Health Care Bill

[Snowman065]

What do you guys think President Obama's health care bill means for the future of podiatry?

---

Members don't see this ad.

 

[air bud]

it means there will be changes to medicine that will take a number of years to play out, and there is still more to be added or taken away.

 

[Shireiqiang]

it means there will be changes to medicine that will take a number of years to play out, and there is still more to be added or taken away.

So true!

 

[dyk343]

It means that we live in a socialist country. Can you believe that the government forces me to carry auto insurance or face a hefty fine? I mean... come on.

Others have pointed out that we don't know what will happen. Its kinda hard to balance out fox news/CNN/politicians and really understand what is going on. I currently support the bill, but we will see what happens in the future.

 

[air bud]

It means that we live in a socialist country. Can you believe that the government forces me to carry auto insurance or face a hefty fine? I mean... come on.

Not true. If you want to drive, you risk getting caught not having insurance, and then you get a fine. Dont get caught=dont pay a fine.

Today the IRS commisioner talked about how they will likely hold your tax refund (subtract the fine from it) if you don't get the mandated insurance. Try getting out of that one.

 

[dyk343]

Not true. If you want to drive, you risk getting caught not having insurance, and then you get a fine. Dont get caught=dont pay a fine.

Today the IRS commisioner talked about how they will likely hold your tax refund (subtract the fine from it) if you don't get the mandated insurance. Try getting out of that one.

Yeah one could also say "well, I just wont drive. I'll take the bus. Now I dont need insurance"

It was just trying to make a point

 

[dtrack22]

Today the IRS commisioner talked about how they will likely hold your tax refund (subtract the fine from it) if you don't get the mandated insurance. Try getting out of that one.

Increase your withholdings and then you won't get a tax return...Houdini

 

[air bud]

Increase your withholdings and then you won't get a tax return...Houdini

But then they will just garnish your wages. I guess the solution is to live off the grid and channel my inner Bear Gryllz

 

[dtrack22]

But then they will just garnish your wages. I guess the solution is to live off the grid and channel my inner Bear Gryllz

According to wikipedia you are the J. Gordon Whitehead to my Houdini. And if you're going to go off the grid, don't do it like survivorman...he's a p****

 

[spo01]

You should probably leave and get on welfare. Obama will take care of you.

 

[Feli]

Long story short: they basically decided health care is everyone's "right" and should be provided by the govt (aka the tax dollars taken from others) for those who can't afford it.

I think it will create the govt health plan as a monopoly health plan that most Americans will have to depend on... whether that was the whole idea or not is debatable. Private insurance companies have a VERY tough time competing when the new bill forces them to include many people with pre-existing conditions who use a lot of health care $ (they previously would've denied to sell coverage to or hiked the rates on these pts). The costs of those private insurance plans will thus have go up since they have more patients that use more health care $$.

Also, even more destructive, the private plans that do survive will gradually lose many of their "healthy" working class patients since many employers will decide to just dumping them to the govt health plan. The financial reality will become that the companies are better off just paying the new bill's govt fines for not providing employees insurance - rather than keep coughing up even more $ for the increasing cost of private plans. The costs of private insurance will thus skyrocket since the group plan loses many healthy working patients who previously paid in (via employers) but used little care. A lot of this doesn't kick in until 2014, so it's not like this will happen overnight, though.

In the end, a govt monopoly is definitely not good for physician payments. When you end up with probably 90% or more of Americans on the govt plan (basically everyone except VIPs or very sick pts who have to have the few remaining super expensive but "Cadillac" coverage private plans), then there really is no negotiation over fees for services. You will get paid what the govt plan decides to pay you, and that's the end of the story.

I mistakenly thought that each person's body is their responsibility. I though only life, liberty and the pursuit of happiness were constitutional rights which should be protected by govt, but what do I know? Health care is now a "right." Maybe soon we'll decide that cars and car insurance are everyone's "right" and we can increase taxes on the working to give vouchers for people who can't afford that "right" too? Stay tuned.

 

[Felt Racing]

My mother had cancer that started in her breast and spread basically everywhere. She battled cancer from the time I was in kindergarden until 8th grade. My father's company had a "cadillac" plan that dumped her after about 3 years of care. We were then forced way (hundreds of thousands) into debt to pay for her roller coaster ride. Luckily the state did pay for her care in the end.

Now after experiencing this I truly do believe that health care is a right to all people. Whether they can afford it or not.

 

[spo01]

My mother had cancer that started in her breast and spread basically everywhere. She battled cancer from the time I was in kindergarden until 8th grade. My father's company had a "cadillac" plan that dumped her after about 3 years of care. We were then forced way (hundreds of thousands) into debt to pay for her roller coaster ride. Luckily the state did pay for her care in the end.

Now after experiencing this I truly do believe that health care is a right to all people. Whether they can afford it or not.

Did it ever occur that part of the reason your mother was able to recieve good care was because that good care was available? With this new bill how are we going to give adequate care to everyone? You could be on a wait list miles long to get treated for cancer and everything else. Who is going to provide for these patients when doctors are going to get reimbursed less and less and yet taxed more and more? We have doctors at our local hospital retiring early or just flat out leaving. How is adequate care going to be provided to patients when doctors are going to be told by the goverment they can't get that MRI or CT because it costs too much? All this to support 'questionable' people who feel health care is a right and feel entitled to it? Get real. Doctors are already getting hit hard. My father is one of them. He works 100-120 hours a week with horrible Rheumatoid Arthritis just to make ends meet and put up with this bull****. Now we have the goverment stepping in telling docs what to do and what not to do, who to see and who not to see, pushing you away from private practice and towards the hospital under their rules, etc. Private message me for the details if you want, but you wouldn't believe the type of **** that's going on already.

 

[Feli]

My mother had cancer that started in her breast and spread basically everywhere. She battled cancer from the time I was in kindergarden until 8th grade. My father's company had a "cadillac" plan that dumped her after about 3 years of care. We were then forced way (hundreds of thousands) into debt to pay for her roller coaster ride. Luckily the state did pay for her care in the end.

Now after experiencing this I truly do believe that health care is a right to all people. Whether they can afford it or not.

Sorry to hear about your mother, but let's play devil's advocate:

You say "the state" paid for most of her care in the end? Well, "the state" is actually other people's taxes. Those taxes are taken. Some would say tactfully stolen. In the dark ages, tax collectors went around with clubs and swords to intimidate and punish until people paid up to the kings. Now, it's a more "civilized"... but tax money is still definitely by force: bank account garnishments, jail, etc for those who don't pay taxes.

With that in mind, do you believe it's your family's "right" to have the govt forcibly take that money from others (productive working people) to pay for your mother's care? Why? Please do explain. What was she contributing to the society that made her more deserving of the money than the people who actually worked hard to earn that money? Was she inventing American technological innovations? Was she making world peace? Or... was she mostly just sitting at home or in a hospital, watching TV, reading magazines, and costing other productive members of society thousands and thousands of dollars of their hard earned money?

I'm sure that sounds heartless, but as you see, it's a complex issue with no easy answers when you look at it from an angle other than simply justifying your mother's "right" to everyone else's money. Everyone selfishly wants the best health care for themselves and their family... and most of those people want the govt (aka other people) to pay for their health care. "The state" and "government" don't have money! It's not some charity organization where people voluntarily gave all this money to help random sick people who never helped them and they have never even met. That is what churches and charities are for.

Back here in the real world, every single dollar the governments "have" was actually taken from other citizens through taxes... by force. That government money is used for military, fire depts, police, roads, basic infrastructure, basic public education, and the judicial system... basic things that protect life and liberty in order to allow the American citzen a pursuit of happiness. If you think sick people automatically deserve the "right" to health care via as much of other American's hard earned money as they require simply because their body is not in good health (often because they did not take care of themself), then that is your opinion... definitely not a constitutional certainty. End of story.

 

[Felt Racing]

With that in mind, do you believe it's your family's "right" to have the govt forcibly take that money from others (productive working people) to pay for your mother's care? Why? Please do explain. What was she contributing to the society that made her more deserving of the money than the people who worked hard to earn the money? Was she inventing American technological innovations? Was she making world peace? Had she previously paid a similar amount of money she had earned for other sick strangers? Or... was she mostly just sitting at home or in a hospital and costing other productive members of society thousands and thousands of dollars of their hard earned money?

.

Simply put your an ass-hole Im sorry that you are going into a health care field with such little compassion.

Yes she did contribute to society. She had a masters in teaching from a very good school, yet choose to work at a "poorer" school that paid 1/2 as much as other schools. Not because she couldnt get a job, but because she loved what she did.

She won best elementary science teacher in my state 4 times. I cant get away from people telling me how much they loved my mother as a teacher.

She collected a million pop tabs with her classes from warehouses over a period of 2-3 years. She did this to both show her students what a million pop tabs looked like and also for charity. Coca cola donated 1 cent to the Ronald Mcdonald house for every pop tab she collected. So yes in short she did contribute to others in need.

In the end our debt was paid for by the state but it was all due to politics. Around senate election times an organization was set up (not by our family) and more or less what happened was people signed a petition threatening not to vote for the particular senator. Magically our debt went away.

 

[Felt Racing]

Im also not going to comment any more in this particular thread. I've already lost my temper with one individual. So comment away but I will not be replying.

 

[Feli]

Simply put your an ass-hole Im sorry that you are going into a health care field with such little compassion.

Yes she did contribute to society. She had a masters in teaching from a very good school, yet choose to work at a "poorer" school that paid 1/2 as much as other schools. Not because she couldnt get a job, but because she loved what she did.

She won best elementary science teacher in my state 4 times. I cant get away from people telling me how much they loved my mother as a teacher.

She collected a million pop tabs with her classes from warehouses over a period of 2-3 years. She did this to both show her students what a million pop tabs looked like and also for charity. Coca cola donated 1 cent to the Ronald Mcdonald house for every pop tab she collected. So yes in short she did contribute to others in need.

In the end our debt was paid for by the state but it was all due to politics. Around senate election times an organization was set up (not by our family) and more or less what happened was people signed a petition threatening not to vote for the particular senator. Magically our debt went away.

That is a touching story, but I would like to learn more. A couple of hypothetical questions I would like your opinion on:

Situation A:
Mrs. Smith is a high school dropout. She works as a waitress for a bit, but she gets fired for using drugs at work. She goes on welfare. She hasn't gone to church a day in her life, she has kids who get neglected and taken away to foster care, and she smokes crack on the weekends. She develops breast cancer and a prolonged and costly hospital course leading to her demise.
...Should "the state" taxpayer monies pay for Mrs. Smith's medical treatment costs, and should she get the same treatments your mother received - maybe better depending on the hospital she ends up in? Does she have the "right" just like anyone else?

Situation B:
Mrs. Doe has a similar career to your mother: she was ten time teacher of the year (volunteering all the while, not even 1/2 wage), a consummate humanitarian, and a veritable saint if there ever was one. Mrs. Doe develops metastatic breast cancer also. However, her nephew happens to be a successful lawyer, her son a well educated researcher for NASA, and her husband is a cardiologist. Her family can pay the bills out of pocket, and they also subsidize their costs through continued purchase of private insurance. Additionally, this family has paid millions in tax dollars which have helped to pay for the health care and govt services of other random Americans.
...Should "the state" taxpayer money pay for Mrs. Doe's hospital bills also? Isn't it her "right" even though her family has the ability to pay?

I'm still trying to understand this fundamental "right" of health care which should be provided by "the state."

 

[JaggerPlate]

Feli ... you are golden. Seriously, amazing analysis, insight, etc. Realistic, honest, concise, etc. I wish you would have been around for some of the battles in pre-Allo where idealistic, 17 year old pre-meds were mouthing off about this BS.

 

[catchburns]

Simply put your an ass-hole Im sorry that you are going into a health care field with such little compassion.

Yes she did contribute to society. She had a masters in teaching from a very good school, yet choose to work at a "poorer" school that paid 1/2 as much as other schools. Not because she couldnt get a job, but because she loved what she did.

She won best elementary science teacher in my state 4 times. I cant get away from people telling me how much they loved my mother as a teacher.

She collected a million pop tabs with her classes from warehouses over a period of 2-3 years. She did this to both show her students what a million pop tabs looked like and also for charity. Coca cola donated 1 cent to the Ronald Mcdonald house for every pop tab she collected. So yes in short she did contribute to others in need.

In the end our debt was paid for by the state but it was all due to politics. Around senate election times an organization was set up (not by our family) and more or less what happened was people signed a petition threatening not to vote for the particular senator. Magically our debt went away.

While I agree that Feli could have stated his point with a bit more tact, your attack is totally uncalled for. Feli makes points just as valid as yours. Your mother may have been deserving of the care she received, but she is undoubtedly the exception to the rule. Do you really think that most people who are utilizing government programs are making a serious contribution to those same programs or the communities they serve? Sure, not every job that contributes to society pays wages that are high enough to justify the cost of good health care, but how is it possibly fair that the government robs from others who work and study very hard to make good wages so that others can take advantage of a health care system that they make little or no contribution to? While I'm glad your mother was able to receive the care she needed, the issue is much larger than one personal situation.

It seems ludicrous to me to expect other people to forcibly pay for someone else's health care. I live in Canada right now and know that socialized medicine is not a solution to our health care problems. While your mother was able to get the health care that helped her, in the same system you are advocating my mother has had to wait over a year to get an MRI for serious back issues that cause her excruciating pain and could eventually result in paralysis if not resolved. Despite the fact that my mom has also worked hard and as a result carries good private health insurance as well as Provincial coverage, she can't get the care she needs because of the problems this system has created. Is that fair?

I'm just pointing out that just because your mom benefited from health care that was funded by the state doesn't give you any right to tell someone else that they lack compassion as a practitioner just because they don't think that socialized medicine is the answer. Please think before you react next time.

 

[Dental Jarry]

That is a touching story, but I would like to learn more. A couple of hypothetical questions I would like your opinion on:

Situation A:
Mrs. Smith is a high school dropout. She works as a waitress for a bit, but she gets fired for using drugs at work. She goes on welfare. She hasn't gone to church a day in her life, she has kids who get neglected and taken away to foster care, and she smokes crack on the weekends. She develops breast cancer and a prolonged and costly hospital course leading to her demise.
...Should "the state" taxpayer monies pay for Mrs. Smith's medical treatment costs, and should she get the same treatments your mother received - maybe better depending on the hospital she ends up in? Does she have the "right" just like anyone else?

Situation B:
Mrs. Doe has a similar career to your mother: she was ten time teacher of the year (volunteering all the while, not even 1/2 wage), a consummate humanitarian, and a veritable saint if there ever was one. Mrs. Doe develops metastatic breast cancer also. However, her nephew happens to be a successful lawyer, her son a well educated researcher for NASA, and her husband is a cardiologist. Her family can pay the bills out of pocket, and they also subsidize their costs through continued purchase of private insurance. Additionally, this family has paid millions in tax dollars which have helped to pay for the health care and govt services of other random Americans.
...Should "the state" taxpayer money pay for Mrs. Doe's hospital bills also? Isn't it her "right" even though her family has the ability to pay?

I'm still trying to understand this fundamental "right" of health care which should be provided by "the state."

I see where you are going with this Feli and I like it. The person in situation A should just be left to rot in the street since she is a drug addict and doesn't go to church. Why should they have any right to live in the first place. I mean, who cares about what possible reasons led to them being in the situation they are in now. We know that people never change and turn their lives around so lets just kill her now. While we are at it we shouldn't allow her children to go to any public school because they may turn out just like her and that would be a waste of tax payer money. Maybe we can can just send them straight to the coal mines to work, and then when they get the black lung, we won't treat them because they don't deserve it. I totally agree with you Feli!

 

[GibsonMan]

QUOTE=Dental Jarry "Maybe we can can just send them straight to the coal mines to work, and then when they get the black lung, we won't treat them because they don't deserve it."



cough... cough... cough I think I'm getting the black lung pop. lol

 

[air bud]

QUOTE=Dental Jarry "Maybe we can can just send them straight to the coal mines to work, and then when they get the black lung, we won't treat them because they don't deserve it."



cough... cough... cough I think I'm getting the black lung pop. lol

MerMan was a very underrated movie. Think fine wine and cougars.

 

[165007]

LOL, Feli stop being an ass-hole.

 

[TexPod1]

We already pay for the care of many people who utilize ER's as their PCP. In my rotation at the ER I couldn't count how many people came in for things like strep throat, pregnancy tests, STD tests, etc...

I think it would be cheaper to buy insurance for these people than have the hospitals continually raise prices to cover pro bono care for indigent patients. But of course, just because they have insurance doesn't mean they will go to a PCP.

By making health insurance mandatory, don't you think rates will go down because of the larger pool of buyers. Anyway, this bill is a boon to the insurance companies, it does not create a "government plan".

 

[G0dFather]

Im not even going to get involved ... but you people have to show more respect for Feli...

 

[that1guyfromFL]

By making health insurance mandatory, don't you think rates will go down because of the larger pool of buyers.

Theoretically yes. The problem lies in who exactly is being added to the pool.

When you force an insurance company to provide coverage, regardless of how much it will cost the company, there are a few scenarios that could play out.

Scenario 1

A private insurance company forced to provide coverage to millions of people with pre-existing conditions does so with premiums 2 times higher than the average for those patients in order to offset the proprtionally higher amount being paid out to them.

Scenario 2

Same insurance company, provides coverage to the same millions of new patients but instead of charging those with higher risk more for their policy, everyone has their premium go up 30% to make up the difference.

Anyway, this bill is a boon to the insurance companies, it does not create a "government plan".

While it seems like the scenarios I outlined would both benefit the private insurance companies, another factor is in play: expanded government run programs like Medicare and Medicaid.

Because those programs are already subsidized by our tax dollars, the cost of coverage compared to a private company will be cheaper.

Many people who qualify for Medicare will choose it over paying the, comparatively, higher premiums of a private insurance company.

----------

It really all comes down to competition.

A private company has to pay all of it's financial obligations from collected policy premiums.

The government program subsidizes it's cost with our tax dollars.

A private company has to be profitable in order to stay in business.

The government program can lose money year after year.

It would be nearly impossible for a private company to compete with a government program under absolutely ideal operating conditions.

By forcing companies to provide coverage to absolutely anyone, this new health bill ensures that private insurance has no chance to compete on price, thus driving a large number of people to the government program conveniently waiting to scoop them up.

 

[that1guyfromFL]

I've already lost my temper with one individual.

Because you let your intense emotion about your individual experience overwhelm all form of reason.


You totally missed the point Feli was trying to make.

 

[Feli]

...It really all comes down to competition.

A private company has to pay all of it's financial obligations from collected policy premiums.

The government program subsidizes it's cost with our tax dollars.

A private company has to be profitable in order to stay in business.

The government program can lose money year after year.

It would be nearly impossible for a private company to compete with a government program under absolutely ideal operating conditions.

By forcing companies to provide coverage to absolutely anyone, this new health bill ensures that private insurance has no chance to compete on price, thus driving a large number of people to the government program conveniently waiting to scoop them up.

Ding ding ding.

Govt plan pays for its members' health care with premiums + tax money.
Private plans pay for their members' care with premiums only.

...You don't have to be a rocket scientist to figure out which plan will be cheaper and chosen by more people. People will also realize their money is already taken to fund the public plan members whether they choose the public plan or not. The majority of currently insured Americans get their insurance through their employer, and nearly all those employers will begin to rapidly dump their employees on the govt option since it is significantly less expensive. Paying the tax penalties for not insuring the employees will be less cost to the company than continuing to go broke trying to afford private plans that are hiking rates rapidly (or going bankrupt altogether). Those corporate pull outs from the private plans will absolutely skyrocket the cost of premiums since those millions of corporate employees the private pools will be losing were relatively healthy and using little care when compared with the other pool members with disability, chronic illness, etc members.

A free market needs competition. Expecting the private health plans compete with the govt option would be like having a private letter mailing company try to compete with USPS (govt funded, gobbles up taxes, never turns a profit... yet stays around nonetheless). A viable competing company could never happen since the private letter delivery company would be gone after a few years of being in the accounting "red." The only way for the private letter company to survive would be to charge maybe $1 per standard letter delivery, and who'd use that service? Therefore, USPS has a monopoly, and now, the govt will soon have a virtual monopoly on health care insurance coverage also.

It'll be interesting to see how the govt plan decides to pay health care providers once the monopoly sets in. Similar to the USPS, there will be no viable competition or negotiation of wages; the employees then take what they are offered. The USPS is losing so many billions of dollars that they are entertaining the idea of cancelling some delivery days to decrease the tax money they're hemmorhaging (I think the idea of actual profit went out the window long ago), but I don't think that idea of limited weekly service days would work too well for health care?

 

[air bud]

Feli, what are you talking about, come rain or shine, the USPS is a well oiled machine http://www.usps.com/communications/newsroom/2009/pr09_098.htm

EDIT: just actually read the CNN article. Can't believe they conveniently forgot to mention losing billions year after year. Thats okay, I am sure they are thorough and unbiased in the rest of their news coverage. Details, schmetails..

 

[NatCh]

Ding ding ding.

Govt plan pays for its members' health care with premiums + tax money.
Private plans pay for their members' care with premiums only.

...You don't have to be a rocket scientist to figure out which plan will be cheaper and chosen by more people. People will also realize their money is already taken to fund the public plan members whether they choose the public plan or not.

Perhaps, although Medicare is already a publicly-funded plan and people still prefer private insurance due to better coverage. Maybe it will depend on how good the government plan coverage is.

The majority of currently insured Americans get their insurance through their employer, and nearly all those employers will begin to rapidly dump their employees on the govt option since it is significantly less expensive.
Paying the tax penalties for not insuring the employees will be less cost to the company than continuing to go broke trying to afford private plans that are hiking rates rapidly (or going bankrupt altogether). Those corporate pull outs from the private plans will absolutely skyrocket the cost of premiums since those millions of corporate employees the private pools will be losing were relatively healthy and using little care when compared with the other pool members with disability, chronic illness, etc members.

I could see that happening, although if private insurance companies can't compete then they may have to cut expenses and run leaner. They could raise their premiums but if people won't pay for it then they have to get cheaper. They could start by not giving their CEOs 7-figure bonuses.

A free market needs competition. Expecting the private health plans compete with the govt option would be like having a private letter mailing company try to compete with USPS (govt funded, gobbles up taxes, never turns a profit... yet stays around nonetheless). A viable competing company could never happen since the private letter delivery company would be gone after a few years of being in the accounting "red." The only way for the private letter company to survive would be to charge maybe $1 per standard letter delivery, and who'd use that service? Therefore, USPS has a monopoly, and now, the govt will soon have a virtual monopoly on health care insurance coverage also. It'll be interesting to see how the govt plan decides to pay health care providers once the monopoly sets in. Similar to the USPS, there will be no viable competition or negotiation of wages; the employees then take what they are offered. The USPS is losing so many billions of dollars that they are entertaining the idea of cancelling some delivery days to decrease the tax money they're hemmorhaging (I think the idea of actual profit went out the window long ago), but I don't think that idea of limited weekly service days would work too well for health care?

Valid point, but USPS might not be the best example since it has run as a private corporation for about 30 years, despite being a government agency. I've read that USPS hasn't been funded by tax money since the early 1980's. UPS and FedEx are the direct competition and email, not government monopoly, is killing the USPS.

 

[air bud]

i know this is getting off topic...yes, the USPS is not technically a "government agency" but it runs and operates by special rules. Similar to the way Fanny and Freddie run. And we all know how that is going...

 

[NatCh]

i know this is getting off topic...yes, the USPS is not technically a "government agency" but it runs and operates by special rules. Similar to the way Fanny and Freddie run. And we all know how that is going...

Apparently it's open to debate:

http://usgovinfo.about.com/od/consumerawareness/a/uspsabout.htm

 

[Feli]

... USPS might not be the best example since it has run as a private corporation for about 30 years, despite being a government agency. I've read that USPS hasn't been funded by tax money since the early 1980's. UPS and FedEx are the direct competition and email, not government monopoly, is killing the USPS.

Well, it's a "private corporation" with a laundry list of special rules. Govt laws make them tax exempt, allow borrowing and safety nets of tax funds, give the benefit of other govt services, have "funds" which are nothing more than cleverly disguised tax money gifts, and even make it illegal for a competing letter delivery company to be formed, etc etc. There is definitely no other such "private corporation" in the country.

I think the emerging govt health plan's functionality will be pretty similar to USPS. Blue Cross pays taxes, MediCare does not. Blue Cross folds if they lose money, but MediCare just gets more tax money injected in. The new health bill won't expressly forbid private insurance company competition in the way USPS letter delivery competition is monopolized in the legislature, but when the govt now plans to give people and corporations a tax penalty for not having insurance for themselves or employees AND they happen to run the only nontaxed and bankruptable insurance plan, they honesly mised well forbid competition since that competition won't survive long anyways. It's a crafty way to make a monopoly IMO, and it'll be very hard for docs and hospitals to negotiate with (virtually) one single govt health care payer.

 

[NatCh]

Well, it's a "private corporation" with a laundry list of special rules. Govt laws make them tax exempt, allow borrowing and safety nets of tax funds, give the benefit of other govt services, have "funds" which are nothing more than cleverly disguised tax money gifts, and even make it illegal for a competing letter delivery company to be formed, etc etc. There is definitely no other such "private corporation" in the country.

I think the emerging govt health plan's functionality will be pretty similar to USPS. Blue Cross pays taxes, MediCare does not. Blue Cross folds if they lose money, but MediCare just gets more tax money injected in. The new health bill won't expressly forbid private insurance company competition in the way USPS letter delivery competition is monopolized in the legislature, but when the govt now plans to give people and corporations a tax penalty for not having insurance for themselves or employees AND they happen to run the only nontaxed and bankruptable insurance plan, they honesly mised well forbid competition since that competition won't survive long anyways. It's a crafty way to make a monopoly IMO, and it'll be very hard for docs and hospitals to negotiate with (virtually) one single govt health care payer.

Hard to negotiate? Have you ever tried to negotiate with a private insurance company?

If private insurance can offer something better than whatever the government plan offers, then they would still find a market. I have mixed feelings about the whole thing since I despise private insurance companies and would enjoy seeing them in pain (to return the favor). How any physician can rally in support of insurance companies, I don't know. So far they, not we, run the show.

I like the idea of having health care coverage for every child and the removal of the dreaded pre-existing condition clause. Insurance...what a racket.

 

[that1guyfromFL]

I could see that happening, although if private insurance companies can't compete then they may have to cut expenses and run leaner.

You can't cut enough expenses to compete when the other guy doesn't have to play by the same rules.

They could start by not giving their CEOs 7-figure bonuses.

Since when do we arbitrarily decide how much someone is allowed to earn in the private sector?

Wait........

 

[Feli]

Hard to negotiate? Have you ever tried to negotiate with a private insurance company?

Of course I haven't. I will in the future... if they still exist.

The point is that with multiple payers, there are still negotiations to be done. If Chrysler HMO and United will offer only peanuts in payment for our bunionectomies, initial office visits, and casting, then we can refuse to participate in their plan and instead talk to Blue Cross and Diamond PPO to see how much they will offer for those services. The bottom line is that we have options and negotiating power.

With MediCare and MedicAid in their present form, you get what they offer. You might not like their offer, but heck... they have a lot of patients, so almost every DPM will take their offer in order to have the volume. Their offers are low, but they must remain at least somewhat competitive with the private plans. As most docs get established and garner more and more overall patients, they gradually try to see fewer and fewer govt pts in favor of better paying private plan patients. Well, what if the M&M govt plans went from currently having circa 40% of the American population to 95% of all patients after this new health bill is in full swing? The govt insurance plans no longer have any incentives whatsoever to keep their provider payments competive with the private plans. The only choice for providers is to take what govt plans offer or have a virtually empty office... and probably pick up a side job in order to feed their family. That is a major problem IMO, and it's the iceberg on the horizon for American docs.

 

[NatCh]

Of course I haven't. I will in the future... if they still exist.

The point is that with multiple payers, there are still negotiations to be done. If Chrysler HMO and United will offer only peanuts in payment for our bunionectomies, initial office visits, and casting, then we can refuse to participate in their plan and instead talk to Blue Cross and Diamond PPO to see how much they will offer for those services. The bottom line is that we have options and negotiating power.

With MediCare and MedicAid in their present form, you get what they offer. You might not like their offer, but heck... they have a lot of patients, so almost every DPM will take their offer in order to have the volume. Their offers are low, but they must remain at least somewhat competitive with the private plans. As most docs get established and garner more and more overall patients, they gradually try to see fewer and fewer govt pts in favor of better paying private plan patients. Well, what if the M&M govt plans went from currently having circa 40% of the American population to 95% of all patients after this new health bill is in full swing? The govt insurance plans no longer have any incentives whatsoever to keep their provider payments competive with the private plans. The only choice for providers is to take what govt plans offer or have a virtually empty office... and probably pick up a side job in order to feed their family. That is a major problem IMO, and it's the iceberg on the horizon for American docs.

As it is now, with private insurance companies we take whatever they decide to give. We can charge as much as we want but that's not what we get. At the same time, it's a major pain in the ass to deal with insurance companies just to get paid, and they base their rates off of Medicare anyway. Dealing with Medicare is easy in comparison.

Who knows, however much you might get less in reimbursement per E&M or CPT code, you could save that in staffing costs (your cadre of billers who have to chase down your payments). At the same time, with more insureds out in the community, you will have more patients. I guess we'll see.

 

[NatCh]

You can't cut enough expenses to compete when the other guy doesn't have to play by the same rules.

This scenario already exists (e.g. USPS v. UPS/FedEx, Medicare v. Blue Cross).

Since when do we arbitrarily decide how much someone is allowed to earn in the private sector?

Wait........

Insurance companies are just the middle man. They get paid to hold funds for when patients need it to pay doctors and other providers, yet when it comes time to pay up they try their best not to wherever possible. Those 7-figures that the CEO got, he got in part because he prevented his company from paying providers, so I wouldn't lose any sleep if his salary dropped a figure or two.

As a physician you too will be limited in what you can earn. We can only bill for "usual & customary" charges, not whatever the market will bear. Then we take whatever the insurance company decides to pay us.

Edit: Excuse me, 8-figures:

http://www.healthreformwatch.com/20...-care-insurance-executives-and-wheres-hr-676/

http://www.ama-assn.org/amednews/2009/06/01/bisc0601.htm

 

[zloetakoe]

Long story short: they basically decided health care is everyone's "right" and should be provided by the govt (aka the tax dollars taken from others) for those who can't afford it.

I think it will create the govt health plan as a monopoly health plan that most Americans will have to depend on... whether that was the whole idea or not is debatable. Private insurance companies have a VERY tough time competing when the new bill forces them to include many people with pre-existing conditions who use a lot of health care $ (they previously would've denied to sell coverage to or hiked the rates on these pts). The costs of those private insurance plans will thus have go up since they have more patients that use more health care $$.

Also, even more destructive, the private plans that do survive will gradually lose many of their "healthy" working class patients since many employers will decide to just dumping them to the govt health plan. The financial reality will become that the companies are better off just paying the new bill's govt fines for not providing employees insurance - rather than keep coughing up even more $ for the increasing cost of private plans. The costs of private insurance will thus skyrocket since the group plan loses many healthy working patients who previously paid in (via employers) but used little care. A lot of this doesn't kick in until 2014, so it's not like this will happen overnight, though.

In the end, a govt monopoly is definitely not good for physician payments. When you end up with probably 90% or more of Americans on the govt plan (basically everyone except VIPs or very sick pts who have to have the few remaining super expensive but "Cadillac" coverage private plans), then there really is no negotiation over fees for services. You will get paid what the govt plan decides to pay you, and that's the end of the story.

I mistakenly thought that each person's body is their responsibility. I though only life, liberty and the pursuit of happiness were constitutional rights which should be protected by govt, but what do I know? Health care is now a "right." Maybe soon we'll decide that cars and car insurance are everyone's "right" and we can increase taxes on the working to give vouchers for people who can't afford that "right" too? Stay tuned.

B- to the ingo.

 

[miller4362]

You will soon realize that your opinions no longer matter. At least not for the next 7 years (unless you have a lot of money to donate). Just study as much as you can and have fun before you start classes. Good luck everyone!!

 

[janV88]

Who knows, however much you might get less in reimbursement per E&M or CPT code, you could save that in staffing costs (your cadre of billers who have to chase down your payments). At the same time, with more insureds out in the community, you will have more patients. I guess we'll see.

NatCh, Quick question...what is the usual cost per year for billing? I realize it will probably depend on a lot of factors such as solo or group practice but a rough figure would help put things into perspective.

 

[NatCh]

NatCh, Quick question...what is the usual cost per year for billing? I realize it will probably depend on a lot of factors such as solo or group practice but a rough figure would help put things into perspective.

Between salary, bennies, and payroll taxes figure roughly $40,000 per year per Biller.

Or you can use a billing service. They typically charge a percentage of collections, maybe 4% (I think).

We pay about $1200/mo. per employee to provide them with health insurance, so from the viewpoint of a small business owner I'd save a lot each year if I didn't have to insure them.

I don't really know how it'll all work out. I could make less income per patient but if my overhead went down an equivalent amount it could be a wash. I'd rather have health care dollars go towards actual patient care rather than to some insurance company executives.

Best case scenario would have the above happening plus we'd see an increase in patient volume from having more insureds and therefore make more in the end. I won't hold my breath though.

 

[Feli]

...We pay about $1200/mo. per employee to provide them with health insurance, so from the viewpoint of a small business owner I'd save a lot each year if I didn't have to insure them...

But starting soon, that'll cost you tax penalties. You can't go depriving your employees of their "right" to health care. That will make...
http://rds.yahoo.com/_ylt=A0WTefPM28BLXisACO2jzbkF/SIG=122hg9nta/EXP=1271016780/**http%3a//earthhopenetwork.net/obama_frowning.jpg

...Who knows, however much you might get less in reimbursement per E&M or CPT code, you could save that in staffing costs (your cadre of billers who have to chase down your payments). At the same time, with more insureds out in the community, you will have more patients. I guess we'll see.

I agree that having a govt monopoly health plan *may* simplify the billing, but it's always going to be a game.

The govt (and any private insurances that survive) will continue to try to control increasing health care costs by cutting payments, and docs will keep coming up with "creative" coding, referral and consulting loops, etc etc to stop their income from dwindling. The reimbursement for overutilized codes eventually get a fee downgrade, those codes are then used less, and new "hot" codes will sprout up in their place. It's fast paced excitement there in round 1.

Round 2 starts once the payment amount and diagnosis/procedure codes are finally verified and agreed on by the doc and the insurance plan. The goal here is actually getting the physical fee for services check while the insurance plan delays mailing it as long as possible to collect a bit more interest off their massive health insurance account.

In the end, we will still probably need a billing/collections person (or two?) per doc. IMO, there's still just no way that simplified billing (more of a "maybe" than a certainty) is worth creating a govt monopoly health care provider and losing basically all of our negotiating power on the payment amounts.

 

[NatCh]

But starting soon, that'll cost you tax penalties. You can't go depriving your employees of their "right" to health care. That will make...

Would it? I don't have 50 employees. This is what I pulled up:

From: http://www.cbsnews.com/8301-503544_162-20000846-503544.html

Individual Mandate:

• In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Employer Mandate:

• Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

and

From: http://abcnews.go.com/GMA/HealthCar...l-law-republicans-challenge/story?id=10176898

Under the health care bill, by 2014 most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans. Employers would also be required to provide coverage to their workers, or pay a fine of $2,000 per worker. Companies with fewer than 50 employees, however, are exempt from this rule.

*****************************************************************************

This article says I'd get a tax credit for providing coverage:
http://www.cbsnews.com/8301-503544_162-20000848-503544.html?tag=contentMain;contentBody

1. SMALL BUSINESS TAX CREDITS-- Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
2. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE-- Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)
3. FREE PREVENTIVE CARE UNDER MEDICARE-- Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
4. HELP FOR EARLY RETIREES-- Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Effective 90 days after enactment
5. ENDS RESCISSIONS-- Bans health plans from dropping people from coverage when they get sick. Effective 6 months after enactment.
6. NO DISCRIMINATON AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS-- Prohibits health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
7. BANS LIFETIME LIMITS ON COVERAGE-- Prohibits health plans from placing lifetime caps on coverage. Effective 6 months after enactment.
8. BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE-- Tightly restricts new plans' use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.)
9. FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS-- Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment. (Beginning in 2018, this requirement applies to all plans.)
10. NEW, INDEPENDENT APPEALS PROCESS-- Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
11. ENSURING VALUE FOR PREMIUM PAYMENTS-- Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)-- Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition - through a temporary high-risk pool. Effective 90 days after enactment.
13. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS' INSURANCE - Requires health plans to allow young people up to their 26th birthday to remain on their parents' insurance policy, at the parents' choice. Effective 6 months after enactment.
14. COMMUNITY HEALTH CENTERS-- Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.
15. INCREASING NUMBER OF PRIMARY CARE DOCTORS-- Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.
16. PROHIBITING DISCRIMINATION BASED ON SALARY-- Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
17. HEALTH INSURANCE CONSUMER INFORMATION-- Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.
18. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM-- Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.

 

[Feli]

Would it? I don't have 50 employees. This is what I pulled up:

From: http://www.cbsnews.com/8301-503544_162-20000846-503544.html

Individual Mandate:

In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Employer Mandate
Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances...

You're right, your LLC (or mine, when I establish it) won't get the tax penalties unless the group practice grows bigger and has 50+ employees, but how are we going to attract decent employees once the bill is in full swing? You won't be able to afford the costs of privately insuring your employees anymore (no way tax credits will offset the upticks in premiums), and that insurance is almost surely one of your best selling points to get/keep your key employees such as office mgr, biller, associates, etc.

Their options will soon become:
A) Keep working for you but buy their own health care... govt or private.
B) Go work for a bigger employer who has to give them health care (hospital, large group, NH, etc) or pay a fine to help them buy govt plan.
C) Be unemployed and get govt health plan free.

-A is unattractive since they will have a tough time affording private, and nobody wants to go from good private insurance to MediCare.
-B obviously doesn't work out for your group too well
-C is pretty non-viable for an educated person with a sense of self worth.

The magic bullet would seem like they could work part time for your practice (for the high job quality) and part time at a larger employer (for the health insurance), but I don't think many large companies will want part time employees once all employees - full or part time - begin to cost them $2k per year in tax penalties (or much more if they want to chase the increasing costs of private plans that can't compete with the tax-fueled govt option). Once the massive corporate flushing of employee pools to the govt plan starts, that $2k per year will surely be increased to help compensate. In the past, part timers didn't get full benefits, but soon, I'd imagine it'll be VERY tough to find companies looking for part-time workers that will bring full tax penalties.

 

[Feli]

Don't get me all wrong here. As a new practitioner (and likely small business owner or part owner), it sounds ABSOLUTELY great to me to have a new health bill with potentially simplified billing and a cheaper public health option that my employees can get - likely with help from my company - if I can't afford a private plan for them.

However, I just think we're being shortsighted here. A monopoly entity is never good for the people who work there. As docs, we can't exactly go on strike like construction workers, auto workers, engineers, etc. A widespread strike by docs would be bargaining with human lives and well being, so it just isn't a viable option. We'd end up with new laws that make it a punishable offense for physicians to refuse to treat govt insurance patients.

Maybe the new health bill will be all roses and we will have basic simplified billing which offsets the time we spend seeing more patients who now have govt insurance and choose to utilize it. I just don't think we can afford American health care standards as a "right" for everyone without making taxes totally unreasonable, doc and hospital payments pathetic... or both. In a virtual monopoly where one health care payer holds all the patients, any bargaining power on the fees and coverages is nonexistant.

It all depends on whether you want to stick to the original bill of rights (life, liberty, pursuit of happiness) or whether you favor FDR's "second" bill of rights speech (essentially social security, aka communism/socialism IMO). It all depends how far you want to extend government's control of social services... and how much you want to increases taxes to pay for those services.

I don't think health care is a basic constitutional "right," and I don't understand why people should not continue to pay for their health care in the same way they pay for home damages, car trouble, or other major expenses: either out of pocket or subsidized with an insurance plan of their choosing. It's pretty much a basic question of self reliance versus expecting charity from "the state" (aka your neighbor's taxes). You know that whole "ask not what your country can do for you" stuff... JMO.

 

[NatCh]

...how are we going to attract decent employees once the bill is in full swing? You won't be able to afford the costs of privately insuring your employees anymore (no way tax credits will offset the upticks in premiums), and that insurance is almost surely one of your best selling points to get/keep your key employees such as office mgr, biller, associates, etc.

With hiring/keeping employees it goes far deeper than the insurance issue.

I was trying to keep the glass half-full for you guys, but you've worn me out Feli. I'll pull out so you all can fret unfettered.

<<<<<YOU'RE ALL TOTALLY SCREWED!!!>>>>>


There, that feels pretty good.

 

[pieds]

With hiring/keeping employees it goes far deeper than the insurance issue.

I was trying to keep the glass half-full for you guys, but you've worn me out Feli. I'll pull out so you all can fret unfettered.

<<<<<YOU'RE ALL TOTALLY SCREWED!!!>>>>>


There, that feels pretty good.

 

[DJ Quik]

What it means is that there will be less choice for patients, less pay for doctors, and less incentive to innovate.
How do you avoid it?

A) don't go into healthcare
B) Join the AAPPM, where you will learn how to maximize your ability to help patients and get paid for it.
C) go into politics and change the law

 

[FootPro]

This truely concerns me because I will be entering podiatry school in the fall. I know that many people will bash me for saying this but one of the few main reasons I decided to go into this field is for a higher income, way higher than the average american, and much higher than joining the workforce upon graduate. With school costing 50K for four years, the investment of 4 years of TIME and studying, and 3 years of grueling residency, I expect to be rewarded.

The question now arises, "Is it worth it?" What does this really mean for a future podiatrist? I spoke with a young (32 years old) and successful podiatrist several weeks ago. He told me he would loose anywhere from 15-30% of his current income. That is very disheartening. However, he did tell me that he would still be very well off with a substantial decrease in salary but it would force him to either work more hours or accept the lower pay. I don't know many people who can say that if they would loose 15-30% of their income would still be "well off," but I don't think this is the norm.

So I would like to know what others think about this issue strictly in terms of finance. What can I expect? I am a future student bearing full responsibility of these loans and I want to know if you think it is worth it because I am second guessing my future every day and I don't think that I am alone.