Healthcare reform quiz

[BU Pathology]

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Kaiser Permanente has put together a quiz about the elements in the Affordable Care Act. Take the quiz and test your knowledge, it is a short 10 question quiz.

http://healthreform.kff.org/quizzes/health-reform-quiz.aspx

Daniel Remick, M.D.
Chair of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

 

[pathstudent]

Kaiser Permanente has put together a quiz about the elements in the Affordable Care Act. Take the quiz and test your knowledge, it is a short 10 question quiz.

http://healthreform.kff.org/quizzes/health-reform-quiz.aspx

Daniel Remick, M.D.
Chair of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

Ten out of ten baby!

I have some major disagreements with the plan. One is I absolutely think there should be the so called "death panels". I know that term was coined by republicans to strike fear into Americans, but we need to accept that everyone of is going to die, and we can't spend hundreds of thousands of dollars on chemotherapy and ICU beds on elderly people with metastatic disease or other end stage terminal diseases. David Brooks wrote a good piece addressing this in the NYT a couple months ago. http://www.nytimes.com/2011/07/15/opinion/15brooks.html?_r=2&emc=tnt&tntemail1=y We need to say enough is enough when it is being paid with public funds.


Another problem I have with it is that I believe healthcare "savings" will come mostly from decreased physician reimbursements and not from insurance company profits or hospital revenue as those two have much larger and more powerful lobbyists.

 

[Enkidu]

Ten out of ten baby!

I have some major disagreements with the plan. One is I absolutely think there should be the so called "death panels". I know that term was coined by republicans to strike fear into Americans, but we need to accept that everyone of is going to die, and we can't spend hundreds of thousands of dollars on chemotherapy and ICU beds on elderly people with metastatic disease or other end stage terminal diseases. David Brooks wrote a good piece addressing this in the NYT a couple months ago. http://www.nytimes.com/2011/07/15/opinion/15brooks.html?_r=2&emc=tnt&tntemail1=y We need to say enough is enough when it is being paid with public funds.


Another problem I have with it is that I believe healthcare "savings" will come mostly from decreased physician reimbursements and not from insurance company profits or hospital revenue as those two have much larger and more powerful lobbyists.

How does the law affect physician reimbursement? Jusr by expanding medicaid?

 

[pathstudent]

How does the law affect physician reimbursement? Jusr by expanding medicaid?

Technically expanding medicaid should improve pathologist reimburesment because you'll be getting something from people that used to pay nothing.

But ultimately I think the ACOs and slashed to medicare will affect physicians and not hospitals or insurance company revenue. Just my opinion.

 

[Pathwrath]

Ten out of ten baby!

Not to burst your bubble, but the questions were of the "Duh" variety, meant to refute the most egregious misconceptions.

Now, what I'd really like to see is more helpful questions 'n' answers about that supercongress Medicare Advisory Board and what it can do to us in order to sustain this monstrosity.

I also wouldn't mind a few fly-on-the-wall reports of who said what when they were working to buy off Pharma and AHIP.

 

[Enkidu]

Not to burst your bubble, but the questions were of the "Duh" variety, meant to refute the most egregious misconceptions.

Now, what I'd really like to see is more helpful questions 'n' answers about that supercongress Medicare Advisory Board and what it can do to us in order to sustain this monstrosity.

I also wouldn't mind a few fly-on-the-wall reports of who said what when they were working to buy off Pharma and AHIP.

Do you consider healthcare reform to be a monstrosity? What bothers you about it?

 

[Pathwrath]

Do you consider healthcare reform to be a monstrosity? What bothers you about it?

It's not healthcare reform. It's a bloated insurance bill propped up by forcing all citizens to purchase a defective product and empowering a supercongress to cut provider payments. It corrects some of the worst abuses of insurance; fair enough. But it does nothing to address end-of-life benefits accounting for a huge chunk of Medicare waste, nor does it begin to address drug costs.

What bothers me the most about this thing is not the hit physicians are going to take if it is fully implemented. It's the pointlessness of the sacrifice. Reform is only going to work if everybody understands the healthcare gravy train is over--docs, hospitals, insurers, Pharma, seniors, LAWYERS, everyone. You don't get reform by buying off insurers and drug companies and telling seniors that their benefits are untouchable.

 

[Enkidu]

It's not healthcare reform. It's a bloated insurance bill propped up by forcing all citizens to purchase a defective product and empowering a supercongress to cut provider payments. It corrects some of the worst abuses of insurance; fair enough. But it does nothing to address end-of-life benefits accounting for a huge chunk of Medicare waste, nor does it begin to address drug costs.

Fair enough, but end-of-life carereform was a political impossibility at that time. That type of reform is not inconsistent with the current legislation. It would just have to be added later.

What bothers me the most about this thing is not the hit physicians are going to take if it is fully implemented. It's the pointlessness of the sacrifice. Reform is only going to work if everybody understands the healthcare gravy train is over--docs, hospitals, insurers, Pharma, seniors, everyone. You don't get reform by buying off insurers and drug companies and telling seniors that their benefits are untouchable.

What exactly do you mean by gravy train?

 

[Pathwrath]

Fair enough, but end-of-life carereform was a political impossibility at that time. That type of reform is not inconsistent with the current legislation. It would just have to be added later.



What exactly do you mean by gravy train?

I would argue that it is inconsistent with the current legislation. The legislation maintains the benefits and recoups costs by empowered provider cuts even if Congress fails to man up and do its job. What future hypothetical scenario do you envision whereby Congress suddenly reverses itself, takes responsibility, and tells seniors that, yeah, their benefits are on the table? Why should it, given the current bill?

The gravy train is currently 16% of our GDP.

 

[Enkidu]

I would argue that it is inconsistent with the current legislation. The legislation maintains the benefits and recoups costs by empowered provider cuts even if Congress fails to man up and do its job. What future hypothetical scenario do you envision whereby Congress suddenly reverses itself, takes responsibility, and tells seniors that, yeah, their benefits are on the table? Why should it, given the current bill?

The gravy train is currently 16% of our GDP.

My thinking is that savings are made by encouraging preventive care and preventing cost shifting by making people buy insurance. As far as i know there are no provider cuts.

Changes to end-of-life care will always be politically difficult, but has nothing to do with the current law, it has to do with our aging demographic and their political power.

So by saying that the gravy train has to end, you're saying we should decrease the percentage of GEO spent on healthcare? That was the goal of the law, and I think it should work. I'd like to see malpractice reform and change to end-of-life care, as well as changing reimbursement structures, but those are all consistent with the current law.

 

[Pathwrath]

My thinking is that savings are made by encouraging preventive care and preventing cost shifting by making people buy insurance. As far as i know there are no provider cuts.

Changes to end-of-life care will always be politically difficult, but has nothing to do with the current law, it has to do with our aging demographic and their political power.

So by saying that the gravy train has to end, you're saying we should decrease the percentage of GEO spent on healthcare? That was the goal of the law, and I think it should work. I'd like to see malpractice reform and change to end-of-life care, as well as changing reimbursement structures, but those are all consistent with the current law.

To me, the real cost shifting here is the government subsidization of private insurance and drug companies. If you do not address end of life care, you cannot have health care reform, period. It's where too much money goes. Malpractice reform is a lesser priority, but its utter absence in this bill underscores the real problem--the sacrifices are imposed unequally and in inverse proportion to political power, without regard to where the money is really coming from, where it is going, and whether it brings value.

As to whether this thing produces meaningful reduction in global health care spending, we shall see. I know provider cuts alone won't do it:

"The Senate bill would establish an Independent Medicare Advisory Board, which would be required to recommend changes to the Medicare program to limit its spending growth. Its recommendations would go into effect automatically unless Congress votes to block them. Such changes would be required if the Medicare trustees projected that the program's spending per beneficiary would grow more rapidly than the medical inflation rate or the growth in per capita medical spending. The board couldn't change eligibility or benefits, so its recommendations would likely focus on Medicare Advantage plans and on payments to medical providers."

 

[lipomas]

There are provider cuts, right? Because the entire thing assumes the SGR fix will go into place. This is merely political of course, and used to make the cost of the thing seem less by assuming drastic future cuts. If those cuts don't get instituted the savings are a lot less. If the SGR is fixed the savings are also a lot less. So it's hard to tell if there are truly provider cuts. A lot of stuff I read about it talk about how the "bill saves money!" but it doesn't, because most of the savings is an accounting fix made possible by a horrible accounting blunder of a law.

I personally think the republicans blew it in this case. They may have scored political points by painting the whole thing as a socialist Obama plot to destroy the world. But anyone with a brain (which unfortunately excludes most voters) realizes that a lot of the law comes from republican ideas. Note that this does NOT make it a good bill! Pathwrath's points are great and I agree almost 100% with them. It is not a serious bill.

In my view this whole bill was a wasted opportunity to get serious about things. Since the drug companies played along, they got a lot of special favors thrown in. If everybody involved had played along, then we could have gotten a real bill. But instead, too many people decided to take the easy way out and either say no and demonize everything or insist on small things that had a big impact. So what we ended up with was a monstrosity that did a few good things but ultimately ended up just increasing paperwork and extraneous stuff. And also turned into a political football which leaves no real winners except political hotheads who don't really have anything to gain or lose personally from the actual healthcare part of the bill either way.

I got really, really pissed off about the whole thing when instead of actually debating a real bill, the debate turned into "death panels" and "socialism" which were completely unrelated to the bill. So now, to many voters "Obamacare" means "death panels" and "socialism." So people talk about things they don't really understand, when there are so many REAL things they could be objecting to. I think I finally lost it when I started reading articles about whether you would go to jail if you refused to buy insurnace under Obamacare. Then I knew the media was also completely lost.

 

[Pathwrath]

In my view this whole bill was a wasted opportunity to get serious about things.

Yes. Yes.

The Republicans pissed all over everything and deserve a good chunk of the blame, but, I'm sorry, this is a Democratic bill and the Democrats take ultimate responsibility for it. Obama was spooked by what happened to the Clintons when they rolled out their big plan, so he let Congress write it, making side deals with industries to pre-empt their resistance. Congress will not cross seniors or trial attorneys, and there you have it, health care reform that curbs the worst of private insurance and not much else, with any cost overruns magically corrected by automatic provider cuts.

 

[WEBB PINKERTON]

Kaiser Permanente, famous for dumping homeless patients off in the ghetto.

Too bad the legislation does NOTHING to get rid of kickbacks in pathology. Wanna save money, get rid of "client billing" and all that crap for lab medicine. Did they consult anyone in the lab industry at all?

 

[Thrombus]

Does Obamacare prohibit doctors from starting their own hospital, allowing hospitals like Keiser much more leverage in physician re-imbursement?

YES! It does!!!!

These crooks are trying to polish the turd they helped create.

Not surprising, since hospital administration benefits ENORMORMOUSLY from this Obamination.

 

[Thrombus]

Then I knew the media was also completely lost.

The problem is the media is filled with a bunch of clueless, arithmetically-deficient, minions who are incapable of understanding any bit of economic theory or cause and effect. Similarly, the population as a whole is so "dumbed-down" that coherent arguements are rendered ineffective by a simple label or image (death panel by the right or a republican pushing granny off a cliff by the left).

The root of the problem is an uninformed, non-thinking electorate that cannot reason. Democracy really cannot function in this setting. We can thank the last few decades of government sponsored-babysitting....errr "education" and bad/lack of parenting that has gone rampant. We are pretty much screwed IMO.

 

[Euchromatin]

Yes. Yes.

The Republicans pissed all over everything and deserve a good chunk of the blame, but, I'm sorry, this is a Democratic bill and the Democrats take ultimate responsibility for it. Obama was spooked by what happened to the Clintons when they rolled out their big plan, so he let Congress write it, making side deals with industries to pre-empt their resistance. Congress will not cross seniors or trial attorneys, and there you have it, health care reform that curbs the worst of private insurance and not much else, with any cost overruns magically corrected by automatic provider cuts.

Completely agree. The Democrats totally wussed out and the ACA is just filling insurance company pockets.

I also agree with previous posters that some reasonable reforms to end-of-life care would have been extremely valuable.

Health care here in the states is already rationed. Millions of people, mostly those in the lower middle class who make too much money to qualify for Medicaid and not enough to afford decent insurance if their employers weren't already providing it, don't have health care. Everyone who is paying exorbitant fees for their health insurance now is already paying extra for those without insurance to be treated (very inefficiently and at increased cost) in the ER. So given that the current system rations healthcare and those who can afford it are having to pay (unofficially, via increased premiums as well as tax dollars going to Medicare/Medicaid) for those who can't, I was hoping the Democrats would have pushed more for a single payer system with universal coverage. sigh...

 

[WEBB PINKERTON]

Completely agree. The Democrats totally wussed out and the ACA is just filling insurance company pockets.

I also agree with previous posters that some reasonable reforms to end-of-life care would have been extremely valuable.

Health care here in the states is already rationed. Millions of people, mostly those in the lower middle class who make too much money to qualify for Medicaid and not enough to afford decent insurance if their employers weren't already providing it, don't have health care. Everyone who is paying exorbitant fees for their health insurance now is already paying extra for those without insurance to be treated (very inefficiently and at increased cost) in the ER. So given that the current system rations healthcare and those who can afford it are having to pay (unofficially, via increased premiums as well as tax dollars going to Medicare/Medicaid) for those who can't, I was hoping the Democrats would have pushed more for a single payer system with universal coverage. sigh...

You lost your credibility when you said you want insurance to be forced to pay for birth control. Now you are bitching because middle class can't afford insurance. I guess you think "breeders" will quit having kids and that will save us money but it wont as long as more kids=more aid. Instead women, who can already afford birth control, will let US pay for it with higher premiums.

Insurance shouldnt cover everything. It should only cover catastrophic events. Make people pay out of pocket, create total transparency and a real free market. Truth is, most physicians dont want that since it will mean patients might actually question why all the unnecessary tests are being ordered. Medicine is so full of waste it is shameful.

 

[schrute]

"cost transparency" and out-of-pocket heath-care purchases sounds good, but is much harder to implement than by fiat.

How many diabetics would manage their disease if visits cost them $100 a pop?

How many women would pay for an annual pap smear if it was out of pocket?
Furthermore, how many OBs, FPs, etc, would want a BULK of their patient population second-guessing the necessity of their regular appointments if the financial burden is now on them (vs a $20 copay)?

Transparency is necessary and I agree that the notion of "health insurance" is a farce, but it's not as simple as it sounds.

The real problem is that people don't want to pay for healthcare, plain and simple. The value placed on an iPhone, a nice car, and a flat screen TV is higher than that placed on health care, and we've been habituated to feel that way through 1.) decades and decades of a nanny state, and 2.) the exponential increase in technological/medical advancements & their respective costs (which statistically are consumed at the highest rate in the final days/weeks/months of life). Furthermore, people feel entitled to receive any and all options available at their disposal, cost be damned. At some point, society changed the value it placed on medicine. Previously=you couldn't afford it, you accept your misfortune and probably die. Now=there's no excuse for disease states to thrive so long as we have a treatment.

I'm NOT suggesting it "fair" to with-hold medical care to people, I'm just recognizing our society has made a value change...we've trumped every financial issue we've encountered with the "fairness" card and inevitably put ourselves in this situation.

In an economy as complex and intricate as that of the US, the federal government isn't going to spontaneously supplant the drug/technology/treatment development and innovation, nor can they afford to maintain the pace of medical advancements we experience now.

 

[Enkidu]

Insurance shouldnt cover everything. It should only cover catastrophic events. Make people pay out of pocket, create total transparency and a real free market. Truth is, most physicians dont want that since it will mean patients might actually question why all the unnecessary tests are being ordered. Medicine is so full of waste it is shameful.

Medicine can never be a free market. In order for there to be a free market the patient would have to evaluate the quality of the physician, but they will never be able to do this. Physicians can really only be evaluated by their peers. Patients can use a proxy like the success rate of treatments or something, but that isn't normalized by the difficulty of the case. The best thing for a patient to do is go where they're referred, but then the economic imperative would be on the physician to refer to the "value" consultant. Seems a little odd, to me.

How would patients question unnecessary testing? They would have to know the indications for each test.

 

[Ruination]

Insurance shouldnt cover everything. It should only cover catastrophic events. Make people pay out of pocket, create total transparency and a real free market.

Define catastrophic event. In theory, any medical malady could become a "catastrophic event". At what point would you have insurance "kick in"? I have asthma. Do you think its cheaper to help subsidize my $300/mo medication or 20 ED visits with the possibility that I might have a catastrophic event at one of them and need to be intubated and stay in the ICU? Its probably cheaper to do the former.

The days of paying "out of pocket" went by the wayside when new, fancy, expensive drugs costing $10K/mo, esoteric lab test ordering, and a CT scan ordered every 3 hours started becoming the norm. No longer can Grandpa trade you a goat and $20 to see him "'cause his gout actin' up again". I don't know how many times my grandfather lamented to me that he used to see his doctor for $5. Five friggin' dollars. I couldn't explain to him that technology has made it so that we will never ever see those days again. Whether or not the costs would go down if we got rid of insurance companies and administrators (which make up a huge chunk of the healthcare expenditure) and had better tort reform I don't know, but I doubt it would necessarily change the cost of a CT scan or esoteric test x, y, or z at this point in time. F*ck I hate this job.