.ReplyDelete
I am Canadian but lived in the states for 3 years while going to school (am now back in Canada in medical school). I am admittedly quite biased toward own Canadian system, no doubt in part due to its familiarity to me. However, from my experience in the states, I think the current system is both unsustainable and uncompassionate. I'm not convinced that the new legislation for healthcare will effectively address the issues it is aiming to change, but I think it is a good step toward America finding a system that will work for everyone. I have seen (at least among my American friends) a shift in the past few years from being absolutely opposed to any change to health legislation and coverage to a more open point of view where at least more meaningful dialogue is taking place. So, from my perspective, I don't know that "Obamacare" will address the needed issues in the healthcare system, but it does seem to be opening up a more civil debate and meaningful discussion of the issues, which will hopefully lead to a better outcome for everyone over time.ReplyDelete
I absolutely think Obomacare is a step in the right direction. It infuriates me that special interests are spending millions to misinform people about it. It is far from perfect, but at least we are moving forwardReplyDelete
I go back and forth about how I feel about Obamacare, depending on the day.I think a lot of the features are good and I'd rather have something than nothing at all. If anything, I don't feel that ACA goes far enough! There are still so many issues that need to be addressed within health care - one of which is graduate medical education. I'd like the residency bottle neck to be addressed ASAP. I don't want a system like the UK and I'm pretty distrusting of government in general but I do think ACA is a step in the right direction. The big question on my mind - how are we going to pay for all this in the long run?ReplyDelete
If the IRS is any indication of how well the government does things, then I am not optimistic about how this will end. How many pages are in the tax code? Now there are more regulations to follow and for the IRS to enforce. Something had to change - just not sure if these changes are going to help long term. Everyone is excited about "free" and "reduced" costs for themselves. Who is paying for it?ReplyDelete
I have mixed feelings - on the one hand, the current system just doesn't work. People shouldn't be getting most of their care in EDs and society should be taking care of its citizens. But, I also think that in the excitement of everyone getting 'insurance' people don't realize that there are no additional doctors to see all these newly insured people (what's the point of having insurance if you still don't get access) and with the government (I can never remember if it's Medicaid or Medicare that pays for those spots, but either way it's our govt) not increasing the number of residency spots that's not going to change in the near future. I guess it'll help people who get admitted to the hospital, but I fail to see how it will help people get the routine care that would prevent them from getting admitted in the first place. So I think people are going to be disappointed and not much is actually going to change. I also still don't understand HOW this is going to be paid for.ReplyDelete
Agree about needing more doctors. Additional costs will be paid for by young healthy people signing up for health insurance.ReplyDelete
Make medical school free if you go into primary care. You'd see a shift almost immediately.Delete
^This is a legitimately interesting proposal. The math is a little daunting even if you exclude IM/psych but still doable compared to some of the things our gov't spends money on.Delete
FYI: Texas has a program to reimburse med school loans if you commit to 3 years in an underserved area after residency (which is less time than the military requires). I'm fairly certain that other states with regional physician shortages have similar programs.Delete
I think it's a good idea, the problem I have with it is two fold.ReplyDelete
First off the US cannot afford it right now- this is my primary concern! Maybe in a few years if we pull out of wherever we are now, increase taxes (Blasphemy I know! But, that's what all the other countries that have universal health care), and pay off our insane debt.
Second: I'm worried that not all people will be equal under this policy. Though this may be a load of garbage I'm going to share what I've heard --> I have a friend who works with mentally disabled patients and under obama care they don't qualify for random things like seizure medicine and bi-monthly check ups. What if that were my family member or even me? I'd be kind of upset (assuming I had the mental capacity to realize what was going on). I've also heard from others about possible "rationing" (for lack of better word) of care...again, we won't know until it's really in effect. But, I don't think either way it will live up to everyones expected standards.
My husband (who reads about this constantly) says the govt will actually save $800 billion dollars by using Obamacare in the long run. Countries with universal healthcare spend half as much on healthcare.Delete
I'm Canadian, so I doubt my opinion counts much, but for what its worth, its a step in the right direction. When I was pregnant I'd frequent pregnancy blogs and I couldn't believe one discussion which was about "how much will it cost" to have a baby - I couldn't believe that some women were paying (or going into debt) tens of thousands of dollars what costs me about $200 (and only because I had a private postpartum room). Obviously someone has to pay for it all, but personally I'm ok with paying higher taxes.ReplyDelete
Ask seniors over 65 if they want to have medicare taken away. NOPE. Same will be true for medical insurance.ReplyDelete
I think medical insurance should be TOTALLY removed as an employment benefit so people understand what the costs really are. Congress and ALL government employees should have only healthcare through ACA also.
But then, I also think no child or infant should ever go hungry in this country. SO SILLY OF ME!
I personally can't say I think it will be a cure for our undeniable failing medical system. However, I think it might will be the push that puts it on (or towards) the right track. That may be all it is and in a few years the government reformulates it to work better for our needs. Though who knows the the future holds?ReplyDelete
MY BIGGEST PET PEEVE with the debate is when people say our system can't handle the influx of millions of new patients. We don't have enough doctors, resources, etc... Hey guess what America, they already are being seen by our doctors and using way more than their fair share of the resources. Joe schmo without insurance doesn't see a family doc when he has a cough... he waits until its unbearable and goes to the ER with full blown pneumonia and he ends up costing an ER visit plus several days in the hospital, which gets paid by the taxpayers and hospitals. That's my soap box.
I think we need to start somewhere, and I don't see anyone else putting viable plans on the table. Without government regulation I truly don't believe the industry will begin making changes.ReplyDelete
While I am disappointed in the ACA, because it wasn't the radical change I was hoping for, I feel that this is definitely the first step in the right direction. Even as an anesthesiologist, with all predictions pointing to lower pay in my future, I'm still for this.ReplyDelete
Here is the view from Europe (Austria, in my case), where there is mandatory health care.ReplyDelete
First, it's far cheaper than in the US. In part, that is because the US are the biggest market for everything, from pharmaceuticals to MRI scanners: A vial of insulin glulisine, $130 in the US, is ~$45 here. Why? Because US customers cover the development cost and more, so every cent earned in Austria is a bonus. A small bonus from a small country, but why leave money on the table?
Second, the whole discussion misses the point. We are only discussing the different ways of rationing: In Austria, it happens by simply not providing services and therapies. Example: With many forms of macular degeneration, giving a VEGF inhibitor is standard and, the literature claims, effective in preventing further bleeds. Regrettably, it costs $umpteen K per month, so if you live here, why, you can just suck it up and go blind.
Or perhaps you have a herniated disc with severe radiculopathy and progressive paralysis of the right leg? The health care system sees no use in paying lots of surgeons, so I had to wait eight months for surgery (the bottleneck are post-op beds). Clearly, I have two legs which means I have a spare, what with one of them being halfway to useless.
So the choice, to me, seems to be crappy care for everyone; or really crappy care for some, OK care for most, and superb care for those with money. Six of one, half a dozen of the other. Our Canadian commenter above forgot to mention that her countrymen see it the same way: If they want decent treatment fast, they travel to the US ... assuming they have money.
There is one thing I would change about the US insurance system. Currently, individual insurance in the US is structured as a bet: If you are healthy, you lose; if you develop an expensive condition, you win, and the insurer loses.
The change I would make is this: If you develop a health condition, your current insurer is liable to cover, under the conditions of your current policy, all costs resulting from that -- until you stop paying premiums. In other words, if the insurer loses the bet, I would prevent the company from cutting its losses (and the patient's throat). That also fixes the problem of existing conditions nicely, I think.
In Germany (same system as here in Austria), there is a saying about the health care offered by the mandatory system: "Too little to live, too much to die."
I have family in England, Canada, the Bahamas and the US system is great for urgent care, but terrible for prevention and terribly expensive compared to the others. Personally, I think that the benefit of doing away with pre-existing conditions is one HUGE perk of Obamacare. As an example, I have a patient still working like crazy to avoid healthinsurance because she is dying of ovarian cancer and can't get health insurance if she isn't working. BUT SHE's DYING!!! Now, her husband will be able to get a plan for her that they can afford so she can stop working.ReplyDelete
For anyone reading - Frontline did a great trip around the word looking at healthcare systems everywhere. Switzerland has a story very similar to the USA's - narrow voting in, lots of opposition. Now, 5 yrs later, they say it's so good they could never go back. We aren't the first to do this - we are the last. US healthcare is not #1 despite many US citizens thinking it is. Wake up and look around.
There are some real and very sad consequences to very real people. It is easy for those of us who are in a higher income bracket to sit back and say it doesn't make sense to allow people to be uninsured. I'm going to share some real stories with you that is affecting real people. There is this one guy who signed up,or at least he tried to sign up. He has type 1 diabetes and his income is $52,000 a year. Not a lot of money any way you look at it. It, however, disqualifies him from assistance. He tried to sign up for the bronze plan. The sticker price was over $500 a month. He doesn't have it. You can't squeeze that kind money from someone who doesn't have it. He declined insurance and his penalty was over $4,100. He doesn't have that either. Reading his comments, his despair came through my computer screen and honestly, I teared up for him. The penalty for not paying the penalty is loss of your driver's license and a tax lien if you're a homeowner. Where on earth is someone making that salary going to come up with that kind of money on a monthly basis? So now he still doesn't have insurance and he now has to come up with over $4,000 a year. He is screwed any which way you look at it.ReplyDelete
Where do you think families will come up with that kind of money who are in that tax bracket?
A friend of mine is a type 2 diabetic. He is 63 years old. He cancelled his insurance because the price kept going up. He finally canceled it after it went up to $1,200 a month. I don't know what his insurance will be under obamacare but he told me that he is going to speak to his accountant and if the penalty is cheaper, he will pay that until he qualifies for medicare.
If my income was in the $50,000 range and I had to come up with $500 a month that I did not plan on, I honestly don't know what I would do. Many of these people are living paycheck to paycheck, and now they have to come up with a huge chunk of money they simply do not have. It is NOT affordable in any way to many, many, many people. What do you think they should do? Sell their homes? Cut back on food? Sell their cars? Something has to give. If my life consisted of trying to make an insurance premium payment while trying to juggle the rest of my bills, where is the quality of life? Sell my house and get something smaller? Change my life to accommodate an insurance payment? You may laugh but many people will find themselves in this quandary.
Lastly, quite a few corporations have cut back the hours of their employees across the board to a 29 hour work week so they don't have to provide insurance for their employees. What about those people? They will now have to purchase insurance, albeit probably be able to get assistance, but now they have lost a huge chunk of their income.
Health care for people is a good thing. But this is a disaster because many, many Americans that just don't have the money. I honestly don't know what they are going to do. I know I wouldn't know what to do if I were in that position. I can't even imagine being forced to come up with money that I don't have for and then if I can't come up with what I don't have, lose my home and/or my driver's license.
I keep thinking about that man. I feel so bad for him. And he is not alone.
I question the veracity of a story you read on the internet. But I know a lot of type 1 diabetics, including a close family members, and the yearly cost of health care is far more than $6,000 per year. He's getting a bargain and not having health insurance with such a serious health condition means that someday you personally will be paying that man's health care bills.Delete
Sorry, but those numbers just don't make sense. The fine is capped at 1% of your total income in 2014 and ramps up to a cap of 2.5% total income by 2016. If you make $50k then your fine won't be more than $1250/year even three years down the line.Delete
Furthermore, there is a provision which says that if the cheapest health plan available to you costs >8% of your income, then you are NOT FINED for going without health insurance. So on a $50,000/yr income, if you can't find a plan that costs $333/month or less, you can go without health insurance and pay NO FINE. In fact according to this handy chart-- http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/ -- the income threshold is computed based on total income minus $10k filing threshold, so if your friend can't be insured for less than 8% of $40,000 ( = $266/month), he again pays no fine.
Unfortunately there is a lot of misinformation (unintentional as well as intentional) about the ACA and the Obama admin hasn't done nearly enough to educate the public. That chart is pretty helpful and you should pass it on to your friends who are worried.
Aside from all that, if you have diabetes you are going to be getting way more out of your health plan than you pay in, as Fizzy said, and you should go to heroic lengths to get some damned health insurance. Going bankrupt from medical debts is a very real problem for the uninsured.
Snopes.com totally disproved the fake woe-is-me premium and fine stories that are going around the internet: http://www.snopes.com/politics/medical/penalty.aspDelete
I am in favor...even though I am currently working for no pay as an RN. I feel everybody should have access to healthcare. I have seen people turned away for simple procedures because they don't have health insurance. I don't think it is fair for them. Or a family being wiped financially due to a car accident. So, will it cause some problems, yes but is it worth it, yes...ReplyDelete
I'm jumping right to the "my two cents" section but I will go back and read other comments. I am pro Obamacare for several reasons, My stepdaughter had reached the lifetime maximum on her husband's healthcare policy. She is a diabetic with every complication possible. You know that over the years healthcare costs have risen an insane amount and the lifetime maximum figure has not changed? That goes away with the Affordable Healthcare Act. I think doing away with pre-existing condition restrictions is a wonderful. I worked as a self-employed realtor for years and fortunately, was covered under my husband's policy because the older I got, the less I could afford my own insurance. Now I run a hospital communications center and have insurance, albeit not wonderful insurance, but I am aware of all the charity care/unpaid services we provide. I have to believe that once people can afford their own insurance, it will translate to better reimbursement numbers for the hospital. I really like "Affordable Health Care Act" so much better than the vaguely derogatory "Obamacare". Maybe not so vague in my Southern neck of the woods...ReplyDelete
My son is in his fourth year of med school. He never wanted to be a doctor for the money. I have no problem that the government wants EVERYONE to get healthcare. Pay my son's 200,000+ loans off and we will call it even!ReplyDelete
Most people aren't against PPACA they are against one or two parts of the law. Mainly against the so individaul mandate (IM). Most people against the IM aren't effected by it. So, are these people against the IM doing so out of the godness of their hearts or some political reason? For serious people who want a good blog on this and other healthcare related issues I suggest http://theincidentaleconomist.com/wordpress/ReplyDelete
here's a great chart to determine if a family is eligible for premium tax credits for marketplace (exchange) plans.
What people don't realize is they are already paying FOR healthcare whether they use it or not. PRO-Obamacare. Let's share the cost. You want to drink and drive and cut up your body....fine, you're insured and doc's will get reimbursed for your emergency middle of the night idiotic surgery. You refuse to put the cookie down and ride around in your motorized scooter yet have the energy to move like the dickens for your moon pies and donuts--fine you've got insurance you pay for your insulin, clinic costs and medication; you were born with a congenital defect that is NOT your fault, ok you've got insurance your parents who refused to abort you against doctor's suggestions will help cover your cost. FINE, everyone needs healthcare. Middle class is paying for it all. Upper class just gets pissed and the general public (working poor) don't get help for preventative medicine. LEt's hand out free birth control---all kinds including tubal ligations; let's hand out free vitamins and coupons for fruits and vegetables instead of that nasty WIC crap. Let's outlaw moon pies and twinkies. You won't hear people boo-hooing about healthcare because truly they won't need it for their diabetic cardiovascular disease emergencies. Those things will cease to exist. And let's not forget vaccines...Man those people who shout with pride that their kids are "naturally inoculated" ugh! give me a break. Yes, I'm for Obamacare. Let's hope he can re-vamp the education system because W sure did his part with sending that part of our society into the dinosaur ages.ReplyDelete
I believe that we need an affordable heath care plan that covers all of our citizens, but Obamacare is not the correct solution. It is unfortunately set up for failure. There are better solutions to institute changes in healthcare than the processes they are using. I personally would have started out by taking all the people who make up to double minimum wage and offering them an affordable (dollars a month) healthcare coverage. A large part of what they arranged this on was that only 1% of the population make minimum wage, and they should be able to qualify for state run care. Thousands of workers make up to double minimum wage. They tend to be lower middle class, and therefore do not qualify for state assistance. The jobs they work at tend to be cashiers at gas stations and all stores, fast food workers, etc. These are your working class who cannot afford to pay one weeks worth of pay or more per month for the insurance that is offered at their job.ReplyDelete