I hate ACA! ObamaCare Sucks!

[southerndoc]

The ACA has to be one of the worst things to ever happen in the insurance industry. Our very large health system doesn't take a particular health exchange plan, and we must transfer these patients to a hospital that does. The last time I had a guy with appendicitis, it took 5 1/2 hours to get approval for him to be operated on at my institution v. transferring him. I've had admissions that had to be transferred because of it.

Fast forward to today when I find out that the health insurance I have is not accepted at the health system where I work (I'm an independent contractor). So if I require admission, I will need to be transferred to another hospital in Atlanta that is pretty far from where we live. Our daughter had to visit the ED last week, and I can only wonder what kind of bill I will receive.

I logged onto Blue Cross/Blue Shield's website to try to change insurance only to find you can only change insurance plans during open enrollment periods. That means I have to wait until November to change plans. Previously, I could change plans at any time I chose.

The insurance my wife and I had -- both individual policies -- were terminated at the end of 2013 despite Obama's claims that individuals would be able to keep their current policies. Like many Americans, my family found that to be a lie.

So hat's off to Obama and the Democrats for creating the worst healthcare law ever, and probably one of the worst pieces of legislature ever to be signed into law in the history of democracy.

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[DocEspana]

Just dont punch your computer. Because you'll end up at the ED where they will transfer you out. Which... is an understandable reason to punch a computer, but just feeds the cycle.

 

[@JackShephard]

I'm amazed that you can get a bunch of people to set up and agree upon such a terrible healthcare system.

It's unbelievable.

 

[southerndoc]

DocEspana, frustrated, yes. Angry? No. It's an annoyance that like everything else in life, I will overcome. I rarely get angry at anything.

 

[RustedFox]

Falcon-PUNCH!

 

[Rendar5]

Isn't transferring patients for lack of a particular insurance a major emtala violation?

 

[Spinach Dip]

The insurance my wife and I had -- both individual policies -- were terminated at the end of 2013 despite Obama's claims that individuals would be able to keep their current policies. Like many Americans, my family found that to be a lie.

Wait.... Politicians Lie?

 

[southerndoc]

Isn't transferring patients for lack of a particular insurance a major emtala violation?

Not if they're stable. Better than the patient being stuck with a $30,000 bill.

 

[worfndata]

100% your fault for not knowing what open enrollment is and not checking what type of hospital coverage you have in time.

Healthcare reform not perfect? So its the end of the world!11!1!!

Millions of low income people have insurance for the first time. And millions more to follow...

WHO CARES RIGHT?????

 

[Rendar5]

Not if they're stable. Better than the patient being stuck with a $30,000 bill.

Except if they need to be admitted, they don't meet EMTALA definition of stability. Your hospital system will eventually be hit by a major EMTALA suit, and I mean major, if they persist in their regard. Transfer out of a patient your hospital has the capacity to treat because they don't take their insurance is explicitly an EMTALA violation.


Hospitals have three obligations under EMTALA:

1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once they have ensured that doing so will not interfere with or otherwise compromise patient care.
2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.

Amendments[edit]
Since its original passage, Congress has passed several amendments to this act. Additionally, state and local laws in some places have imposed additional requirements on hospitals. These amendments include the following:

• A patient is defined as "stable," therefore ending a hospital's EMTALA obligations, if:
  • The patient is conscious, alert, and oriented.
  • The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital's ability.
  • Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital's ability to ensure the patient does not need further inpatient care
  • more showed up here, but i'm stopping the copy-pasting bit..

 

[Birdstrike]

Wait.... Politicians Lie?

Yes, lies are their form of truth. And everyone should know that. Yet, if people know that, why do they keep begging these liars to take more of their hard earned money in taxes, rewrite the rules of our lives, tap every phone call and text message and dictate everything in our lives from conception, to circumcision, and on through to cremation?

Why?

Why?

Why do we keep electing them to FIX things, knowing damn well it's nothing but a pack of lies for them to create disasters?

Please tell me (and Southerndoc) why we keep hiring them to screw things up?

You'd think we'd have learned, would be fed up, and be demanding they give us our healthcare decisions, our lives, our money, and our country back.

For how many more four year cycles will we buy the same recycled see-through "hope and change" mantra before we finally learn from history, and demand to be left alone?

The answer ain't "blowin' in the wind" my friends, it's right here smack dab up in our grill!

We need to be asking for politicians to,


LEAVE US ALONE.


Please recite these words 1,000 times, from the only President in my lifetime that got this:

"The nine most terrifying words are, 'I'm from the government and I'm here to help.'"-Ronald Reagan

 

[henge]

OK, we get it. You don't like the ACA. Shouldn't this kind of ranting be in the Wolf's Den?

But I'll take one parting shot. No, we should NOT be left alone. Sick people left alone can NOT cover their medical expenses without insurance. Insurers left alone will NOT cover sick people. If you want sick people to able to get medical care, you can NOT leave the industry alone. Nothing new or controversial about any of this. See Kenneth Arrow's seminal work on the economics of health care and insurance at http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf Either taxpayers will cover the cost of the sick getting care (as is done with MA and MC) or co-workers/employers will cover the cost (as is done with employer provided coverage) or co-insured will cover the cost (as is done with ACA).

 

[gman33]

How about a patient requesting transfer?
Is this transfer an EMTALA violation?

We are obligated to treat regardless of ability to pay, but they will get a bill if the insurance is not accepted.
I think patient's should be informed of this and given options.
Not sure if it's legal or practical.

 

[two guys]

anybody else transferring apppys for patient request due to insurance or VA issues? Doesn't seem right to me. They clearly have an emergency condition, I don't see how any insurance can claim "out of network" for an emergency surgery. I generally tell them that I don't think the risks of transfer (perf and delayed care) are worth the benefit (theoretical change in bill). That being said, I could be entirely ignorant about this. Certainly don't want the patient to get stuck with the bill, but I also don't think they should get less than the level andspeed of care that I'd give to an uninsured person.

 

[Rendar5]

How about a patient requesting transfer?
Is this transfer an EMTALA violation?

We are obligated to treat regardless of ability to pay, but they will get a bill if the insurance is not accepted.
I think patient's should be informed of this and given options.
Not sure if it's legal or practical.

How about a patient requesting transfer?
Is this transfer an EMTALA violation?

We are obligated to treat regardless of ability to pay, but they will get a bill if the insurance is not accepted.
I think patient's should be informed of this and given options.
Not sure if it's legal or practical.

not violation if pt requests it. their insurance just won't cover it. our transfer forms require us to mark if it's medically necessary or patient requested

 

[Old_Mil]

I feel your pain. Our insurance is not accepted at the only level 1 trauma center in the state. So if I'm involved in a serious trauma, I better be dead on the scene.

Sent from my Z10 using Tapatalk

 

[Birdstrike]

OK, we get it. You don't like the ACA. Shouldn't this kind of ranting be in the Wolf's Den?

This is "man on the street" feedback, from an Emergency physician (Southerndoc, the OP) who's telling you (and anyone else in the world who cares to read it) how this law has affected his life?

You can't bear to read it?

It needs to be brushed under the rug into some "Wolf's Den" so you can be sure you never have to read it again?

Nobody's calling for anarchy, here. If you are in favor of a law or policy. Own it. And deal with the those who are affected by it. I know you didn't read the ACA before it passed, and neither did I or any single person on Planet Earth.

Many of us were lied to, and told if we had good insurance we could be assured we could keep it. I, like Southerndoc, was also lied to and my group could no longer keep our plan due to the ACA changes. Now I'm forced into a high deductible plan which, for most things, is like having no insurance.

So yes, he's ranting. I'm ranting. Millions are ranting. Because we were lied to, about a law that was promised to fix what was broken, without breaking what didn't need a fix.

This is not propaganda. This is real people, giving real feedback about a policy.

Watch him say it 36 times, "If you like your plan, you can keep it":

 

[VA Hopeful Dr]

This is "man on the street" feedback, from an Emergency physician (Southerndoc, the OP) who's telling you (and anyone else in the world who cares to read it) how this law has affected his life?

You can't bear to read it?

It needs to be brushed under the rug into some "Wolf's Den" so you can be sure you never have to read it again?

Nobody's calling for anarchy, here. If you are in favor of a law or policy. Own it. And deal with the those who are affected by it. I know you didn't read the ACA before it passed, and neither did I or any single person on Planet Earth.

Many of us were lied to, and told if we had good insurance we could be assured we could keep it. I, like Southerndoc, was also lied to and my group could no longer keep our plan due to the ACA changes. Now I'm forced into a high deductible plan which, for most things, is like having no insurance.

So yes, he's ranting. I'm ranting. Millions are ranting. Because we were lied to, about a law that was promised to fix what was broken, without breaking what didn't need a fix.

This is not propaganda. This is real people, giving real feedback about a policy.

Watch him say it 36 times, "If you like your plan, you can keep it":

This is the part of the whole thing the pisses me off the most. Anyone who actually knows anything about how medicine works knew from the onset that there would be unexpected consequences. You can't just demand that all of these people now be covered without doing something to contain those costs. I swear its like the people behind the law thought to themselves "Well, now that this is the law those insurance companies will have to just take all of these formerly uninsured people and not change their plans whatsoever".

 

[henge]

This is "man on the street" feedback, from an Emergency physician (Southerndoc, the OP) who's telling you (and anyone else in the world who cares to read it) how this law has affected his life?

You can't bear to read it?

It needs to be brushed under the rug into some "Wolf's Den" so you can be sure you never have to read it again?

Nobody's calling for anarchy, here. If you are in favor of a law or policy. Own it. And deal with the those who are affected by it. I know you didn't read the ACA before it passed, and neither did any single person on Planet Earth.

Many of us were lied to, and told if we had good insurance we could be assured we could keep it. I, like Southerndoc, was also lied to and my group could no longer keep our plan due to the ACA changes. Now I'm forced into a high deductible plan which, for most things, is like having no insurance.

So yes, he's ranting. I'm ranting. Millions are ranting. Because we were lied to, about a law that was promised to fix what was broken, without breaking what didn't need a fix.

This is not propaganda. This is real people, giving real feedback about a policy you supported and still support. Own it.

This is not the first time we've crossed swords on the ACA, and obviously neither of us changed the others mind. see http://forums.studentdoctor.net/threads/the-epic-boondoggle-many-predicted.1010262/#post-14126641 I was under the naive impression that an emergency medicine forum should discuss emergency medicine issues, and a forum on sociopolitical issues should discuss sociopolitical issues. I now understand that I misunderstood.

As for standing up for ACA, sure, I'll do that, and have done it in the past on SDN (see above), though my recent comment was primarily directed at your rant, about the evils of government and how we should be left alone.

I note you failed to address substantively the comment that I made; to wit that if we were left alone, as you demand, sick people could not get insurance or health care. What is your response? Own the issue! If you really think it's OK for sick people to not be able to get healthcare because insurance companies will rate them so expensively that they can't afford it, say so. Own the issue!

You did this in the past as well, throwing stones without offering any substantive rebuttal. For example, in the above linked thread, you ranted about how ACA did not cover every person in America (the food is terrible, and the portions are so small!). After linking to supporting sites, I pointed out that:

"So, I'd guesstimate that close to half of the 9% of the population who will be uninsured will be uninsured because of the refusal of States to expand Medicaid (3M), because they are undocumented aliens (~8M) or they are exempted from the mandate because they have religious objection or are American Indians. So, maybe 5%+ will uninsured for other reasons--they choose to free ride, they can't afford a policy even with subsidies, they don't understand options, especially Medicaid availability.

The simplest way to reduce the rate of uninsurance would be for states to expand Medicaid and to allow undocumented aliens to get coverage thru the exchanges. But of course, that won't happen for political reasons. Increased outreach to encourage poor people to sign up for Medicaid would also help a lot, but, again, there is little appetite to incur the expense that would entail.

What do you say Birdstrike, you going to champion Medicaid expansion and extension of coverage to uninsured illegal aliens?"

You refused to comment. If you think its a problem for the ACA to not cover everyone, then get behind measures that will correct that. Explain how you'd increase coverage, or explain why you felt it appropriate to throw stones at the ACA for not providing universal coverage, but really don't think that lack is a problem. Own the issue!

I truly feel sorry for OP who had to get rid of a crummy policy (because the insurer, probably as part of a plan to cull bad risk from its risk pool, changed the terms of the policy after the 'keep your policy statement' was made) and failed to understand how open enrollment periods work. Terribly sad, sad beyond words. Much sadder than someone who could not get insurance because they had cancer or a heart condition. Much sadder than someone who went broke because of medical bills. So sad.

Its great fun to poke at problems with programs, but if you really think the government ought to just 'LEAVE US ALONE', explain how impoverished seniors are going to get care in nursing homes once we abolish Medicaid. Explain how sick people will get care without community rating. Explain why its OK for people who get insurance thru their to get government mandated community rating but its not OK for people in the individual market to get community rating. Explain why its OK for people who get insurance thru their employers to get hundreds of billions of dollars per year in tax subsidies, but its not OK to give subsidies to people in the individual markets. Own the issues!

 

[henge]

If you are in favor of a law or policy. Own it. "

At Birdstrike's suggestion, the attached chart shows the number of people who got policies because of the ACA, including groups which the media does not always mention, like under 26ers, woodworkers (previously eligible, but uncovered, people who came out of the woodwork to sign up for MA), off exchange sign ups, etc. The number of insureds likely exceeds the number who lost non-qualifying policies by an order of magnitude.

And, as the recent detailed study of insurance coverage in Massachusetts shows, coverage matters, coverage saves lives. Extrapolated to the national level: "A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year." http://www.nytimes.com/2014/05/06/h...massachusetts-after-health-care-overhaul.html Even conservatives like Megan McCardle acknowledge it is a good study.
http://theincidentaleconomist.com/wordpress/in-which-i-agree-with-megan-mcardle/

As for your comments on the 'keep your policy' statement, your outrage is touching, but everything you've posted leads me to believe that you hated the ACA--you hate the very concept of government intervention in even failed markets-- well before those comments were made and I would be utterly shocked if they made one bit of difference to your health care or insurance situation. Moreover, the opponents ACA, both those in and out of office, have told plenty of lies, ranging from the infamous $20,000 minimum policy, to ads featuring people who supposedly people who lost insurance, but really didn't. For a sampling of lies from both sides, see
http://www.factcheck.org/2013/09/obamacare-myths/

And whereas Obama's 'misleading' statement probably made little difference in the real world--the GOP legislators certainly didn't vote in favor of ACA as a result--the lies, misinformation and obstructionist tactics of the ACA's opponents have had a real effect. For example, according to Kaiser, 42% of Americans did not know the ACA was still law http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-april-2013/ and in West Virginia, doctors report individuals failing to sign up because they think the ACA requires that a chip will be implanted in them if they sign up. http://www.nytimes.com/2014/04/27/u...s-depressing-participation-in-health-law.html All of that has resulted in people missing out on benefits that could save their lives. That is a much bigger issue than whether someone had to switch policies, because his insurer changed the terms of his policy, thereby killing its grandfather protection.

 

[Apollyon]

100% your fault for not knowing what open enrollment is and not checking what type of hospital coverage you have in time.

Healthcare reform not perfect? So its the end of the world!11!1!!

Millions of low income people have insurance for the first time. And millions more to follow...

WHO CARES RIGHT?????

Spoken like a true pre-med-student communist who has never truly worked in the world in which we live. And will you be saying the same thing to the "millions of low income people" and "millions more to follow" - "100% your fault", when something goes wrong, or no one takes the garbage ACA insurance, and the patients don't want to go 30 miles out of the way to a place that DOES take it, for a non-emergency condition? That is an honest question.

Defending this program is like defending a gang of teenagers that are vandalizing and stealing cars, because a few of them work in a mini-mart.

Make a note to yourself, and revisit this idea in 10 or 20 years, and see if you still agree.

"Anyone that is not a liberal at 20 has no heart. Anyone that is not a conservative at 40 has no brain."

 

[Birdstrike]

If the ACA is so great, why were the constant and repeated lies necessary to get it passed?

 

[henge]

Spoken like a true pre-med-student communist who has never truly worked in the world in which we live. And will you be saying the same thing to the "millions of low income people" and "millions more to follow" - "100% your fault", when something goes wrong, or no one takes the garbage ACA insurance, and the patients don't want to go 30 miles out of the way to a place that DOES take it, for a non-emergency condition? That is an honest question.

Defending this program is like defending a gang of teenagers that are vandalizing and stealing cars, because a few of them work in a mini-mart.

Make a note to yourself, and revisit this idea in 10 or 20 years, and see if you still agree.

"Anyone that is not a liberal at 20 has no heart. Anyone that is not a conservative at 40 has no brain."

Well, I've been in the real world--paying taxes, paying my kids tuition, etc.--for 30+ years and agree with worfundata. Of course, I could respond in kind with Mill's famous quote about conservatives, but I guess I'll just accept your expert diagnosis that I have no brain. It's good to see this thread is returning to medical issues--my lack of a brain-- rather than just providing a platform for ranting.

 

[henge]

If the ACA is so great, why were the constant and repeated lies necessary to get it passed?

See earlier comments on right wing disinformation, add death panels. Also, see Bismarck's comments about law and sausage making.

How did the comments affect the content of the legislation? It was drafted well before March 19.

Still waiting for your substantive replies, Birdstrike. Waiting for you to take ownership of kicking sick people out of community rated policies, etc.

 

[Birdstrike]

Still waiting for your substantive replies, Birdstrike.

Look. I'm not going to waste your or my time getting into any more of a ----ing match than I already have. You can go ahead and declare victory. The ACA is passed. It's law. For better or worse, you won.

What I think about it means little (but it's great to know at least one person cares). It makes no sense for me to argue any further about politics or religion. Neither of us are going to change our minds. I'd rather post an interesting case or "story".

There are winners and loses in every battle. Don't discount those who feel the law has made their life worse. Part of "winning" is dealing with the fall out from those that feel they were on the losing end. Nobody (not Rand Paul or any other 2016 Presidential candidates included) is going to repeal, over turn or defund the ACA, any more than they're going to eliminate Medicare, Medicaid, Roe v. Wade or any other sacred cows, despite the talk. Right or wrong, good or bad, the ACA is here to stay. Frankly, I'm more interested in making lemonade out of lemons than a ----ing match over past battles lost.

There's plenty of silver lining in the ACA and the current state of "Medicine" to keep me happy for quite some time. There's plenty of opportunity out there. I'm not frustrated with the current state of affairs. I'm adapting. Good luck to you, and congratulations on your win.

 

[goodoldalky]

At Birdstrike's suggestion, the attached chart shows the number of people who got policies because of the ACA, including groups which the media does not always mention, like under 26ers, woodworkers (previously eligible, but uncovered, people who came out of the woodwork to sign up for MA), off exchange sign ups, etc. The number of insureds likely exceeds the number who lost non-qualifying policies by an order of magnitude.

All the numbers at this point in time are foggy but the numbers we have now suggest something like half of the Obamacare "enrollees" are actually people who had previous insurance or were cancelled from their prior policy due to ACA cancellations of their existing insurance.
Rand report: Only 1/3 of new enrollees were uninsured previously
http://www.forbes.com/sites/theapot...-sign-ups-were-from-the-previously-uninsured/
Goldman Sachs: projecting only 1 million of obamacare signups among previously uninsured
http://www.washingtonpost.com/opini...d97eba-b8d1-11e3-899e-bb708e3539dd_story.html
McKinsey: 27% of new enrollees previously uninsured
http://hotair.com/archives/2014/03/...-for-obamacare-exchange-plans-have-signed-up/

The fact is that there seems to be a lot of funny math out there to try and make the impact of the ACA sound good. The fact is that Obama was wrong when he said that people could keep their insurance (either he lied willingly or he did not understand what was in the ACA) and there are a large number of people like Southern who have been hurt by the ACA in some way.

The truth is that these numbers, I don't care about too much. I believe the whole problem with the ACA is that it is misguided. It does nothing to decrease the cost of care in the US and ultimately is not going to fix the access issues to care in the US. Just because you have insurance (some high deductible plan requiring high copays) does not mean you are going to be able to get access to a healthcare provider nor that you will be able to afford the subsequent costs.

The main problem is that the healthcare we provide in this country is too expensive. Medical Malpractice and tort reform is a joke most places. We order too many tests and give too many treatments because the costs of missing something are prohibitive.

We keep too many patients on ventilators, home primacor, and activate code stroke and code STEMI protocols on too many patients who shouldn't be candidates. We keep too many patients on multi drug chemotherapy regimens for metastatic cancer when we should really just stop in all of these situations and address the patient's comfort aggressively, but nothing else. The problem with our system is that the CARE we provide is too expensive, and too much. The only TRUE answer is to tell the American people that we can no longer afford to be giving this care and you can no longer have it... but that is something that most Americans don't want to hear. It's also not something that will be fixed by the ACA. My problem with the ACA is that it trades one set of problems for a different set of problems and ultimately fixes nothing.

 

[worfndata]

Spoken like a true pre-med-student communist who has never truly worked in the world in which we live. And will you be saying the same thing to the "millions of low income people" and "millions more to follow" - "100% your fault", when something goes wrong, or no one takes the garbage ACA insurance, and the patients don't want to go 30 miles out of the way to a place that DOES take it, for a non-emergency condition? That is an honest question.

Defending this program is like defending a gang of teenagers that are vandalizing and stealing cars, because a few of them work in a mini-mart.

Make a note to yourself, and revisit this idea in 10 or 20 years, and see if you still agree.

"Anyone that is not a liberal at 20 has no heart. Anyone that is not a conservative at 40 has no brain."

Not all pre-meds on sdn are 19...

I would love to get in a back and forth and talk about the 10+ real jobs I have had and how this has exposed me to more of the real world than some of you will ever be exposed to; and how that quote (which is nonsense of course) you quoted is a perfect example of the conservative mindset that shaming or belittling people into agreeing with you is normal; but, I have school and I'm job hunting so I'm not going to. When I have more free time I probably will if thread is still active.

 

[henge]

All the numbers at this point in time are foggy but the numbers we have now suggest something like half of the Obamacare "enrollees" are actually people who had previous insurance or were cancelled from their prior policy due to ACA cancellations of their existing insurance.
Rand report: Only 1/3 of new enrollees were uninsured previously
http://www.forbes.com/sites/theapot...-sign-ups-were-from-the-previously-uninsured/
Goldman Sachs: projecting only 1 million of obamacare signups among previously uninsured
http://www.washingtonpost.com/opini...d97eba-b8d1-11e3-899e-bb708e3539dd_story.html
McKinsey: 27% of new enrollees previously uninsured
http://hotair.com/archives/2014/03/...-for-obamacare-exchange-plans-have-signed-up/

The fact is that there seems to be a lot of funny math out there to try and make the impact of the ACA sound good. The fact is that Obama was wrong when he said that people could keep their insurance (either he lied willingly or he did not understand what was in the ACA) and there are a large number of people like Southern who have been hurt by the ACA in some way.

The truth is that these numbers, I don't care about too much. I believe the whole problem with the ACA is that it is misguided. It does nothing to decrease the cost of care in the US and ultimately is not going to fix the access issues to care in the US. Just because you have insurance (some high deductible plan requiring high copays) does not mean you are going to be able to get access to a healthcare provider nor that you will be able to afford the subsequent costs.

The main problem is that the healthcare we provide in this country is too expensive. Medical Malpractice and tort reform is a joke most places. We order too many tests and give too many treatments because the costs of missing something are prohibitive.

We keep too many patients on ventilators, home primacor, and activate code stroke and code STEMI protocols on too many patients who shouldn't be candidates. We keep too many patients on multi drug chemotherapy regimens for metastatic cancer when we should really just stop in all of these situations and address the patient's comfort aggressively, but nothing else. The problem with our system is that the CARE we provide is too expensive, and too much. The only TRUE answer is to tell the American people that we can no longer afford to be giving this care and you can no longer have it... but that is something that most Americans don't want to hear. It's also not something that will be fixed by the ACA. My problem with the ACA is that it trades one set of problems for a different set of problems and ultimately fixes nothing.

I don't disagree with a lot of what you are saying.

As for the funny numbers, remember that virtually all of the media coverage (including, I think the articles you cite, all of which are from March and hence don't include the final surge) has addressed only enrollment thru the exchanges and has ignored enrollment directly thru insurance companies, thru MA, thru the under 26s etc. Charles Gaba's site, where the previously attached chart came from, gives a detailed breakdown. See http://acasignups.net/

Also, realize that in many cases people whose policy its lost its grandfathering protection when their insurance company changed the policy terms, will be happy to get rid of a poor coverage policy and get a better one (which may, with subsidies, be cheaper). I don't know if there are numbers on that, but it would be interesting to see just how many people actually wanted to keep their lapsed, un-grandfathered policies.

As for ACA "ultimately fixing nothing," I disagree. Under ACA sick people can buy insurance without being rated, and policies can't be cancelled due to poor health. ACA fixed that big problem, maybe not perfectly, but I don't see how anyone can seriously argue that sick people who could not get insurance pre-ACA are not better off under the ACA. The inability of ACA critics to acknowledge that is maddening, as is their inability to recognize that sometimes markets fail, and that health insurance is a classic, textbook and real world example of market failure. I get frustrated at the willingness of people who have insurance to simply accept the results when market failure results in other people being unable to get insurance.

As for costs, yup, a huge issue, and I agree, Americans simply don't want to hear the word 'no.' Every other country manages it somehow (with many different methods). Crying about death panels and railing against MC cuts doesn't help, though.

And as for medmal reform, I agree the tort system is a total mess. As has been pointed out, most medmal that occurs does not generate a lawsuit, but most medmal lawsuits are not the result of medmal. So, we have a system where lots of bad suits are brought, but bad medicine generates no liability. Medmal reform might help, but don't expect too much, even if caps and procedural limits are imposed. Somewhere else I posted on Michigan's extensive medmal reform which drastically reduced the number of lawsuits, but not medmal premiums.

 

[@JackShephard]

100% your fault for not knowing what open enrollment is and not checking what type of hospital coverage you have in time.

Healthcare reform not perfect? So its the end of the world!11!1!!

Millions of low income people have insurance for the first time. And millions more to follow...

WHO CARES RIGHT?????

The problem with the ACA isn't that it's helping some people.

It's that the ACA did NOTHING to address the problems of healthcare. It doubled down on crappy policies.

Insurance companies gaming the system? ACA does nothing
Broken EMR and billing practices, forcing independent doctors to work for groups due to the complexities of billing? The ACA does nothing (the government played the same game with taxes. Make a huge code that is so complicated that it creates a new job)....
The problems of this thread, trouble's with transfers and insurances blocking each other? ACA doesn't help

I posted an article discussing the bargaining power that large emloyers will soon have due to changes by the ACA. As larger groups own more practices, prices are increasing - because they now have bargaining power - think Cable companies (Time Warner and Comcast???).

Anyway, the ACA basically increased the dysfunction of a dysfunctional system. When you have a broken system the idea isn't to let more people in to make it worse. Instead, they should have addressed the issues with healthcare. We have the most expensive healthcare in the world, and we did virtually nothing to address costs - defensive medicine? tort reform? fee for service? etc... they just made the most expensive system worse. I think the OP's example is a good one.

Wait for all the primary care midlevels who send everyone to the emergency department...

Under ACA sick people can buy insurance without being rated, and policies can't be cancelled due to poor health.

I always hear this, and that's great... but that's about 1% of the ACA... how does that address any of the major problems of our healthcare system? It's not like we have this perfect system that just was lacking the ability for some people to get pre-existing conditions covered. That's just a small problem in a huge collapsing system.

 

[@JackShephard]

Here's a video I saw awhile ago:

Traditional hospital: $7,452
Independent physician: $2,700

another procedure? $5,800 (with anesthesia) vs. $33,000 +anesthesia charges

Also, the patient's deductible wasn't used up so she would have paid more at the traditional hospital with insurance.

"In any other business, tons of research goes into making systems more efficient, but in medicine that reasoning is lost"

Obamacare just makes more money for those profiting off our healthcare system. So much waste.

 

[Beargryllz]

Just put everyone on Medicare and be done with it. Why even bother with insurance in the first place? Seems so primitive and inefficient. At least the middle man makes out like a bandit, so there is that...

 

[@JackShephard]

.

 

[GeneralVeers]

There will be flood of idealistic medical students on this forum supporting the law. However it's been nothing but a pack of lies, and continues to be.

The administration is crowing in triumph over the "8.1 million" who signed up. But let's look at the numbers (such as they have been provided in their incompleteness):

- 6 million people thrown off their existing private plans (me included). It is uncertain how many of these signed up for ACA
- 2.5 million "sign-ups" are in fact Medicaid. I don't count that as insurance since most providers don't take it, and it is heavily subsidized by the government. Not only that, a large number of them would have signed up for medicaid during the natural cycle, regardless of whether the ACA was in effect or not, but for argument's sake I'll give the administration these numbers.
- 20% of the remaining 5.5 million haven't/will not pay their premiums.

So 8.1 million - 2.5 million = 5.6 million. Then take 5.6 million x 0.8 = 4.48 million. Then subtract 6 million who have lost private insurance. Net = -1.52 million.

THAT IS THE REAL NUMBER. NEGATIVE 1.52 million people with private health insurance! After 4 years, constant fighting, and BILLIONS OF DOLLARS spent, we have a net loss of 1.52 million insured patients!

Anyone remember the argument that this was going to help 47 million people?

 

[GeneralVeers]

Just put everyone on Medicare and be done with it. Why even bother with insurance in the first place? Seems so primitive and inefficient. At least the middle man makes out like a bandit, so there is that...

Yes, because our government is so fantastically efficient at delivering even basic services, we certainly want to entrust them with all our healthcare needs!

 

[dpmd]

Except if they need to be admitted, they don't meet EMTALA definition of stability. Your hospital system will eventually be hit by a major EMTALA suit, and I mean major, if they persist in their regard. Transfer out of a patient your hospital has the capacity to treat because they don't take their insurance is explicitly an EMTALA violation.


Hospitals have three obligations under EMTALA:

1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once they have ensured that doing so will not interfere with or otherwise compromise patient care.
2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.

Amendments[edit]
Since its original passage, Congress has passed several amendments to this act. Additionally, state and local laws in some places have imposed additional requirements on hospitals. These amendments include the following:

• A patient is defined as "stable," therefore ending a hospital's EMTALA obligations, if:
  • The patient is conscious, alert, and oriented.
  • The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital's ability.
  • Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital's ability to ensure the patient does not need further inpatient care
  • more showed up here, but i'm stopping the copy-pasting bit..

Not everyone that gets admitted has an immediate threat to life limb or organ, and in particular it has been demonstrated that appys can safely be delayed overnight (and in fact some can be treated nonoperatively) therefore it is perfectly reasonable to transfer those pts to the hospital their insurance requests. The better strategy would be for pts to present to in network ers whenever possible (obviously some stuff can't wait but a lot of things people come to the er for would be fine delaying things long enough to go to the er their insurance covers).

 

[wholeheartedly]

....

 

[EctopicFetus]

Just put everyone on Medicare and be done with it. Why even bother with insurance in the first place? Seems so primitive and inefficient. At least the middle man makes out like a bandit, so there is that...

Im not gonna get into all the details here but hospitals lose money on every single medicare and medicaid patient. They lose if seen in the ED and lose even more if admitted.

What would happen if we went to this? hospital closures, fewer resources, longer waits. Hospitals would have to find a way to stay afloat.

 

[southerndoc]

Except if they need to be admitted, they don't meet EMTALA definition of stability. Your hospital system will eventually be hit by a major EMTALA suit, and I mean major, if they persist in their regard. Transfer out of a patient your hospital has the capacity to treat because they don't take their insurance is explicitly an EMTALA violation.


Hospitals have three obligations under EMTALA:

1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once they have ensured that doing so will not interfere with or otherwise compromise patient care.
2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.

Amendments[edit]
Since its original passage, Congress has passed several amendments to this act. Additionally, state and local laws in some places have imposed additional requirements on hospitals. These amendments include the following:

• A patient is defined as "stable," therefore ending a hospital's EMTALA obligations, if:
  • The patient is conscious, alert, and oriented.
  • The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital's ability.
  • Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital's ability to ensure the patient does not need further inpatient care
  • more showed up here, but i'm stopping the copy-pasting bit..

Rendar, while I appreciate you pointing out EMTALA definitions, I believe I will take more faith in the healthcare attorneys who have advised us that patient's EMTALA obligations are met once they are stabilized, and they are being transferred to a hospital that provides an equal level of care.

If you come in as a STEMI, need an ICU bed, emergent surgery (e.g., thoracic aortic dissection, ruptured viscous, etc.), then those patients are admitted and dealt with. We are not refusing to care for patients whom we have no contractual obligation with their insurer. If they want to stay, they can stay. They are responsible for the bill and filing anything with their insurer.

This goes on around the country on a frequent basis, particularly with Kaiser Permanente patients. Many of the health exchange plans are now doing this with hospitals around the nation.

Just because a patient needs further inpatient treatment doesn't mean they are unstable for transfer.

 

[southerndoc]

100% your fault for not knowing what open enrollment is and not checking what type of hospital coverage you have in time.

Healthcare reform not perfect? So its the end of the world!11!1!!

Millions of low income people have insurance for the first time. And millions more to follow...

WHO CARES RIGHT?????

Thanks for your amazing insight. FYI, BCBS didn't have participating hospitals/physicians available to search online when I applied. Additionally, if you were to look now, you still can't find it. You can only find out AFTER you signed up, unless you wanted to spend 6 hours on hold to talk to someone.

Please continue to post more valuable information.

 

[deleted6669]

our group also lost our excellent coverage and got stuck with a high deductible policy, which for all intents and purposes is a catastrophic care policy. a few months into it and I am already out of pocket well over a thousand dollars for stuff that would have been copay only before. many of our homeless patients now have coverage for the first time(which I am happy about), but many "working class poor folks" are still getting hosed as they make too much to qualify and their employer does not provide coverage...have not had to transfer anyone yet due to aca, but I guess it's coming. hopefully can't be much worse than the VA transfers I have to do now...what a nightmare, closest facility is 3 hrs away and local hospitalists will not accept va pts as admits unless va refuses or is full.

 

[henge]

There will be flood of idealistic medical students on this forum supporting the law. However it's been nothing but a pack of lies, and continues to be.

The administration is crowing in triumph over the "8.1 million" who signed up. But let's look at the numbers (such as they have been provided in their incompleteness):

- 6 million people thrown off their existing private plans (me included). It is uncertain how many of these signed up for ACA
- 2.5 million "sign-ups" are in fact Medicaid. I don't count that as insurance since most providers don't take it, and it is heavily subsidized by the government. Not only that, a large number of them would have signed up for medicaid during the natural cycle, regardless of whether the ACA was in effect or not, but for argument's sake I'll give the administration these numbers.
- 20% of the remaining 5.5 million haven't/will not pay their premiums.

So 8.1 million - 2.5 million = 5.6 million. Then take 5.6 million x 0.8 = 4.48 million. Then subtract 6 million who have lost private insurance. Net = -1.52 million.

THAT IS THE REAL NUMBER. NEGATIVE 1.52 million people with private health insurance! After 4 years, constant fighting, and BILLIONS OF DOLLARS spent, we have a net loss of 1.52 million insured patients!

Anyone remember the argument that this was going to help 47 million people?

Oh my, so much wrong, so little time. The 8.1M is ONLY the number of people who enrolled thru the exchanges. Millions more enrolled directly with insurance companies, millions of under 26ers were covered. http://acasignups.net/graph (graph previously attached). The 6M cancelled policies is almost certainly way too high, and ignores that many of those policies were very poor and the people could replace them with something better. The 80% payment rate is almost certainly way too low (many states reported to the feds only fully paid up policies, and the recent House report has been widely ridiculed for, among other things, counting as unpaid policies whose payment date had not yet arrived). And you deliberately ignore MA and SCHIPS in your analysis, but in your summary you don't qualify for that omission. Plus, as people begin to realize they won't have chips implanted in them when they sign up, more will sign up in future years.

 

[henge]

The problem with the ACA isn't that it's helping some people.

It's that the ACA did NOTHING to address the problems of healthcare. It doubled down on crappy policies.

Insurance companies gaming the system? ACA does nothing
Broken EMR and billing practices, forcing independent doctors to work for groups due to the complexities of billing? The ACA does nothing (the government played the same game with taxes. Make a huge code that is so complicated that it creates a new job)....
The problems of this thread, trouble's with transfers and insurances blocking each other? ACA doesn't help

I posted an article discussing the bargaining power that large emloyers will soon have due to changes by the ACA. As larger groups own more practices, prices are increasing - because they now have bargaining power - think Cable companies (Time Warner and Comcast???).

Anyway, the ACA basically increased the dysfunction of a dysfunctional system. When you have a broken system the idea isn't to let more people in to make it worse. Instead, they should have addressed the issues with healthcare. We have the most expensive healthcare in the world, and we did virtually nothing to address costs - defensive medicine? tort reform? fee for service? etc... they just made the most expensive system worse. I think the OP's example is a good one.

Wait for all the primary care midlevels who send everyone to the emergency department...



I always hear this, and that's great... but that's about 1% of the ACA... how does that address any of the major problems of our healthcare system? It's not like we have this perfect system that just was lacking the ability for some people to get pre-existing conditions covered. That's just a small problem in a huge collapsing system.

Thanks for addressing the uninsurability issue. I think you are the only anti-ACA poster who thinks it is worthy of mention. I disagree that it is minor, and as dysfunctional as the system may be, for a sick patient being in it is better than being on the outside unable to get the benefits. Of course other problems with the system exist. But why not blame Bush or Clinton who didn't deal with the issues, or the House or the Senate who haven't dealt with them, or the Medicare prescription drug expansion or the hundreds of other bills that also did not address those issues?

 

[Apollyon]

Well, I've been in the real world--paying taxes, paying my kids tuition, etc.--for 30+ years and agree with worfundata. Of course, I could respond in kind with Mill's famous quote about conservatives, but I guess I'll just accept your expert diagnosis that I have no brain. It's good to see this thread is returning to medical issues--my lack of a brain-- rather than just providing a platform for ranting.

Did you just ad hom yourself? Even if you DO have anything to share, YOU are ranting and just being a mouthpiece for the administration. You are a different kind of off-the-left-side deep end, if you are 50 and still happy to throw away your money than the idealistic premeds, which I mention because every doctor - every last one - knows about what I speak concerning uber-liberal students without a realistic viewpoint - who accept "you can see what is in it after it is is passed" as good judgment. Back in 1979, 5 honest to goodness, adult communists were shot and killed in Greensboro NC - 2 of these 5 were doctors, although only one was actually still in practice. Those are people that, 35 years ago, believed in that rhetoric.

So, don't call me a "right winger", don't call me a "Nazi", "Klansman", a "jack booted thug", or anything else, as my protests lie in functional issues - not anything political, as yours do. You don't see it from the doctor's perspective. The OP is a doctor who sees it from a patient perspective. I, too, see it that way, as I am happy to have group health insurance, because I have a job that I worked for and wasn't handed to me, to which I was not automatically entitled, for my chronic illness (which was not brought about by any life choices).

 

[Apollyon]

Not all pre-meds on sdn are 19...

I would love to get in a back and forth and talk about the 10+ real jobs I have had and how this has exposed me to more of the real world than some of you will ever be exposed to; and how that quote (which is nonsense of course) you quoted is a perfect example of the conservative mindset that shaming or belittling people into agreeing with you is normal; but, I have school and I'm job hunting so I'm not going to. When I have more free time I probably will if thread is still active.

I have said in the hospital that I have shoveled more blacktop than anyone working there, but there is the old saw that the orthodox Jews say to the conservatives, who say it to the reform - "If you're not as Jewish as I am, you're not Jewish at all". I don't know why you have had more than 10 jobs. All in different fields? I'm 43 and have had 9 jobs in my life, which includes part time in high school, summer help with the highway in college, and residency (so, in that grey area). Maybe I am just more fortunate that I have not had to have (or had such wanderlust that I sought) such upheaval. Some people are better suited to shed their job and lifestyles like a reptile molting. I prefer to set down roots. Different strokes for different folks.

See, you miss the point, especially here in the EM forum - what is the difference between the US and the UK? In the UK, you get health care. In the US, you get health insurance. And, as has been posted above, it is garbage "insurance" that your vaunted "millions" are getting. What use would be $100million, if you were in Mexico, and they said "We don't take that"?

 

[henge]

Did you just ad hom yourself? Even if you DO have anything to share, YOU are ranting and just being a mouthpiece for the administration. You are a different kind of off-the-left-side deep end, if you are 50 and still happy to throw away your money than the idealistic premeds, which I mention because every doctor - every last one - knows about what I speak concerning uber-liberal students without a realistic viewpoint - who accept "you can see what is in it after it is is passed" as good judgment. Back in 1979, 5 honest to goodness, adult communists were shot and killed in Greensboro NC - 2 of these 5 were doctors, although only one was actually still in practice. Those are people that, 35 years ago, believed in that rhetoric.

So, don't call me a "right winger", don't call me a "Nazi", "Klansman", a "jack booted thug", or anything else, as my protests lie in functional issues - not anything political, as yours do. You don't see it from the doctor's perspective. The OP is a doctor who sees it from a patient perspective. I, too, see it that way, as I am happy to have group health insurance, because I have a job that I worked for and wasn't handed to me, to which I was not automatically entitled, for my chronic illness (which was not brought about by any life choices).

I must say I am impressed that you know the opinions of "every last doctor." Hugs and kisses to you also.

 

[Birdstrike]

I was catching on some news today, and the ACA actually does in fact, appear to be rolling out exactly as expected:



Obamacare Contractor Pays Employees to ‘Do Nothing’


"Last summer, the federal government was greeted with raised eyebrows when it awarded a UK-based firm a contract worth $1.2 billion to process Obamacare applications. At the same time, the company was being investigated for overbilling the British government tens of millions of pounds.

Though it managed to work through a year of Obamacare’s implementation relatively unnoticed, the contractor, Serco Inc., is back in the spotlight—and raising questions over the validity of its work.

A report by KMOV.com in St. Louis claims that Serco—tasked with processing Obamacare applications—is allegedly paying its workers to do nothing at all.

Employees told the local television station that they are instructed to simply stare at a computer screen and hit refresh every 10 minutes."


https://tv.yahoo.com/news/obamacare-contractor-pays-employees-nothing-211700255.html

 

[Apollyon]

I must say I am impressed that you know the opinions of "every last doctor." Hugs and kisses to you also.

Look up "passive/aggressive". Is it telling that you come to a board of emergency physicians, but don't state what it is, if any, that is your profession, and cast about insults and focus on trivialities (such as the above quoted post)? Next should be, "I'm done with this thread", or similar.

 

[henge]

Look up "passive/aggressive". Is it telling that you come to a board of emergency physicians, but don't state what it is, if any, that is your profession, and cast about insults and focus on trivialities (such as the above quoted post)? Next should be, "I'm done with this thread", or similar.

I looked it up; it doesn't tell me that. Is says it is a "pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations." I'm sorry I'm missing your point.

 

[Apollyon]

I looked it up; it doesn't tell me that. Is says it is a "pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations." I'm sorry I'm missing your point.

Are you really 50ish years old? Or maybe it is my fault in my writing style?

They were separate ideas. If I have to explain it to you, then it is idiosyncratic at best, and disingenuous at least, to compare this reading comprehension to that which you've written above. Still, I'll do it.

As you took it literally, I was suggesting a passive/aggressive tone in your posts. The second question was "Is it telling that you do 'this' or 'that'?", separate from the passive/aggressive. In other words, look at the second sentence on its own.

As to your regret at not getting my point, that is appreciated. Or, alternately, was that supposed to be a simplistic, "Sorry, I don't get it"? I'll tell you that, if your next response is another quibble, I'll stop wasting my time.

 

[Birdstrike]

Well, I've been in the real world--paying taxes, paying my kids tuition, etc.--for 30+ years ....

Actually, Henge is a composite of 3 people, only one of whom is pre-med, and has been posting since 2006, long enough to know that respect, courtesy and civility are worthwhile values in any discourse.

Anddd now we have two pre-meds fighting it out in an allo thread...sweet.

Been posting since 2006, just never bothered to change the status. And that matters because ...