Sharpie1

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To those who have been out in practice and understand the system as it currently is, what do you predict for the future of psychiatry in healthcare?
 

masterofmonkeys

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To those who have been out in practice and understand the system as it currently is, what do you predict for the future of psychiatry in healthcare?
The death of therapy. PCP-length appointment slots. Loss of income.
 

OldPsychDoc

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The death of therapy. PCP-length appointment slots. Loss of income.
More of the patients who need our help having insurance that will reimburse at least some of the cost.

No more "lifetime caps" on mental health services which become essentially exhausted in a single admission.
 

Doc Samson

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CL finally being valued appropriately since bundling of payments will mean greater profit for shorter stays, and CL helps get people out the door. So, I might even predict an increase in income for CL docs.

I doubt the current healtcare reform bill will have any significant effect on psychotherapy - that's still going to be market driven (i.e., plans in Boston will cover it, plans in flyover land won't).
 

whopper

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Don't know.

I've been trying to follow the bill, but I don't have the time to read all of it (who can?), and in the last few weeks, my knowledge of the bill has mostly been through what I see in the news.

Several of the politicians have given several talking-points that I have to take with a grain of salt, but several of the naysayers have brought some interesting points.

I think we need a change, but I'm not sure if this bill will make one in the right direction.
 

HCE

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Don't know.

I've been trying to follow the bill, but I don't have the time to read all of it (who can?), and in the last few weeks, my knowledge of the bill has mostly been through what I see in the news.

Several of the politicians have given several talking-points that I have to take with a grain of salt, but several of the naysayers have brought some interesting points.

I think we need a change, but I'm not sure if this bill will make one in the right direction.
Whopper, you may be watching the wrong News source.
 

Sharpie1

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thank you for your responses, but it seems that nobody can agree on what will actually happen, or what this bill will actually do.

i hope this is only going to be good, but that looks dubious as of now...
 

billypilgrim37

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thank you for your responses, but it seems that nobody can agree on what will actually happen...
I think we can all agree that Glen Beck is going to have a total meltdown on air over the next few days, thumbsucking and all. The only question will be whether it's on TV or his radio show.
 

masterofmonkeys

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I think we can all agree that Glen Beck is going to have a total meltdown on air over the next few days, thumbsucking and all. The only question will be whether it's on TV or his radio show.
You know, I miss the old Glenn Beck. Silly, irreverent, and a lot of fun to listen to. Now he's so preachy and socially conservative he makes me quite sick.

The subsidized high-risk pool is sort of one of the very few things in this bill I can get behind. And only sort of, because at the end of the day a lot of high-risk behavior is chosen willfully. We should not be under obligation to support that. And that's keeping in mind that at 26 I'm already considered a high risk and wouldn't be insurable as an individual under anything but a catastrophic high-deductible plan.

But this was not reform and we did not have a debate. We never even approached the argument of whether or not comprehensive health insurance is sensible (it isn't). And I can't wait for all the special interests like big pharma, chiropractic, massage, acupuncture, etc to start their lobbying for mandated inclusion as part of health insurance.
 

Sneezing

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"The federal government is living on borrowed, economic time. This legislation will be repealed by the bankruptcy of the country." -Some other message board
 

whopper

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thank you for your responses, but it seems that nobody can agree on what will actually happen, or what this bill will actually do.
That's why I have my doubts. I'm neutral on this bill, though not nonchalant or not caring. I'm neutral with serious worries if it passes or not. If it passes, I'm worried it'll skyrocket the federal deficit even worse than it is now, costs may be far worse than projected, and it may make things worse for several people. If it doesn't pass, I'm worried that no one will try to reform healthcare again for another decade, and this bill may have actually been a good one.

We're well beyond this point, but I think some of the suggestions (e.g. by some such as Lieberman) that healthcare reform happen in a piecemeal pattern were the way to go. That way if one thing didn't work, it would've only been one thing. That thing could've been fixed before trying to get onto the next thing.

In any case, we're at where we're at. It passed the House, the Senate is next.

You know, I miss the old Glenn Beck. Silly, irreverent, and a lot of fun to listen to. Now he's so preachy and socially conservative he makes me quite sick.
Just IMHO, several of the conservative pundits have adopted a stronger fire and brimstone tone because their guys are out of office. It's the natural flow of things. When Clinton was President, Limbaugh defended filibustering and other stall tactics that only helped the opposition party. Then when the GOP took over, and shoe was on the other foot, he blasted Democrats for using the same tactic. When the GOP is back in power again (not saying they should be, it's just the natural flow), all of his anti-Presidential rhetoric will be replaced by comments such as "the Democrats do not respect the dignity of the office of President" and his usual BS.
 

OldPsychDoc

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Regnvejr

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More of the patients who need our help having insurance that will reimburse at least some of the cost.

No more "lifetime caps" on mental health services which become essentially exhausted in a single admission.
Pretty much what I expect as well. The problem with psychiatric patients is that they rattle down the socioeconomic ladder quite fast if not fall off it completely. The number of patients without any insurance in my clinic is significant (about 1/3rd). As such, their condition can't do anything but improve with coverage. So for my patient population, this is a good thing.
 

whopper

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The "Fair and Balanced" one?
Nah, I think Fox News is a load of bull.

Fair and Balanced--my arse. Hour after hour of conservative pundits giving political talking points for one side don't sound fair and balanced to me. That's the overwhelming majority of Fox News broadcasts. Their actual news is not much, and when it is on, it gives very opinionated presentations. E.g. a documentary where the commentator is outright giving his final opinion that global warming is not caused by human CO2 emissions.
 

masterofmonkeys

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We report, we decide...

More like our cocktail waitresses report, our angry white, fat, male conservative pundits decide.

BTW: As previously noted, the CBO budget cutting estimate assumes that a 21% doctor pay cut happens immediately. With the doctor fix, the bill goes back to deficit.

I hate it when people play games with omission/accounting. Garrh.
 

st2205

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I hear that psychiatry is a very open profession for gay/lesbian folks who are looking for a more tolerant, understanding group of medical collegues.
More like our cocktail waitresses report, our angry white, fat, male conservative pundits decide.
It's such a shame that at the end of the day tolerance always loses its fight with irony.
 

OldPsychDoc

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I received this today from my state's chapter of NAMI--it's basically the most detailed summary I've seen regarding what is in the bill that passed. FYI.

Included below is a list of the provisions that are of interest to NAMI members.
•Prohibits excluding coverage of preexisting condition or other discrimination based on health status. Group health plans and issuers in the individual and group markets would be prohibited from excluding coverage for pre-existing health conditions. For enrollees under age 19, these provisions would become effective beginning 6 months after date of enactment. For adults the provisions become effective 2014.
•Prohibits discrimination against individual participants and beneficiaries based on health status. Group health plans and issuers in the individual and group markets would be prohibited from basing eligibility (including continued eligibility) for coverage on health status-related factors. Such factors include health status, medical condition (including both physical and mental illness), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability, and any other health status-related factor determined appropriate by the Secretary.
•Authorizes and funds a demonstration program under Medicaid to provide payment to an institution for mental diseases that is not publicly owned or operated and that is subject to the requirements of section 1867 of the Social Security Act of non-public institution to deliver “stabilizing care” for persons over age 21 and under age 65 in an emergency health condition.
•A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not apply any waiting period (as defined in section 2704(b)(4)) that exceeds 90 days.
•Won’t allow lifetime or annual limits - With respect to plan years prior to January 1, 2014, group health plans and a health insurance issuers offering group or individual plans would be prohibited from establishing lifetime limits on the dollar value of benefits for any participant or beneficiary, or annual limits except with respect to the scope of benefits that are essential health benefits under section 1302(b) of this bill as determined by the Secretary.
•Would generally prohibit rescissions for a group health plan and a health insurance issuer offering group or individual health insurance coverage.
•Requires group health plans and health insurance issuers in the group and individual markets to provide coverage for preventive health services and would not impose any cost sharing requirements for them. These preventive services would include:
•evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force (USPSTF)
•immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)
•for infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)
•A group health plan and a health insurance issuer offering coverage in the group or individual markets that provides dependent coverage of children would extend that coverage to unmarried adult children until the individual is 26 years of age.
•Provides for immediate access to insurance for uninsured individuals with a preexisting condition. Not later than 90 days after enactment, the Secretary would establish a temporary high-risk pool program to provide health insurance coverage for eligible individuals during the period beginning on the date the program is established and ending on January 1, 2014.
•Requires Qualified Health Plans (QHPs) and plans offered in the individual and small group markets to provide the essential health benefits package, including the following categories of benefits:
•hospitalization;
•ambulatory patient services;
•emergency services;
•prescription drugs;
•rehabilitative and habilitative services and devices;
•mental health and substance use disorder services, including behavioral health treatment;
•preventive and wellness and chronic disease management;
•maternity and newborn care;
•pediatric services, including oral and vision care; and
•laboratory services.
• A health plan would be permitted to provide benefits in excess of the essential health benefits. Coverage for preventive services would be implemented before the full implementation date. Plans providing the essential health benefits package would be prohibited from applying a deductible to preventive health services.
•Requires mental health parity for insurance plans under the Health Benefit Exchanges – applying to both individual and group plans.
•Creates, funds and lays out the responsibilities of the National Prevention, Health Promotion and Public Health Council. Of note, it requires the creation of a campaign that disseminates information that: (2) promotes the use of preventive services recommended by the United States Preventive Services Task Force and the Community Preventive Services Task Force.
•Creates a grant program for school-based health centers. Grant funds would be used for facility construction, expansion, and equipment; and (b) would require the Secretary to award grants for the operating costs of them.
•Authorizes but does not require mental and behavioral health education and training grants (1) eligible institutions of higher education to support the recruitment and education of students in social work programs, interdisciplinary psychology training programs, and internships or field placement programs in child and adolescent mental health; and (2) state licensed mental health organizations to train paraprofessional child and adolescent mental health workers.
•Creates grants for co-locating primary and specialty care in community-based mental health settings.
•Creates 5-year competitive grants for Centers of Excellence for Depression to eligible entities to establish national centers of excellence for depression, which would be required to engage in activities related to the treatment of depressive disorders.
• Expands Medicaid coverage to childless adults under 133 percent of poverty.
 

whopper

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A problem I have with the bill is I haven't read it, nor do I have the means nor even the time to read it with my 70+ hr work schedule this year. Worse, I don't have access to articles that I trust that neatly give a review of it.

What I'm forced to use are the pundit's opinion which I don't trust.

I will say to anyone staunchly for or against the bill is how can you have your strong opinion if you you haven't even read the bill? In fact most of the people who passed the bill or voted against it likely haven't even read it.
 

FURY 161

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Stopping the 21% pay cut for good would have wiped out their deficit reduction. This bill sucks for physicians. Ultimately the only thing we have going for us is supply and demand.
Not for long, though. The next thing on the Obama agenda is illegal immigration - amnesty for 12 million illegal aliens, who will receive health care subsidized by the government (medicaid). Hopefully, they will quickly become citizens, so they can vote for the appropriate party. Of course, this can exacerbate the doctors shortage, but there is a quick fix for that. AMA can lobby to give the the legalized illegals medical licenses, so to mitigate the shortage. Since they will mostly not speak English, it will be discriminatory to subject them to MCATs,US medschool, USMLEs and US based residency training, which is a very long, expensive and unnecessary process. As we know, americans need affordable health care and they need it NOW!
 
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trophyhusband

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Not for long, though. The next thing on the Obama agenda is illegal immigration - amnesty for 12 million illegal aliens, which will receive health care subsidized by the government (medicaid). Hopefully, they will quickly become citizens, so they can vote for the appropriate party. Of course, this can exacerbate the doctors shortage, but there is a quick fix for that. AMA can lobby to give the the legalized illegals medical licenses, so to mitigate the shortage. Since they will mostly not speak English, it will be discriminatory to subject them to MCATs,US medschool, USMLEs and US based residency training, which is a very long, expensive and unnecessary process. As we know, americans need affordable health care and they need it NOW!
Wow, when is your interview on Glen Beck? I really want to tune in for that one.
 

whopper

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More like our cocktail waitresses report, our angry white, fat, male conservative pundits decide.
Hmm, well I got to admit, those ladies on Foxnews are foxes.
 

notdeadyet

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I will say to anyone staunchly for or against the bill is how can you have your strong opinion if you you haven't even read the bill? In fact most of the people who passed the bill or voted against it likely haven't even read it.
Most educated folks have a strong opinion of Roe v. Wade without ever having read it as well.
 

whopper

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Most educated folks have a strong opinion of Roe v. Wade without ever having read it as well.
True, though how much of that opinion is ill-informed?

Most people I know don't know that the Supreme Court's decision was not based so much on whether or not the fetus is a living human being with rights to life as it was the freedom of a person to choose what happens to her body.

I know for a fact that I have several opinions that differ from those that are more educated on a particular subject, but I at least hope I'd be willing to acknowledge my limitations on this knowledge.

A problem I'm finding with the bill is the strong fervor based on so little understanding. The use of the word "death camps", or Rush Limbaugh's praise of the Hawiian medical system, that he believed was not socialized, that treated his chest pain, but oops, turns out Hawaii has a socialized system!

The emotional fervor has taken a life of its own outside of the reason.
 

kugel

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How can we expect people to really understand anything when the bill in question was not constructed to enable understanding?

Pundits and others will fill the void in people's minds if the bill cannot fill that void.
Some places to find the information so that the void is not filled by rumors, myth, hoaxes:

http://www.chicagotribune.com/health/la-oe-kmiecweb19-2010mar19,0,6516893,full.story

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/21/AR2010032103869.html

http://www.cnn.com/2010/HEALTH/03/24/health.care.viewer.faqs/index.html?iref=allsearch

http://www.tnr.com/article/politics/sink-or-swim






(from The Christian Science Monitor 3/25/10)
Christian Personal Finance

What Obama’s new health care bill means for us
Reforms will be rolled out in five phases. We layout what happens when here.


President Barack Obama's signature on the health insurance reform bill at the White House, March 23.
(Chuck Kennedy/The White House/PSG)
By Christian Personal Finance

posted March 25, 2010 at 6:08 pm EDT

Unless you have been living under a rock lately, you are well aware that our country is about to see some major changes to health care. Health care reform was a top priority of President Obama and it has been very apparent as he has been very determined to sign his reform bill into law.

To be frank, I haven’t been following the whole thing as closely as I would like. I feel like I still need to do some homework to get caught up on the details, but below I have pasted in a great article that explains what the Obama’s health care bill will mean for us – this year, next year, and in the years to come.

If you are unsure of the details, I recommend reading it. There really are a lot of changes that will likely be affecting every American. It isn’t one of those obscure bills that only affects a small handful of people.

So, as the details continue to unfold – which I am sure this whole health care reform thing is just beginning, I will continue to post helpful info about it. Enjoy!

On 3/23/2010 President Obama signed the health care reform bill into law. While there are still differences that need to be reconciled between the various versions of the healthcare bill here is the timeline for the health care reform changes and how Obama’s health plan (”ObamaCare”) and health care reform affects you and your health insurance:

New Health Care Bill: Changes Happening in 2010

Children age 26 and younger will be able to remain covered under their parents health insurance plans (this is increased from past age limits which were anywhere from age 22-25).
Medicare recipients will receive a $250 rebate to help in closing the “doughnut hole” (with the goal being to close the doughnut hole completely by 2020).
Health insurance companies will be banned from excluding coverage for pre-existing conditions for children.
Adults with pre-existing conditions will be eligible for coverage into high risk health insurance pools until future health care exchanges are up and running.
Health insurance companies will be prohibited from levying annual limits and lifetime limits on coverage.
All new health insurance plans must provide coverage for preventative services with no out of pocket cost (all health plans will be forced to comply by 2018).
Those companies that offer health benefits for early retirees ages 55 to 64 will receive assistance from a temporary reinsurance program.
All new health insurance plans will have to comply with new regulations that lay out an appeals process for when health insurance claims are denied.
Small businesses that employ less than 50 people are eligible for a tax credit equal to 35% of their health insurance premiums (this increases to 50% by 2014).
New Health Care Bill: Changes Happening in 2011

Medicare will offer wellness visits for free one a year and personalized prevention plans. All new Medicare plans will offer preventative services with no out of pocket cost.
Seniors enrolled in Medicare Advantage or the Prescription Drug Plan will receive a 50% discount on brand name drugs immediately with additional prescription drug discounts to follow.
The current penalty tax of 10% on all distributions from a Health Savings Account before the age of 65 on nonqualified medical expenses will increase to 20%.
A small business alternative to a cafeteria plan will be presented so that small businesses can offer tax free benefits without having to deal with the administrative costs of a cafeteria plan.
Everyone earning more than $200,000 as an individual or $250,000 for those who file married filing jointly will have their Medicare payroll tax increased from the current 1.45% to 2.35%.
Health Care Bill: Changes Happening in 2013

A $2,500 annual cap will be placed on all contributions to flexible spending accounts (amount indexed for inflation each subsequent year).
The current tax deduction that employers receive for subsidizing the prescription drug costs of their employees who are eligible for Medicare Part D will be done away with.
A 2.9% excise tax on the sale of medical devices will be put into place. Certain common items like glasses, hearing aids, etc. are exempted from this tax.
The hospital insurance tax will increase .09% for those who earn more than $200,000 ($250,000 for those married filing jointly).
Additional requirements on health insurance companies to implement uniform standards for exchanging health care information, electronic communication, and other measures to reduce insurance company administrative costs.
The minimum threshold for being able to claim an itemized deduction for health care expenses increased from 7.5% to 10% of AGI although those over the age of 65 can stay at the 7.5% threshold through 2016.
Health Care Reform: Changes Happening in 2014

All US citizens will be forced to have health insurance coverage considered acceptable by the US Government or else pay a fine of $95 in 2014, $325 in 2015, $695 in 2016 (capped at 2.5% of AGI). All of the fines are per person per year except for families have a cap on the total fine of $2,250 and the fine amount for children is half of the adult fine.
Eligibility standards are implemented for newly formed health care exchanges.
Businesses with 50 or more employees will face a fine of either $2,000 or $3,000 per employee for not offering health insurance coverage.
Group health insurance plans have a maximum waiting period of 90 days.
Health insurance companies are prohibited from using an individual’s health status to issue a policy or renew a policy. All pre-existing conditions must be covered and higher health insurance rates cannot be levied because of health, gender, etc.
The eligibility standards for Medicaid will be changed to 133% of poverty for those who are not considered elderly.
New annual fees will be levied on all health insurance providers based on an insurance companies market share and whose total premiums exceed $25 million.
Health Care Reform Bill: Changes Happening in 2018

The “Cadillac” health insurance plan tax will kick in. An excise tax will be levied on all employer provided health insurance plans costing more than $27,500 for families and $10,200 for individuals (with increased limits for those considered to be in “high risk” professions).
Thoughts?

What do you think about Obama’s health care reform? Is it good for you? Good for the country?