Obama wins.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
NickNaylor said:
Premiums may increase because people that previously didn't have insurance (those with pre-existing conditions, etc.) will now be covered. Since those people will cost more money to take care of, everyone's premiums will increase to cover the cost since the ACA forbids rate changes due to pre-existing conditions. The money is going to care for the small minority of people that spend the large majority of resources.

In theory this increase would be balanced by the increased size of the "risk pool" (i.e., how many people are covered) due to more people being covered via the ACA, but people don't seem to talk about this very often.
Click to expand...

So how will this all supposedly affect physician reimbursement?
Members don't see this ad.
 
Venom5 said:
So how will this all supposedly affect physician reimbursement?
Click to expand...

Who knows? Even healthcare policy people/economists - real experts - don't know (of course, they talk as if they know for a fact, but there are people with opposing views are argue a just-as-supported view). As a post-first pre-second year medical student, I have absolutely no idea what the ACA specifically will do.

As a general rule, though, I think it's safe to assume that reimbursements will always be going down considering 1) the government effectively sets reimbursement rates in the market and 2) the government is under non-stop pressure to cut costs. Those two things alone make it almost impossible for me to believe that reimbursements will go up barring any fundamental changes to the system. Even then I don't see a significant bump in reimbursements - maybe some, but not much.
 
"Obamacare can only increase third party interference in the doctor-patient relationship, increase costs, and reduce the quality of care. Only free market medicine can restore the critical independence of doctors, reduce costs through real competition and price sensitivity, and eliminate enormous paperwork burdens."

My family members in Europe wait a week or more for simple procedures and x-rays. For surgery, they wait on a list for months. And doctors do not earn the salaries there that they earn here. They are upper-middle class at best. Glorified bureaucrats. Our system is broken, but I do not agree that more government intervention is the answer. I've spent time with several successful cash doctors, one of them in primary care, and seen with my own eyes that it can work. I fear that this bill will squash that.

Here's an article on one doc's transformation from near bankrupt to cash only- http://www.lewrockwell.com/orig11/watson-g1.1.1.html
 
Members don't see this ad :)
This is all setting the stage for high deductible plans. Healthy people without insurance won't want to pay for insurance that they (individually) won't be using. It's going to start another firestorm of legislation at the national and state level to stop this activity. Some states block this already (I know here in NJ they do) but I would guess this will become a new hot button issue.
 
ElCapone said:
Wait times and quality there is on par with the US, but they end up having higher quality outcomes. On the other hand, doctors there get paid 1/2 of what they would over here.

I don't want to give the impression here that my desire for the dinero is why I want to go into medicine, but am simply echoing the deep concerns shared by doctors right now (or at least the ones I shadowed). I doubt that they would very much like a paycut.
Click to expand...

There's no reason we can't have a high-paying single-payer system. All we have to do is vote for it. Just look at the wide range of doctor salaries in countries that have single-payer systems. It's also entirely possible for a particular doctor or group or hospital to charge patients extra money beyond what their insurance pays as a premium for being better, thus bringing competition to the doctor-patient level rather than doctor-insurance company. I believe we actually already have a law that limits doctors' ability to do this, so it would have to be repealed.
 
All med schools should offer their students an elective course on the political/policy basis of medicine...that is, assuming that they have enough idea of what's going on to teach anything. :p
 
DietSexy5000 said:
This is all setting the stage for high deductible plans. Healthy people without insurance won't want to pay for insurance that they (individually) won't be using. It's going to start another firestorm of legislation at the national and state level to stop this activity. Some states block this already (I know here in NJ they do) but I would guess this will become a new hot button issue.
Click to expand...


I wouldn't say that health people "won't be using" insurance. The funny thing about getting sick/injured, is that nobody sees it coming. Nobody wakes up and says around age 40 i'm going to develop cancer. Or I think i'll get into a car accident and break my arm today. These things just happen. Even if you are considered "healthy" you never know when you might need a doctor.
 
Cornu Ammonis said:
There's no reason we can't have a high-paying single-payer system. All we have to do is vote for it. Just look at the wide range of doctor salaries in countries that have single-payer systems. It's also entirely possible for a particular doctor or group or hospital to charge patients extra money beyond what their insurance pays as a premium for being better, thus bringing competition to the doctor-patient level rather than doctor-insurance company. I believe we actually already have a law that limits doctors' ability to do this, so it would have to be repealed.
Click to expand...

That's a big "all."
 
aquarius3 said:
Here's an article on one doc's transformation from near bankrupt to cash only- http://www.lewrockwell.com/orig11/watson-g1.1.1.html
Click to expand...

That's one of the shadier websites I've seen...I'm also lovin all the gold and silver ads. Totally not ultra-conservative at all. Here's some more breaking headlines from the site:

"'Constitutional' Government: Leninism on the Installment Plan"
"[FONT=Georgia, Times New Roman, Times, serif]Must Americans Embrace the Empire?."
"[FONT=Georgia, Times New Roman, Times, serif]Never Call 911."

I can't tell if this site is a joke or not...
 
Blais said:
All med schools should offer their students an elective course on the political/policy basis of medicine...that is, assuming that they have enough idea of what's going on to teach anything. :p
Click to expand...

We had a course on healthcare policy this past quarter - it was fantastic. Interestingly enough, it was also the least attended course by far that I've seen. What does that say about future physicians?
 
NickNaylor said:
We had a course on healthcare policy this past quarter - it was fantastic. Interestingly enough, it was also the least attended course by far that I've seen. What does that say about future physicians?
Click to expand...

Ostrich-man-head-in-sand.gif

:D
 
BrainOnFire said:
The same people who dislike the imposition of the health care act are very much in favor of surveying people with drones, wiretapping without warrants, restricting legal medical procedures on religious grounds, and generally acting as if freedom is secondary to protecting the US from a nebulous terrorist threat. Why is it anti-freedom when it involves taking personal responsibility for health but pro-freedom when you legislate against privacy?
Click to expand...

Not sure where you get the idea that opponents of ACA are for drone surveillance. You ought to get out more, because you are flat-out wrong.

Oh, hang on. You mean President Obama is against the ACA? Huh.

BrainOnFire said:
Also, I can read a 2700 page bill if I need to. It's not my fault that Congress is lazy.
Click to expand...

True story, but it amazes me when people say they're for the ACA when nobody even read it before it was passed. "We have to pass it so we can find out what's in it." Remember that?

BrainOnFire said:
I disagree with this statement merely because of the ridiculous fearmongering that has gone along with the debate. The representative who stated that the signed/passed law would put you in jail if you failed to comply directly contrasted the text of the law. All of the people who believe that they're going to be forcibly separated from their doctors, which is why they oppose the bill, are operating under an incorrect set of parameters: if they don't have a doctor, it's not the bill's fault directly or perhaps even indirectly.



Straw man. Politicians often say X and then Y happens; this isn't unique to Obama. Remember that Romney helped health care in MA and generally seemed in favor of gay marriages in the state. Beyond that, though, the government's third argument in front of the Supreme Court was that this was a tax. The administration and its lawyers recognized that if the two original arguments didn't work, they might need to reframe this in terms of a tax. Does it violate the spirit of the original intent? Perhaps. However, it's a legitimate argument.

However, your last statement has zero merit because of the gay marriage debate. Time and again the argument has been used to deny gay marriage because the federal government has an interest in promoting healthy (straight) marriages to benefit children. That's why, in theory, there are so many tax breaks available for the married. If the government can interfere with the administration of taxes and benefits based on sexual status, it can ask people to buy health care. Remember that there are states in which agreements that resemble marriage benefits, such as power of attorney, are specifically forbidden. If you can't see that said act is government interference by the "low interference" party, I don't know what to say to you.
Click to expand...

What?
 
Members don't see this ad :)
TopTomato said:
I wouldn't say that health people "won't be using" insurance. The funny thing about getting sick/injured, is that nobody sees it coming. Nobody wakes up and says around age 40 i'm going to develop cancer. Or I think i'll get into a car accident and break my arm today. These things just happen. Even if you are considered "healthy" you never know when you might need a doctor.
Click to expand...

Exactly, so they use high deductibles. The monthly premium plummets and, say over the course of ten years, they have one health related situation (such as an accident or significant illness), they largely only pay for that. Your point is completely valid, nobody can predict when they will get sick/injured but it's feasible for a family to determine they are low risk (not zero risk, just low). The high deductible would leave them paying for small things like ear infections, etc. out of pocket and really serious things like car accidents, etc. to be covered (in part) by their insurance plan. This type of plan works well for the policy holder as he/she very often saves money, the insurance company spends less where they don't need to, doctors get fewer nonsense patient visits; people cry foul because the chronically ill are the 'losers' when private individuals don't overpay and cover other policy holders' high costs.
 
DietSexy5000 said:
Exactly, so they use high deductibles. The monthly premium plummets and, say over the course of ten years, they have one health related situation (such as an accident or significant illness), they largely only pay for that. Your point is completely valid, nobody can predict when they will get sick/injured but it's feasible for a family to determine they are low risk (not zero risk, just low). The high deductible would leave them paying for small things like ear infections, etc. out of pocket and really serious things like car accidents, etc. to be covered (in part) by their insurance plan. This type of plan works well for the policy holder as he/she very often saves money, the insurance company spends less where they don't need to, doctors get fewer nonsense patient visits; people cry foul because the chronically ill are the 'losers' when private individuals don't overpay and cover other policy holders' high costs.
Click to expand...

This is really the direction health insurance should be moving in. Instead of just trying to give insurance to everyone, it should be reserved for catastrophes. Like other kinds of insurance. Now that would actually bring healthcare costs down (not merely overall insurance premiums).

I also think there should be a safety net (funded by tax) to help those with pre-existing genetic conditions. Though it's not necessarily the case that this would be as necessary, were costs lower.
 
Here is a brief summary (NOT MY POST) that I found on another site:

"
Okay, explained like you're a five year-old (well, okay, maybe a bit older), without too much oversimplification, and (hopefully) without sounding too biased:
What people call "Obamacare" is actually the Patient Protection and Affordable Care Act. However, people were calling it "Obamacare" before everyone even hammered out what it would be. It's a term mostly used by people who don't like the PPACA, and it's become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.
Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn't have to.
So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):
Already in effect:

  • It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
  • It increases the rebates on drugs people get through Medicare (so drugs cost less)
  • It establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 665, sec. 1181 )
  • It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 499, sec. 4205 )
  • It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them. ( Citation: Page 30, sec. 1101, Page 45, sec. 2704, and Page 46, sec. 2702 )
  • It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) ( Citation: Page 47, sec. 2705 )
  • It renews some old policies, and calls for the appointment of various positions.
  • It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
  • It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending. ( Citation: Page 14, sec. 2711 )
  • Kids can continue to be covered by their parents' health insurance until they're 26. ( Citation: Page 15, sec. 2714 )
  • No more "pre-existing conditions" for kids under the age of 19.
  • Insurers have less ability to change the amount customers have to pay for their plans.
  • People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend.
  • Insurers can't just drop customers once they get sick. ( Citation: Page 14, sec. 2712 )
  • Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific).
  • Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.
  • Anti-fraud funding is increased and new ways to stop fraud are created. ( Citation: Page 699, sec. 6402 )
  • Medicare extends to smaller hospitals.
  • Medicare patients with chronic illnesses must be monitored more thoroughly.
  • Reduces the costs for some companies that handle benefits for the elderly.
  • A new website is made to give people insurance and health information. (I think this is it: http://www.healthcare.gov/ ).
  • A credit program is made that will make it easier for business to invest in new ways to treat illness.
  • A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.
  • A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover.
  • Employers need to list the benefits they provided to employees on their tax forms.
8/1/2012

  • Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.
1/1/2013

  • If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word "tiny", a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we're talking about people in the top 5% of earners. ( Citation: Page 818, sec. 9015 )
1/1/2014
This is when a lot of the really big changes happen.

  • No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history.
  • If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it.
  • Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. ( Citation: Page 14, sec. 2711 )
  • Make it so more poor people can get Medicaid by making the low-income cut-off higher.
  • Small businesses get some tax credits for two years. ( Citation: Page 138, sec. 1421 )
  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
  • Limits how high of an annual deductible insurers can charge customers.
  • Cut some Medicare spending
  • Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. ( Citation: Page 801, sec. 9005 )
  • Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
  • Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. ( Citation: Page 81, sec. 1312 )
  • A new tax on pharmaceutical companies.
  • A new tax on the purchase of medical devices.
  • A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.
  • The amount you can deduct from your taxes for medical expenses increases.
1/1/2015

  • Doctors' pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in this post. If you're looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.
1/1/2017

  • If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). ( Citation: Page 98, sec. 1332 )
2018

  • All health care plans must now cover preventative care (not just the new ones).
  • A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).
2020

  • The elimination of the "Medicare gap"
.
Aaaaand that's it right there.
The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. Personally, I take the opposite view, as it's not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.
Plus, as previously mentioned, it's necessary if you're doing away with "pre-existing conditions" because otherwise no one would get insurance until they needed to use it, which defeats the purpose of insurance.
Whew! Hope that answers the question!
Edits: Fixing typos.
Edit 2: Wow... people have a lot of questions. I'm afraid I can't get to them now (got to go to work), but I'll try to later.
Edit 3: Okay, I'm at work, so I can't go really in-depth for some of the more complex questions just now, but I'll try and address the simpler ones. Also, a few I'm seeing repeatedly:

  • For those looking for a source... well, here is the text of the bill, all 974 pages of it (as it sits currently after being amended multiple times). I can't point out page numbers just now, but they're there if you want them.
  • The website that was to be established, I think, is http://www.healthcare.gov/.
  • A lot of people are concerned about the 1/1/2015 bit that says that doctors' pay will be tied to quality, not quantity. Because so many people want to know more about this, I've sought out what I believe to be the pertinent sections (From Page 307, section 3007). It looks like this part alters a part of another bill, the Social Security Act, passed a long while ago. That bill already regulates how doctors' pay is determined. The PPACA just changes the criteria. Judging by how professionals are writing about it, it looks like this is just referring to Medicaid and Medicare. Basically, this is changing how much the government pays to doctors and medical groups, in situations where they are already responsible for pay.
Edit 4: Numerous people are pointing out I said "Medicare" when I meant "Medicaid". Whoops. Fixed (I think).
Edit 5: Apparently I messed up the acronym (initialism?). Fixed.
Edit 6: Fixed a few more places where I mixed up terms (it was late, I was tired). Also, for everyone asking if they can post this elsewhere, feel free to.
Edit 7: Okay, I need to get to work. Thanks to everyone for the kind comments, and I hope I've addressed the questions most of you have (that I can actually answer). I just want to be sure to say, I'm just a guy. I'm no expert, and everything I posted here I attribute mostly to Wikipedia or the actual bill itself, with an occasional Google search to clarify stuff. I am absolutely not a difinitive source or expert. I was just trying to simplify things as best I can without dumbing them down. I'm glad that many of you found this helpful.
Edit 8: Wow, this has spread all over the internet... and I'm kinda' embarrassed because what spread included all of my 2AM typos and mistakes. Well, it's too late to undo my mistakes now that the floodgates have opened. I only hope that people aren't too harsh on me for the stuff I've tried to go back and correct.
Edit 9: Added a few citations (easy-to-find stuff). But I gotta' run, so the rest will have to wait.
Edit 10: Adding a few more citations (it'll probably take me a while to get to all of them) and a few more additional entries as well."


Source: http://www.reddit.com/tb/vbkfm
 
I simply copied and pasted it, and put the source on the bottom. It's just another source of information; use it if you want. If not, ignore it and move on.
 
Fastedia said:
I simply copied and pasted it, and put the source on the bottom. It's just another source of information; use it if you want. If not, ignore it and move on.
Click to expand...

I read it. Nice summation. The link (1/1/2015 section) on physician reimbursement is also worth reading.
 
Fastedia said:
I simply copied and pasted it, and put the source on the bottom. It's just another source of information; use it if you want. If not, ignore it and move on.
Click to expand...

Not saying its bad but you could have just given the link and said what it was instead of copy/pasting the whole thing. It's formatted much more nicely on reddit for whoever wants to read it.
 
Fastedia said:
Here is a brief summary (NOT MY POST) that I found on another site:

"
Okay, explained like you're a five year-old (well, okay, maybe a bit older), without too much oversimplification, and (hopefully) without sounding too biased:
What people call "Obamacare" is actually the Patient Protection and Affordable Care Act. However, people were calling it "Obamacare" before everyone even hammered out what it would be. It's a term mostly used by people who don't like the PPACA, and it's become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.
Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn't have to.
So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):
Already in effect:

  • It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
  • It increases the rebates on drugs people get through Medicare (so drugs cost less)
  • It establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 665, sec. 1181 )
  • It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 499, sec. 4205 )
  • It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them. ( Citation: Page 30, sec. 1101, Page 45, sec. 2704, and Page 46, sec. 2702 )
  • It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) ( Citation: Page 47, sec. 2705 )
  • It renews some old policies, and calls for the appointment of various positions.
  • It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
  • It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending. ( Citation: Page 14, sec. 2711 )
  • Kids can continue to be covered by their parents' health insurance until they're 26. ( Citation: Page 15, sec. 2714 )
  • No more "pre-existing conditions" for kids under the age of 19.
  • Insurers have less ability to change the amount customers have to pay for their plans.
  • People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend.
  • Insurers can't just drop customers once they get sick. ( Citation: Page 14, sec. 2712 )
  • Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific).
  • Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.
  • Anti-fraud funding is increased and new ways to stop fraud are created. ( Citation: Page 699, sec. 6402 )
  • Medicare extends to smaller hospitals.
  • Medicare patients with chronic illnesses must be monitored more thoroughly.
  • Reduces the costs for some companies that handle benefits for the elderly.
  • A new website is made to give people insurance and health information. (I think this is it: http://www.healthcare.gov/ ).
  • A credit program is made that will make it easier for business to invest in new ways to treat illness.
  • A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.
  • A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover.
  • Employers need to list the benefits they provided to employees on their tax forms.
8/1/2012

  • Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.
1/1/2013

  • If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word "tiny", a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we're talking about people in the top 5% of earners. ( Citation: Page 818, sec. 9015 )
1/1/2014
This is when a lot of the really big changes happen.

  • No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history.
  • If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it.
  • Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. ( Citation: Page 14, sec. 2711 )
  • Make it so more poor people can get Medicaid by making the low-income cut-off higher.
  • Small businesses get some tax credits for two years. ( Citation: Page 138, sec. 1421 )
  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
  • Limits how high of an annual deductible insurers can charge customers.
  • Cut some Medicare spending
  • Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. ( Citation: Page 801, sec. 9005 )
  • Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
  • Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. ( Citation: Page 81, sec. 1312 )
  • A new tax on pharmaceutical companies.
  • A new tax on the purchase of medical devices.
  • A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.
  • The amount you can deduct from your taxes for medical expenses increases.
1/1/2015

  • Doctors' pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in this post. If you're looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.
1/1/2017

  • If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). ( Citation: Page 98, sec. 1332 )
2018

  • All health care plans must now cover preventative care (not just the new ones).
  • A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).
2020

  • The elimination of the "Medicare gap"
.
Aaaaand that's it right there.
The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. Personally, I take the opposite view, as it's not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.
Plus, as previously mentioned, it's necessary if you're doing away with "pre-existing conditions" because otherwise no one would get insurance until they needed to use it, which defeats the purpose of insurance.
Whew! Hope that answers the question!
Edits: Fixing typos.
Edit 2: Wow... people have a lot of questions. I'm afraid I can't get to them now (got to go to work), but I'll try to later.
Edit 3: Okay, I'm at work, so I can't go really in-depth for some of the more complex questions just now, but I'll try and address the simpler ones. Also, a few I'm seeing repeatedly:

  • For those looking for a source... well, here is the text of the bill, all 974 pages of it (as it sits currently after being amended multiple times). I can't point out page numbers just now, but they're there if you want them.
  • The website that was to be established, I think, is http://www.healthcare.gov/.
  • A lot of people are concerned about the 1/1/2015 bit that says that doctors' pay will be tied to quality, not quantity. Because so many people want to know more about this, I've sought out what I believe to be the pertinent sections (From Page 307, section 3007). It looks like this part alters a part of another bill, the Social Security Act, passed a long while ago. That bill already regulates how doctors' pay is determined. The PPACA just changes the criteria. Judging by how professionals are writing about it, it looks like this is just referring to Medicaid and Medicare. Basically, this is changing how much the government pays to doctors and medical groups, in situations where they are already responsible for pay.
Edit 4: Numerous people are pointing out I said "Medicare" when I meant "Medicaid". Whoops. Fixed (I think).
Edit 5: Apparently I messed up the acronym (initialism?). Fixed.
Edit 6: Fixed a few more places where I mixed up terms (it was late, I was tired). Also, for everyone asking if they can post this elsewhere, feel free to.
Edit 7: Okay, I need to get to work. Thanks to everyone for the kind comments, and I hope I've addressed the questions most of you have (that I can actually answer). I just want to be sure to say, I'm just a guy. I'm no expert, and everything I posted here I attribute mostly to Wikipedia or the actual bill itself, with an occasional Google search to clarify stuff. I am absolutely not a difinitive source or expert. I was just trying to simplify things as best I can without dumbing them down. I'm glad that many of you found this helpful.
Edit 8: Wow, this has spread all over the internet... and I'm kinda' embarrassed because what spread included all of my 2AM typos and mistakes. Well, it's too late to undo my mistakes now that the floodgates have opened. I only hope that people aren't too harsh on me for the stuff I've tried to go back and correct.
Edit 9: Added a few citations (easy-to-find stuff). But I gotta' run, so the rest will have to wait.
Edit 10: Adding a few more citations (it'll probably take me a while to get to all of them) and a few more additional entries as well."


Source: http://www.reddit.com/tb/vbkfm
Click to expand...

Basically, a jumble of stuff which has nothing to do with insurance (e.g. the generic drug stuff and Macdonalds stuff) and rules which completely destroy the idea of insurance, as pre-existing conditions (i.e. risk assessment) are crucial to the process of insurance.

While it's not a word I use, a term that works very well for this bill is "clusterf*ck."

It was not necessary to stick all of this in one bill.

You guys all but got your single-payer. Hope it works, but if not... we tried.

Edit: I didn't see this in your list, maybe I just missed it. Obamacare includes a 3.5% capital gains tax on your home when you sell it. WTF has that got to do with healthcare?
 
Last edited:
Lokhtar said:
I don't think we did, unfortunately, but I do hope you're right.
Click to expand...

It's not actually single payer, but it demolishes the idea of private health insurance.
 
Dave89 said:
It's not actually single payer, but it demolishes the idea of private health insurance.
Click to expand...

Huh? How does making people buy private insurance demolishing the idea of private insurance? :confused:
 
Lokhtar said:
Huh? How does making people buy private insurance demolishing the idea of private insurance? :confused:
Click to expand...

See the parts of the summary discussing all the new regulations on health insurance.

Edit: It's not necessarily the mandate which irks so may people about the bill. Sure, the mandate is a big issue, but there are so many other problems here. I do wish they's just passed the mandate. We could have actually had a debate about a reasonably-sized bill.
 
DietSexy5000 said:
Exactly, so they use high deductibles. The monthly premium plummets and, say over the course of ten years, they have one health related situation (such as an accident or significant illness), they largely only pay for that. Your point is completely valid, nobody can predict when they will get sick/injured but it's feasible for a family to determine they are low risk (not zero risk, just low). The high deductible would leave them paying for small things like ear infections, etc. out of pocket and really serious things like car accidents, etc. to be covered (in part) by their insurance plan. This type of plan works well for the policy holder as he/she very often saves money, the insurance company spends less where they don't need to, doctors get fewer nonsense patient visits; people cry foul because the chronically ill are the 'losers' when private individuals don't overpay and cover other policy holders' high costs.
Click to expand...

The problem is that even the diagnosis of many diseases costs more than people can pay out of pocket. $2000 for imaging is not an insignificant cost to the majority of people, nor are $500 specialist consults. On top of this, treatment itself is often so costly that without pricing premiums based on preexisting conditions insurance companies will be unable to function. Even if we saw a great influx of people buying into high-deductible plans (which already exist, btw), it wouldn't make a dent in the ever-rising costs for the chronically ill.

Maybe you consider these to be 'nonsense visits,' but the truth is that the majority of health care costs today and the pressure that has driven costs up since the 1960s comes from the use of newer diagnostic tools and treatments for diseases that could not in the past be treated, along with a bit of a bump from obesity. There is no way to go back to the old reimbursement scheme without also giving up all our new tools.
 
Cornu Ammonis said:
Just look at the wide range of doctor salaries in countries that have single-payer systems. It's also entirely possible for a particular doctor or group or hospital to charge patients extra money beyond what their insurance pays as a premium for being better, thus bringing competition to the doctor-patient level rather than doctor-insurance company. I believe we actually already have a law that limits doctors' ability to do this, so it would have to be repealed.
Click to expand...


1) You're confusing a Bismarkian system with a National system.

2) That's not the way it works.
 
Dave89 said:
Basically, a jumble of stuff which has nothing to do with insurance (e.g. the generic drug stuff and Macdonalds stuff) and rules which completely destroy the idea of insurance, as pre-existing conditions (i.e. risk assessment) are crucial to the process of insurance.

While it's not a word I use, a term that works very well for this bill is "clusterf*ck."

It was not necessary to stick all of this in one bill.

You guys all but got your single-payer. Hope it works, but if not... we tried.
Click to expand...

People say this until its your kid who has asthma or diabetes or cerebral palsy...then suddenly you'll wonder why you're bankrupt because you can't get insurance coverage for them. It's called having a frickin heart man. You'd fit right in at an insurance company though when you'd tell a mom that her 12 year old is denied coverage because your "risk assessment" deems her child too big of a risk.
 
I don't want to sound stupid or shallow, however, I'll ask anyways. How will this effect the salaries of people in the medical field? Will it vary from a GP to a specialist to a surgeon, or will it be the same?
Now, it seems as if this is just a substitute for medicare and medicaid, aren't people under those plans a minority of people doctors end up treating, and isn't this an optional type of insurance for those who don't have any or can't afford what's out there? And, is this a complete overhaul of what we currently have or is it something that stands aside of current insurance?
 
3 weeks from now the conspiracy theories about the supreme court and obama will be all over the net.

Ron Paul was an inside job - 9/11 for president
 
So..will I be able to make it rain at the strip club as a doctor??
 
calvnandhobbs68 said:
People say this until its your kid who has asthma or diabetes or cerebral palsy...then suddenly you'll wonder why you're bankrupt because you can't get insurance coverage for them. It's called having a frickin heart man. You'd fit right in at an insurance company though when you'd tell a mom that her 12 year old is denied coverage because your "risk assessment" deems her child too big of a risk.
Click to expand...

I did say that there should be some sort of safety net for genetic conditions. Especially handicaps.
 
iqe2010 said:
So..will I be able to make it rain at the strip club as a doctor??
Click to expand...

There's going to be a lot of people shifting from private health insurance to Medicaid, which has horrible reimbursement rates. So, no.
 
Dave89 said:
There's going to be a lot of people shifting from private health insurance to Medicaid, which has horrible reimbursement rates. So, no.
Click to expand...

How do you figure? The ruling specifically says that the feds can't force states to expand Medicaid and I doubt many of them are going to be doing that on their own right now.
 
DocHollywood745 said:
I don't want to sound stupid or shallow, however, I'll ask anyways. How will this effect the salaries of people in the medical field? Will it vary from a GP to a specialist to a surgeon, or will it be the same?
Now, it seems as if this is just a substitute for medicare and medicaid, aren't people under those plans a minority of people doctors end up treating, and isn't this an optional type of insurance for those who don't have any or can't afford what's out there? And, is this a complete overhaul of what we currently have or is it something that stands aside of current insurance?
Click to expand...

No one is certain...

But looks like it might depend on the field. For example, the discussion in the EM sub-forum is kind of optimistic. While, on the other hand, the anesthesiology sub-forum is not pleased.

Regardless, cash practice, FTW.
 
calvnandhobbs68 said:
That's one of the shadier websites I've seen...I'm also lovin all the gold and silver ads. Totally not ultra-conservative at all. Here's some more breaking headlines from the site:

"'Constitutional' Government: Leninism on the Installment Plan"
"[FONT=Georgia, Times New Roman, Times, serif]Must Americans Embrace the Empire?."
"[FONT=Georgia, Times New Roman, Times, serif]Never Call 911."

I can't tell if this site is a joke or not...
Click to expand...

it's a reprint from http://www.aapsonline.org/newsoftheday/00998
as long as aaps is more legit...
 
iqe2010 said:
So..will I be able to make it rain at the strip club as a doctor??
Click to expand...
Sure just go into private practice and have it be your policy that you don't accept health insurance of any kind. That's really difficult if you're a new doctor but for the well established doctors in my area, many have switched to this and have increased their incomes. Sure, you lose some patients but many decide that the personal, trustworthy service they get from their long time doctor is worth the out of pocket cash. The physicians my family sees use this policy and we continue to go regardless of the fact our health insurance doesn't cover any of it.

Would be pretty dope to roll up to a strip club after a long day at the hospital/office and pull off a classic Nelly 'tip drill'...
 
Dave89 said:
There's going to be a lot of people shifting from private health insurance uninsured status to Medicaid, which has horrible greater-than-zero reimbursement rates. So, no maybe?
Click to expand...

Fixed! :thumbup:
 
NickNaylor said:
Getting zero money is better than losing money IMO (which is the situation many PCPs find themselves in).
Click to expand...

Are you alluding to a situation in which the cost of the extra paperwork, in terms of clerk-hours, exceeds the Medicaid reimbursement itself? If this happens, I'd imagine it'd be for things like routine office visits in states with stingy Medicaid benefits like Texas. In your experience, second-hand or otherwise, what are the situations in which this happens?
 
eHombre said:
Are you alluding to a situation in which the cost of the extra paperwork, in terms of clerk-hours, exceeds the Medicaid reimbursement itself? If this happens, I'd imagine it'd be for things like routine office visits in states with stingy Medicaid benefits like Texas. In your experience, second-hand or otherwise, what are the situations in which this happens?
Click to expand...

I'm talking about the numerous anecdotes where, without double-booking patients or working extremely long days, physicians literally lose money on Medicare/Medicaid reimbursements. Paperwork might have something to do with it, but it's more that the reimbursement rate doesn't even cover the cost of overhead, much less provide enough for the doc to receive what might be considered "profit" i.e. income.

Obviously this is a problem limited primarily to solo practice situations as larger organizations are able to absorb these losses with the big money makers like critical care, cancer treatments, and surgical procedures.
 
And you're saying that physicians are financially worse off in these situations compared to giving charity care to uninsured patients?
 
eHombre said:
And you're saying that physicians are financially worse off in these situations compared to giving charity care to uninsured patients?
Click to expand...

No. I'm saying that in some cases they're better off not treating them at all. Obviously receiving a reimbursement that causes you to lose money is better than not receiving a reimbursement at all.

(sent from my phone - please forgive typos)
 
So I am basically gonna die under the weight of my 320k-not-including-interest loan?
 
NickNaylor said:
If you're a PCP and you're seeing primarily Medicare/Medicaid patients as a solo practitioner, my guess is that things are looking bleak for you.
Click to expand...

2 words: concierge practice
 
Blais said:
No one is certain...

But looks like it might depend on the field. For example, the discussion in the EM sub-forum is kind of optimistic. While, on the other hand, the anesthesiology sub-forum is not pleased.

Regardless, cash practice, FTW.
Click to expand...


Interesting! May turn out to be a big case of supply and demand, or how uncommon the speciality is from like a general surgeon to a cardiovascular one.
 
You must log in or register to reply here.
Next unread thread

Similar threads

K
Taking non pre-requisite course over winter?
Replies
8
Views
416
Goro
Goro
V
  • Locked
Winning a short story competition
Replies
21
Views
2K
gyngyn
gyngyn
Almostmedstudent1996
Let’s celebrate the Wins! Any LOW STAT Students been accepted to DO or MD schools this cycle?
Replies
1
Views
1K
NY_Med
NY_Med
CHCl3
gone like the wind
Replies
16
Views
1K
LizzyM
LizzyM
LizzyM
Olympic Medal Winning Canadian Med Student speaks about Covid19
Replies
2
Views
1K
yokiguz
yokiguz
Top