The obamacare revolt

[g8orbill]

http://reason.com/archives/2013/03/1...cian-fight-bac

my Dr stopped taking insurance over 10 years ago

From the article:

"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel.

[gatordowneast]

Concierge medicine will become widespread among the more affluent should the POS called Obamacare be fully implemented. Just like in Canada and England. Those who want and can afford the health care most of us enjoy now, will opt for the 1 doctor per 300 patient route. And the better docs (especially primary care) will prefer that type of practice. $5 K gets you personalized care and your doc's cell.

[HudsonGator]

Originally Posted by g8orbill

http://reason.com/archives/2013/03/1...cian-fight-bac

my Dr stopped taking insurance over 10 years ago

From the article:

"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel.

There is nothing new in this article. Physicians have been griping about trying to practice medicine while at the same time fighting with insurers/HMO's/PPO's/Medicare/Medicaid/etc. for years. The ACA has not changed that fact. Go ask a hospital CEO what he thinks about the ACA and I'll bet he tells you that he's happy that once it is fully implemented instead of having to treat lots of uninsured folks for free, they'll be seeing people with insurance or medicaid.

[gatorman_07732]

Originally Posted by HudsonGator

There is nothing new in this article. Physicians have been griping about trying to practice medicine while at the same time fighting with insurers/HMO's/PPO's/Medicare/Medicaid/etc. for years. The AFCA has not changed that fact. Go ask a hospital CEO what he thinks about the AFCA and I'll bet he tells you that he's happy that once it is fully implemented instead of having to treat lots of uninsured folks for free, they'll be seeing people with insurance or medicaid.

There is still going to be uninsured people and they are going to take a bigger beating once more and more people roll into the federal exchanges. Doctors in private practice will take the biggest beating. I would prefer to have a policy that does not cover office visits and pay cash which is a win-win.

[Emmitto]

Here's an anecdotal story (first hand though, it was me) that I believe is a valid example of how ridiculous our healthcare/insurance system is (and FWIW, Obamacare doesn't fix):

I've had sinus/ear problems for months. Pressure, moderate pain, left side perpetually stopped up, etc. I went to my doctor twice, got antibiotics for ear infection both times. No help. I did the dreaded (to doctors) self-diagnosis thing. First I learned that ear infections are 80% viral and not responsive to antibiotics. I also learned that it can morph into a bacterial infection, which is indeed treatable with antibiotics. Further, I settled on "chronic sinusitis" as my issue.

Went back to my doctor and explained my reasoning, with apologies for having the gall to self-diagnose. As I expected, he acted all offended and referred me to an ENT. Fine, I'm desperate at this point. Two ENT visits later, guess what she settled on: chronic sinusitis via bacterial infection, perhaps from an original viral ear infection.

Tally: five visits, three rounds of antibiotics, and double-digit hours of time on both ends. Approximately $3000 in charges, about $250 out of pocket. That doesn't include the time cost, of course.

I just started this last round of antibiotics and a steroid nasal spray. But I started using a saline solution (OTC) to cleanse my sinuses, and the symptoms largely subsided except for some persistent congestion on my left side. I read about that, only on my last visit to the ENT did a doctor suggest it, and I'd already started.

Point being, at this point it doesn't appear my condition is exceptional and hopefully I'm close to being AOK. But five visits between two doctors over about three months, $3000 (and you should see some of these individual charges--$400 for "surgery" at my original doctor which was essentially him flushing my ear with warm water to remove a foreign object--it was a dead bug--and I eventually got that charge removed--another hour or so of life), and $250 or so out of pocket.

I find that incredibly ineffective and inefficient. If anything, me paying the $250 and a visit or two should've done it. But the system doesn't allow it. And insurance was a big part of the problem. Doctors charge them excessively and they pay and still make a profit.

What's the fix for that? To be clear, I am ambivalent toward the ACA because philosophically I'm for anything beyond the monstrosity that exists, yet it doesn't address the fundamental problems. Seems like sloppy mouth-love to the unimaginably bloated insurance industry to me.

IOW, one should be able to pay the equivalent of a new Ping driver to address common medical issues and move on with life. Obamacare doesn't do that and it certainly doesn't exist without it either.

[HudsonGator]

Single-payer, essentially Medicare for all.

[108]

direct primary care is an interesting idea, but as hudson pointed out, the gripe is nothing new

just another way to blame Obama

[QGator2414]

Originally Posted by Emmitto

Here's an anecdotal story (first hand though, it was me) that I believe is a valid example of how ridiculous our healthcare/insurance system is (and FWIW, Obamacare doesn't fix):

I've had sinus/ear problems for months. Pressure, moderate pain, left side perpetually stopped up, etc. I went to my doctor twice, got antibiotics for ear infection both times. No help. I did the dreaded (to doctors) self-diagnosis thing. First I learned that ear infections are 80% viral and not responsive to antibiotics. I also learned that it can morph into a bacterial infection, which is indeed treatable with antibiotics. Further, I settled on "chronic sinusitis" as my issue.

Went back to my doctor and explained my reasoning, with apologies for having the gall to self-diagnose. As I expected, he acted all offended and referred me to an ENT. Fine, I'm desperate at this point. Two ENT visits later, guess what she settled on: chronic sinusitis via bacterial infection, perhaps from an original viral ear infection.

Tally: five visits, three rounds of antibiotics, and double-digit hours of time on both ends. Approximately $3000 in charges, about $250 out of pocket. That doesn't include the time cost, of course.

I just started this last round of antibiotics and a steroid nasal spray. But I started using a saline solution (OTC) to cleanse my sinuses, and the symptoms largely subsided except for some persistent congestion on my left side. I read about that, only on my last visit to the ENT did a doctor suggest it, and I'd already started.

Point being, at this point it doesn't appear my condition is exceptional and hopefully I'm close to being AOK. But five visits between two doctors over about three months, $3000 (and you should see some of these individual charges--$400 for "surgery" at my original doctor which was essentially him flushing my ear with warm water to remove a foreign object--it was a dead bug--and I eventually got that charge removed--another hour or so of life), and $250 or so out of pocket.

I find that incredibly ineffective and inefficient. If anything, me paying the $250 and a visit or two should've done it. But the system doesn't allow it. And insurance was a big part of the problem. Doctors charge them excessively and they pay and still make a profit.

What's the fix for that? To be clear, I am ambivalent toward the ACA because philosophically I'm for anything beyond the monstrosity that exists, yet it doesn't address the fundamental problems. Seems like sloppy mouth-love to the unimaginably bloated insurance industry to me.

IOW, one should be able to pay the equivalent of a new Ping driver to address common medical issues and move on with life. Obamacare doesn't do that and it certainly doesn't exist without it either.

I agree with what you are getting at. Insurance should not be involved in non catastrophic events.

Pay a doctor $250 to remove a bug from your ear and give you a prescription. If that does not work and you do not like your doctor pay $100 for another doctor to work with you.

HSA's! Make Insurance just that. Insurance! And get government mandates out of the insurance industry!

[Emmitto]

Originally Posted by 108

direct primary care is an interesting idea, but as hudson pointed out, the gripe is nothing new

just another way to blame Obama

Agreed, about the Obamascare rhetoric, but how does it address $3000 sunus infections?

If our healthcare/insurance system were a house, you'd burn it down and live in a Holiday Inn Express while one that doesn't suck was built. Plus you'd know all that stuff from staying at a HIE.

[rivergator]

I'm sure that insurance is a major pain for doctors. But the revolt is against insurance. Bill is just pretending it's against Obama.

[Emmitto]

Originally Posted by QGator2414

I agree with what you are getting at. Insurance should not be involved in non catastrophic events.

Pay a doctor $250 to remove a bug from your ear and give you a prescription. If that does not work and you do not like your doctor pay $100 for another doctor to work with you.

HSA's! Make Insurance just that. Insurance! And get government mandates out of the insurance industry!

I like HSA's so long as you can get "ahead" before needing to use it, which the vast majority of young people should be able to pull off. But I don't know that it addresses the overall cost problem. Would it have addressed my situation? I'm sincerely asking, not disputing (yet!)

[QGator2414]

Originally Posted by Emmitto

I like HSA's so long as you can get "ahead" before needing to use it, which the vast majority of young people should be able to pull off. But I don't know that it addresses the overall cost problem. Would it have addressed my situation? I'm sincerely asking, not disputing (yet!)

Do I know for sure? No.

But doctors treating patients and being paid for that treatment makes the most sense for the patient. Remove the middleman and let the doctor charge what their service is worth in non life threatening circumstances and if a person wants to buy extra coverage for certain things (like an extended warranty) then let them. Let local communities set up clinics through their health departments for those that cannot afford a checkup while pushing emergency care clinics (that NP/PA's can own and operate) to remove the nonsense from the ER.

[Emmitto]

Originally Posted by QGator2414

Do I know for sure? No.

But doctors treating patients and being paid for that treatment makes the most sense for the patient. Remove the middleman and let the doctor charge what their service is worth in non life threatening circumstances and if a person wants to buy extra coverage for certain things (like an extended warranty) then let them. Let local communities set up clinics through their health departments for those that cannot afford a checkup while pushing emergency care clinics (that NP/PA's can own and operate) to remove the nonsense from the ER.

Gotcha. Yeah, I can't disagree on the concept. But I don't see a workable mechanism for that without tearing the whole thing down.

Personally this is a field in which I don't like a market setup (life/death.) There's an inherent demand side problem. The supply needs perpetual bad health. There's no profit incentive for consistent, good health. But I suppose that's a philosophical debate for another thread.

[QGator2414]

Originally Posted by Emmitto

Gotcha. Yeah, I can't disagree on the concept. But I don't see a workable mechanism for that without tearing the whole thing down.

Personally this is a field in which I don't like a market setup (life/death.) There's an inherent demand side problem. The supply needs perpetual bad health. There's no profit incentive for consistent, good health. But I suppose that's a philosophical debate for another thread.

Quick 1:45 from Dr. Carson on the idea of HSA's which one of the parts I love is the implicit removal of Medicare from the end of life care. Especially after watching my grandfather go through it a year and a half ago.

I think we both agree the issue is too complex to solve in quick sound bites and a message board but I really get frustrated knowing how much money was wasted in my grandfathers last two months of life. He should have been sent home and given the hospice care he needed to keep him out of pain instead of a miserable hospital experience that did not benefit anyone except some Medicare code billings on tests and doctor drop ins...

[Emmitto]

Originally Posted by QGator2414

Quick 1:45 from Dr. Carson on the idea of HSA's which one of the parts I love is the implicit removal of Medicare from the end of life care. Especially after watching my grandfather go through it a year and a half ago.

I think we both agree the issue is too complex to solve in quick sound bites and a message board but I really get frustrated knowing how much money was wasted in my grandfathers last two months of life. He should have been sent home and given the hospice care he needed to keep him out of pain instead of a miserable hospital experience that did not benefit anyone except some Medicare code billings on tests and doctor drop ins...

Yes, we agree, largely. My focus is mostly on run-of-the-mill situations that I believe are currently treated as a profit opportunity, like adding cables to a TV purchase, but humane yet sensible end of life treatment is certainly a giant factor that must be part of the equation.

I'm sorry to hear about your grandfather. We've all seen this, or will at some point.

[Gatorrick22]

Originally Posted by 108

direct primary care is an interesting idea, but as hudson pointed out, the gripe is nothing new

just another way to blame Obama

It might not be new, but it's about to get a whole lot more popular.