The Obamacare Bomb Explodes

[Skunkle]

I'm very, very glad that this is taking effect. I'm glad it has at least BEGUN before the Conservatives manage to kill it.

I'd bet money that THE reason - THE ONE AND ONLY reason - the Republicans are so against what they've termed Obamacare, throwing money, time, effort and nasty lies (like the outright insane "death panels" crap) at getting rid of it - yes, EVERY BIT of the mad rush to vilify it and, once shreds of the original plan squeaked through, to pull it back down - are entirely because of the loss of profit to people who contribute to them and put money in their pockets, and in their own pockets - croneyism is full swing.

I do not believe, personally, that there is the tiniest molecule of good, caring intent in their plan. In fact, their plan as far as I've been able to tell is, "Everything is golden just the way it is." Call me stupid, but I hear all these arguments that those who can't afford health care are just whiny, lazy bums, the whole fuckin' lot of 'em - and all I hear is, "I got mine. You can freeze, starve or rot and I won't care. Nobody should have to, or should want to, or should care about anyone but themselves. I got care, I got megabucks in my pocket, so go to hell and rot!!"

[Panacea]

Sadly a for-profit driven medical system is bass-akwards. See there is no profit in CURING people. Once they are well, they do not need the doctors/hospitals any more. So it is best to treat the symptoms, not the actual disease/problem. Do not get me wrong, I am sure doctors and nurses do everything they can to actually fix the problem, but the research just is not there for a lot of things. Because there is no profit in it, and the big companies which have the money to fund the research won't. Why shoot themselves in the foot?

I'm afraid you've got the problem a bit backwards.

Physicians really do want to give good care. The problem isn't that they don't want to give the best care. Many of the conditions that are the most expensive are chronic; there IS no cure, only new treatments. The vast majority of Medicare dollars spent per person are spent during that person's last six weeks of life delivering futile care in a direct effort to "cure" the patient.

The problem is the perverse incentive system. Doctors are paid by the tests they order and the procedures they perform. That's why cardiologists are a dime a dozen. They can make money hand over fist putting stents in patients with unstable angina (chest pain that is not a heart attack). They make next to nothing doing the CORRECT and safer treatment, which is beta blockers, statins and aspirin.

We have a surplus of specialists because that's where the money is. The result is we don't have enough family docs, pediatricians, and OBs and have to make up the shortfall with PAs, nurse practitioners and nurse midwives.

Physicians should be salaried. Then the system of perverse incentives would disappear and physicians would be free to treat based on the medical evidence rather than a need to make money to stay in business. Physicians would have time to actually TALK to their patients, and get complete histories so they can order the RIGHT tests and RIGHT treatments. Satisfaction would improve.

CMS (Centers for Medicare and Medicaid Services) has actually done trials where physicians were put on salary, and that's exactly what happened. This is how the Mayo Clinic and Kaiser Permanente are modeled. They control costs, and patients are satisfied.

[Mytical]

Sadly a for-profit driven medical system is bass-akwards. See there is no profit in CURING people. Once they are well, they do not need the doctors/hospitals any more. So it is best to treat the symptoms, not the actual disease/problem. Do not get me wrong, I am sure doctors and nurses do everything they can to actually fix the problem, but the research just is not there for a lot of things. Because there is no profit in it, and the big companies which have the money to fund the research won't. Why shoot themselves in the foot?

Donations and government grants help a little, but only go so far. It would take a massive effort to get the best and brightest, pay them amazingly JUST to work on cures..and then not worry about actually making much money on the cure. Not going to happen anytime soon. Imagine the impact on an already staggering economy, also, if the billions for certain currently incurable diseases suddenly were able to be cured.

Factor in how it woudl affect the worlds population..and there are a lot of people out there who never want to see a cure. Ever. Sounds cold and cruel, but it is true. But I am just probably a conspiracy nutjob , so ignore the man behind the curtain

[Panacea]

We do need to move away from payouts that are designed to increase unneeded treatments and procedures and tests because it's bogging the whole thing down and people are getting hurt or sicker as a result.

^-.-^

To do that, we need to move away from fee for service. Doctors won't like that; they like being able to charge what they want and be independent rather than salaried.

[Andara Bledin]

I do like the idea of refusing to pay for things that are essentially fixing problems created by bad care, such as bedsores and UTIs.

We do need to move away from payouts that are designed to increase unneeded treatments and procedures and tests because it's bogging the whole thing down and people are getting hurt or sicker as a result.

^-.-^

[Panacea]

Maybe doctors could get paid an annual salary and then a bonus if they actually make someone better?

Actually, there is a movement for that. Medicare is already starting to pay based on outcome, and refusing to pay for specific preventable complications, like UTI's and bedsores. This is good for patient care.

A system to pay based on outcomes can be designed with the understanding the outcome may not be the one desired by the patient. Incurable illnesses are still incurable illnesses. But if the care follows the medical evidence, then the physician should be reimbursed.

[HYHYBT]

Not long ago our local hospital went from non-profit (run by the town plus two counties for benefit of their residents) to for-profit. I do not know exactly what happened, but I get the impression it was because it wasn't run too well, the counties weren't interested anymore., and the city couldn't support it on its own. I do know that it came down to the only realistic options being either to sell it to this company that promised to keep it as a hospital or else to close it and turn the whole thing into just a nursing home.

Now, there's no way they'll ever make *much* profit out of it, but maybe they can make some and stay in business, keeping people (in most cases; of course they send on what they cannot handle) from having to go to a city. Because sometimes by the time you get there it's too late, among other advantages of having a small hospital close by.

As for paying doctors by whether the patient gets better... often there's no way to make someone better. All that can be done is to slow their decline. Sometimes not even that, but just making it more bearable.

[Rapscallion]

You'd risk having doctors turning away time-consuming and low-survival type patients, though quite frankly there is no perfect system anywhere. I suspect in the fullness of time we'll end up with a 'least worst' one, but there's no best system I'm aware of.

Rapscallion

[bara]

Maybe doctors could get paid an annual salary and then a bonus if they actually make someone better?

[Panacea]

now if you can get the hospitals to not be run for profit you might actually stand a chance.

run for profit they pad expense to the customer to get more money, when both health insurance and hospital are government run you now get them trying to stay under budget.

Most hospitals are already run not for profit. Many hospital organizations are a mix of non and for profit enterprises, the latter used to subsidize the former.

What we need to get rid of is the perverse system of incentives that pays physicians to order tests and perform procedures but not to actually talk to their patients.

We need to get rid of fee for service.

[gremcint]

now if you can get the hospitals to not be run for profit you might actually stand a chance.

run for profit they pad expense to the customer to get more money, when both health insurance and hospital are government run you now get them trying to stay under budget.

[Ree]

An edit has been made to the first post in this thread giving credit to the original source.

[Panacea]

Ive said before that health care is an industry that should not be profit driven.

Adam Smith, author of Wealth of Nations, and father of modern capitalism agreed with you.

Fascinating reading, but I'll believe it when I see it.

If you are right, and Obamacare makes a real difference, sure as I'm sitting here the legion of healthcare opponents will try to claim credit. I can already see their press release: "Uh well we were always in favour of better care for working-class Americans, but teh ebil Obama socialist-nazi-commie regulations stood in our way. Our tireless efforts have shown once again that the way to prosperity and health is less regulations and more free market blah blah blah..." I swear it's all becoming routine.

Ironically, most of the ideas in the ACA were actually proposed by Republicans during the fight over the Clinton health care reform plan, and many ACA ideas were drawn out of Massachusett's version of those ideas . . . supported and signed into law by Mitt Romney.

I'm not sure whose idea the medical loss ratio was, but it is one of the better provisions of the law.

BCBS has been trying to claim this idea as their own ever since the ACA passed, and that they actually implement 85% . . . which is blatantly untrue . . . in an effort to blunt the effects of the law.

and this is why my health insurance is provided by a not-for-profit cooperative.

Look again. Many non-profits operate under the umbrella of a for profit organization.

[HYHYBT]

I'd thought this was something they specifically *didn't* put in; glad to hear it exists.

Yes, they can make a profit on what remains. Just not a large one. Perhaps small enough that they'd rather invest their resources elsewhere. One thing: hopefully this would make them less inclined to spend so much time searching for every excuse in the book to deny payment

[BlaqueKatt]

and this is why my health insurance is provided by a not-for-profit cooperative.