Obamacare canceled my insurance!

[Chip N Sawbones]

Only a fool would go uninsured when they have real assets to lose.
Good luck finding a new plan that meets your needs.

Assets don't always directly translate into money that can be readily spent on insurance. I've got a house that is technically a $180,000 asset, but is actually more of a liability until I can sell the stupid thing. Until then I'll be living off student loans, which aren't enough for me to be able to buy insurance without making serious sacrifices in other areas of my life, like whether I eat lunch or not. I don't really mind going without insurance, except that next year the government is supposed to start fining me for not having it. Thanks for nothing, Obama, I thought you were supposed to be helping people with incomes as low as mine.

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[Chip N Sawbones]

Quit whining. At least now your birth control and triennial pap smears are covered.

I use my personality as birth control. It's free and you don't see any little kids running around calling me Daddy yet.

 

[Silent Cool]

You don't think physicians make medical decisions based on fee schedules? I don't think anyone is intentionally causing harm for fees, but when there's conflicting evidence concerning the risks and benefits of different procedures its very easy to let yourself be convinced that the correct management is the financially advantageous one. I don't think there was anything unfair about this comment.



On of the best studied examples of this is reimbursement schedules for C-sections. Multiple studies have found that the differential in reimbursement between C-sections and SVDs is directly related to the rate of cesarean delivery. I'm sure none of the OB-Gyns truly believed that they were performing an unnecessary procedure. Interestingly the few studies on populations that underwent a sudden rapid change in reimbursement show no change in physican C-section rates, strongly suggesting that physicians continue to adhere to what they believe is the standard of care. However the standard of care that they adhere to reliably matches the fee schedule they have spent most of their career practicing under, given enough time physicians seem to generally convince themselves that the best financial decision is the right decision for the patient. I'm pretty sure that people in states with high fee differentials do not have more indications for cesarians than patients in states with equalized pay for deliveries, so I think there is a case to be made for getting rid of fee for service.

Some hastily googled Sources:
http://www.sciencedirect.com/science/article/pii/S0167629608001288
http://www.sciencedirect.com/science/article/pii/S0167629699000090
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069989/

Case in point: wisdom tooth extractions.
"The piggy bank is behind the second molar."

There is a reason most OMFS set up their practice to focus on high volume, simple procedures and avoid the hospital-based work. Additionally, many in dentistry believe that wisdom tooth extraction (especially prophylactic) is of dubious value.

 

[IlDestriero]

C sections are a bad example. They really don't know what is going on with the baby. They only have that HR tracing to follow. When labor is very prolonged with limited progress, what's the end point? Profound fetal depression? Mom collapsing in exhaustion?
What about a prolonged non reassuring fetal heart rate. Again, what's the end point.
You wait too long and the baby will have a lifetime of disability. And you get to have a multimillion dollar verdict after a line of elite experts say you should have done the c section hours before.
This is one of many reasons I dislike OB anesthesia. At some point they start to panic that they waited too long and there is unnecessary drama for the c/s.