Obamacare upheld, now what...

[FollowTheMoney]

What now?

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[deleted171991]

Same old, same old.

 

[BLADEMDA]

What now?

The progression towards a single payer system continues. In 8-10 years look for the Public Option to be added to the Exchanges because the public will be unable to afford most of the plans. After 3-5 years of the Public option Insurance companies will begin closing their doors leaving only 2-3 major players competing for an ever smaller slice of the pie.

Obama was correct that the ACA/Obamacare will eventually lead to a single payer system even though it may take 20 years to get there.

 

[BLADEMDA]

 

[deleted50478]

The progression towards a single payer system continues. In 8-10 years look for the Public Option to be added to the Exchanges because the public will be unable to afford most of the plans. After 3-5 years of the Public option Insurance companies will begin closing their doors leaving only 2-3 major players competing for an ever smaller slice of the pie.

Obama was correct that the ACA/Obamacare will eventually lead to a single payer system even though it may take 20 years to get there.

Hopefully along with that we all become federal employees!

 

[FollowTheMoney]

Hopefully along with that we all become federal employees!

Making 30k a year?

 

[FollowTheMoney]

What will it ultimately mean for anesthesiologists and doctors in general?

 

[postbacpremed87]

The progression towards a single payer system continues. In 8-10 years look for the Public Option to be added to the Exchanges because the public will be unable to afford most of the plans. After 3-5 years of the Public option Insurance companies will begin closing their doors leaving only 2-3 major players competing for an ever smaller slice of the pie.

Obama was correct that the ACA/Obamacare will eventually lead to a single payer system even though it may take 20 years to get there.

You've been saying it....you've been saying it for 6 **** years. Hasn't BLADEMDA been saying it?

 

[deleted50478]

Making 30k a year?

Making the same as with an AMC but better in every other way.

 

[BLADEMDA]

You've been saying it....you've been saying it for 6 **** years. Hasn't BLADEMDA been saying it?

It's going to take 15-20 years. I've learned just how slow things move at the Federal level. The ACA is expensive and the general public must complain a lot about the cost before Congress will act. The most likely action is to add the Public option to the exchanges.

This won't happen in the next election cycle or even the one after that. We will be keeping the ACA in its current format for at least 8-10 more years.

Ultimately, the ACA and health care will just be too expensive for the majority of Americans.

 

[postbacpremed87]

It's going to take 15-20 years. I've learned just how slow things move at the Federal level. The ACA is expensive and the general public must complain a lot about the cost before Congress will act. The most likely action is to add the Public option to the exchanges.

This won't happen in the next election cycle or even the one after that. We will be keeping the ACA in its current format for at least 8-10 more years.

Ultimately, the ACA and health care will just be too expensive for the majority of Americans.

I thought the Independence Day humor would be good medicine for this sad day. You've been warning about this for a long time. You will be proven correct.

 

[BLADEMDA]

What will it ultimately mean for anesthesiologists and doctors in general?

Medicare Plus or Medicare for all. In the future only a small percentage of citizens will be able to afford private insurance and the vast majority of those will go to Elite hospitals or hospital systems like Mayo.

Don't worry because by the time you become a Federal Employee it won't seem so bad as the AMCs will have decimated salaries for Anesthesiologists.

 

[postbacpremed87]

The progression towards a single payer system continues. In 8-10 years look for the Public Option to be added to the Exchanges because the public will be unable to afford most of the plans. After 3-5 years of the Public option Insurance companies will begin closing their doors leaving only 2-3 major players competing for an ever smaller slice of the pie.

Obama was correct that the ACA/Obamacare will eventually lead to a single payer system even though it may take 20 years to get there.

What are the best specialties in a single payer system?

 

[BLADEMDA]

The ACA is a terrible law but we are stuck with it "as is" until the public forces the Congress to change it. I truly believe the next change to the ACA is to add the public option but this won't happen anytime soon.

Does anyone really think that most GOP presidential candidates really want to repeal the ACA? Except for Cruz and Paul the rest just see the ACA as another necessary evil of our Federal govt to appease the masses.

 

[BLADEMDA]

What are the best specialties in a single payer system?

Look to the VA or Military for your answer. Posters like PGG would be better able to answer your question.

 

[pgg]

Look to the VA or Military for your answer. Posters like PGG would be better able to answer your question.

I have no idea what a single-payer system would be like in the US, really.

Well, I take that back, partly - I am certain that any future single-payer system that directly employed all physicians will have a pay structure nothing like the one the military uses. Military physician pay is this bizarre weird mess of special pays shoehorned on top of a pay system that was designed around how infantry should be paid. They pay us as ordinary officers of a given rank, and then add on juuuuuust enough doctor-pay to get juuuuuust enough of us to stay in order to staff the places that need staffing.

The fact that in the military, the difference in pay between the highest paid specialties and the lowest paid ones is relatively small (<$100K or so?), is at least partially a consequence of that weird system and the recruiting system (medical school "scholarships") that get doctors into it. How much that specialty pay differs in the military is determined by calculations made to retain the right number of each specialty to meet manning goals. This calculus wouldn't apply at all to a future single-payer system, so I think predicting specialty differences in that system based on today's military pay is a fool's errand.

Remember, we're a piece of a warfighting machine that happens to have a few hospitals in the United States. I think our pay is a reasonable floor for a 100% nationalized system.

As for the VA system, I don't know enough about it to comment intelligently.

 

[BLADEMDA]

My best guess (and it's a guess) is that a single payer system would be similar to the the current VA model in terms of salary.

 

[deleted50478]

My best guess (and it's a guess) is that a single payer system would be similar to the the current VA model in terms of salary.

Sounds good to me. Similar income, better hours, lower cost for patients by eliminating middlemen. I'll take it. I'd head to the VA now if they were hiring in one of the 5-6 cities I'd be happy to live in. -And if the nursing handbook b.s. wasn't hanging over our heads.

 

[Pooh & Annie]

Now we just wait and see what happens. I'm very happy with the ruling, and I have a little more faith n what has become an embarrassingly partisan Supreme Court.

My guess is that in ten years, as the novelty of health care for all becomes fully ingrained, our absolutely atrocious health statistics will improve significantly in comparison to the other developed countries, who continue to DESTROY us in most parameters of national health. I know people disagree, but I'm pretty sure I'm on the right side of this. If that is the case, I think Obama's legacy will be quite a bit more positive than a lot of you will want to admit.

Then again, maybe I'm wrong. All we can do is wait and see.

 

[pgg]

My guess is that in ten years, as the novelty of health care for all becomes fully ingrained, our absolutely atrocious health statistics will improve significantly in comparison to the other developed countries, who continue to DESTROY us in most parameters of national health.

Don't you think it's far more likely that the real reason we lag many countries in 'parameters of national health' is because we're FATTER than they are, and perhaps not because their health care is better than ours?

WHO rankings are a funny thing. I wouldn't get too wrapped up on rankings and imagine who's destroying who.

Cuba (#181 in infant mortality at 4.70 per 1000) isn't a better place to have your premature baby delivered than the United States (#168, 6.17/1000), whether you're insured or uninsured, rich or bankrupt. Cuba just games the stats by writing off all the preemies as stillbirths, not infant deaths.

Ethiopia isn't at their enviable #217 (out of 223) in diabetes prevalence because they have great healthcare. I think we all know why nobody there needs metformin.

I could go on. The numbers are a game. Bankruptcy from catastrophic illness striking an uninsured person is the main sin I lay at the feet of our system. And it's a huge sin, and the only reason nationalized healthcare in the US is worth talking about. I could get behind such a thing here, if it wasn't funded twice off my back (#1 by cuts to greedy doctors, #2 by higher taxes on the greedy doctors' bracket). The "we need to fix inferior US care, look how much worse we are than the rest of the world" angle is ridiculous.

 

[doctalaughs]

(#1 by cuts to greedy doctors, #2 by higher taxes on the greedy doctors' bracket). The "we need to fix inferior US care, look how much worse we are than the rest of the world" angle is ridiculous.

And #3 medical school costs

 

[cchoukal]

I don't know enough about the ACA to say whether it's good or bad, but since the topic of VA healthcare has come up a few times, I thought I'd weigh in. The first thing I'd say is that not all VA's are the same and it's probably not fair to speak on behalf of them all, but working at one of the larger, more academic ones, I can say that from the standpoint of the physicians, it could be a whole lot worse. Living in San Francisco, they could never pay me enough to feel wealthy, but it's enough to get by, and although I would always want more, it's acceptable. For that I work probably 50 hours per week with a moderate amount of low intensity call. There's a small pension, a 401K with a great match, and good vacation/benefits (5-6 weeks/year plus meetings, heavily subsidized health insurance).

One of the things I really like about the VA is the that the emphasis can be on safety, quality, and, yes, cost, as opposed to marketability, PR, profit, etc. If I have to stay late to do a case, it's because the patient needs it, not because a surgeon has a boat payment to make, or some a$$hole in a suit wants a few more duckets to swim around in. That's not to say that the workload isn't increasing (it is) or that leadership wouldn't like more work out of us without paying us more (they would), but honestly, I think I would grow really bitter being pushed around for someone else's profit, and I don't feel that way at the VA. The VA is not exactly nimble, but they're trying to instill some private/industrial improvement frameworks, and I think it helps. They're also great at the kinds of things that are hard to make money on in the private world (primary care and mental health). You're always going to hear about the (too large) number of people who fail or are failed by the system, but there are a lot more wins than losses. The VA has been measuring its performance long before it was cool, and when it comes to quality for a population, they're at or near the top.

Now, to be sure, the administrative hurdles to things like equipment purchases, hiring, etc are unbelievable. Literally, my success rate of having a piece of paperwork succeed at whatever it was meant to do without tons of additional leg work is ZERO percent.

But all that being said, it's not a bad place to work.

 

[deleted682700]

There is going to be a huge black market, aka practice of concierge medicine. But this will be demonized by the government as illegal. The reason being the poor would want everything that the rich can afford but the govt doesn't have the courage to tell the truth. That means blade mda will be right on, single payer system. Welcome to NHS.
Read American Will never be As NICE as the Brits NICE.
For those who would still want to practice concierge medicine they will have to set up shop in Cuba or in floating yachts just beyond the international borders of the USA.
You can just book your medical cruise to those exotic locations and get your state of the art care if only u can afford it.

 

[Pooh & Annie]

Don't you think it's far more likely that the real reason we lag many countries in 'parameters of national health' is because we're FATTER than they are, and perhaps not because their health care is better than ours?

WHO rankings are a funny thing. I wouldn't get too wrapped up on rankings and imagine who's destroying who.

Cuba (#181 in infant mortality at 4.70 per 1000) isn't a better place to have your premature baby delivered than the United States (#168, 6.17/1000), whether you're insured or uninsured, rich or bankrupt. Cuba just games the stats by writing off all the preemies as stillbirths, not infant deaths.

Ethiopia isn't at their enviable #217 (out of 223) in diabetes prevalence because they have great healthcare. I think we all know why nobody there needs metformin.

I could go on. The numbers are a game. Bankruptcy from catastrophic illness striking an uninsured person is the main sin I lay at the feet of our system. And it's a huge sin, and the only reason nationalized healthcare in the US is worth talking about. I could get behind such a thing here, if it wasn't funded twice off my back (#1 by cuts to greedy doctors, #2 by higher taxes on the greedy doctors' bracket). The "we need to fix inferior US care, look how much worse we are than the rest of the world" angle is ridiculous.

I don't know that Cuba or Ethiopia are the "developed" countries that we're behind in most categories. I think the reports from the first world countries, who make our statistics laughable, are legit. If you're arguing that our system is so much better than all the parameters suggest, I think literally EVERY public health official in the country would disagree.

 

[Pooh & Annie]

Also, it's clear that obesity is linked to socioeconomic status. Many of these folks don't have the money or jobs that allow them to have insurance. I think getting more of these people insured, while not eliminating the obesity issue, will help get that particular "epidemic" going in the right direction.

 

[NOsaintsfan]

Bankruptcy from catastrophic illness striking an uninsured person is the main sin I lay at the feet of our system. And it's a huge sin, and the only reason nationalized healthcare in the US is worth talking about.

I absolutely agree with this. Instead of the ACA we currently have I wish some sort of program would have been created to address this exact issue.

I know the pre-ACA system wasn't sustainable and needed to be reformed but I'm not convinced the ACA is any better and fear that it is purposefully much worse so as to "force" the situation BLADEMDA alluded to in an earlier post.

The progression towards a single payer system continues. In 8-10 years look for the Public Option to be added to the Exchanges because the public will be unable to afford most of the plans. After 3-5 years of the Public option Insurance companies will begin closing their doors leaving only 2-3 major players competing for an ever smaller slice of the pie.

Obama was correct that the ACA/Obamacare will eventually lead to a single payer system even though it may take 20 years to get there.

To me this is so painfully obvious that I honestly don't understand how people can argue or believe otherwise. Obama pre-election has said exactly what he wants to see happen with health care in our country as evidenced by the video in an above post. That is exactly where we are headed.

 

[msmith83]

The ACA is a terrible law but we are stuck with it "as is" until the public forces the Congress to change it. I truly believe the next change to the ACA is to add the public option but this won't happen anytime soon.

Does anyone really think that most GOP presidential candidates really want to repeal the ACA? Except for Cruz and Paul the rest just see the ACA as another necessary evil of our Federal govt to appease the masses.

Carson? My favorite of them all, being in healthcare himself I believe he could bring some good changes in

 

[Twiggidy]

I don't know enough about the ACA to say whether it's good or bad, but since the topic of VA healthcare has come up a few times, I thought I'd weigh in. The first thing I'd say is that not all VA's are the same and it's probably not fair to speak on behalf of them all, but working at one of the larger, more academic ones, I can say that from the standpoint of the physicians, it could be a whole lot worse. Living in San Francisco, they could never pay me enough to feel wealthy, but it's enough to get by, and although I would always want more, it's acceptable. For that I work probably 50 hours per week with a moderate amount of low intensity call. There's a small pension, a 401K with a great match, and good vacation/benefits (5-6 weeks/year plus meetings, heavily subsidized health insurance).

One of the things I really like about the VA is the that the emphasis can be on safety, quality, and, yes, cost, as opposed to marketability, PR, profit, etc. If I have to stay late to do a case, it's because the patient needs it, not because a surgeon has a boat payment to make, or some a$$hole in a suit wants a few more duckets to swim around in. That's not to say that the workload isn't increasing (it is) or that leadership wouldn't like more work out of us without paying us more (they would), but honestly, I think I would grow really bitter being pushed around for someone else's profit, and I don't feel that way at the VA. The VA is not exactly nimble, but they're trying to instill some private/industrial improvement frameworks, and I think it helps. They're also great at the kinds of things that are hard to make money on in the private world (primary care and mental health). You're always going to hear about the (too large) number of people who fail or are failed by the system, but there are a lot more wins than losses. The VA has been measuring its performance long before it was cool, and when it comes to quality for a population, they're at or near the top.

Now, to be sure, the administrative hurdles to things like equipment purchases, hiring, etc are unbelievable. Literally, my success rate of having a piece of paperwork succeed at whatever it was meant to do without tons of additional leg work is ZERO percent.

But all that being said, it's not a bad place to work.

Hook a brother up....

Also, it's clear that obesity is linked to socioeconomic status. Many of these folks don't have the money or jobs that allow them to have insurance. I think getting more of these people insured, while not eliminating the obesity issue, will help get that particular "epidemic" going in the right direction.

 

[deleted50478]

Carson? My favorite of them all, being in healthcare himself I believe he could bring some good changes in

He doesn't believe in the separation of church and state. He's disqualified.

 

[Baller MD]

I don't know enough about the ACA to say whether it's good or bad, but since the topic of VA healthcare has come up a few times, I thought I'd weigh in. The first thing I'd say is that not all VA's are the same and it's probably not fair to speak on behalf of them all, but working at one of the larger, more academic ones, I can say that from the standpoint of the physicians, it could be a whole lot worse. Living in San Francisco, they could never pay me enough to feel wealthy, but it's enough to get by, and although I would always want more, it's acceptable. For that I work probably 50 hours per week with a moderate amount of low intensity call. There's a small pension, a 401K with a great match, and good vacation/benefits (5-6 weeks/year plus meetings, heavily subsidized health insurance).

One of the things I really like about the VA is the that the emphasis can be on safety, quality, and, yes, cost, as opposed to marketability, PR, profit, etc. If I have to stay late to do a case, it's because the patient needs it, not because a surgeon has a boat payment to make, or some a$$hole in a suit wants a few more duckets to swim around in. That's not to say that the workload isn't increasing (it is) or that leadership wouldn't like more work out of us without paying us more (they would), but honestly, I think I would grow really bitter being pushed around for someone else's profit, and I don't feel that way at the VA. The VA is not exactly nimble, but they're trying to instill some private/industrial improvement frameworks, and I think it helps. They're also great at the kinds of things that are hard to make money on in the private world (primary care and mental health). You're always going to hear about the (too large) number of people who fail or are failed by the system, but there are a lot more wins than losses. The VA has been measuring its performance long before it was cool, and when it comes to quality for a population, they're at or near the top.

Now, to be sure, the administrative hurdles to things like equipment purchases, hiring, etc are unbelievable. Literally, my success rate of having a piece of paperwork succeed at whatever it was meant to do without tons of additional leg work is ZERO percent.

But all that being said, it's not a bad place to work.

Great info. Thnx.

 

[chessknt]

I don't know enough about the ACA to say whether it's good or bad, but since the topic of VA healthcare has come up a few times, I thought I'd weigh in. The first thing I'd say is that not all VA's are the same and it's probably not fair to speak on behalf of them all, but working at one of the larger, more academic ones, I can say that from the standpoint of the physicians, it could be a whole lot worse. Living in San Francisco, they could never pay me enough to feel wealthy, but it's enough to get by, and although I would always want more, it's acceptable. For that I work probably 50 hours per week with a moderate amount of low intensity call. There's a small pension, a 401K with a great match, and good vacation/benefits (5-6 weeks/year plus meetings, heavily subsidized health insurance).

One of the things I really like about the VA is the that the emphasis can be on safety, quality, and, yes, cost, as opposed to marketability, PR, profit, etc. If I have to stay late to do a case, it's because the patient needs it, not because a surgeon has a boat payment to make, or some a$$hole in a suit wants a few more duckets to swim around in. That's not to say that the workload isn't increasing (it is) or that leadership wouldn't like more work out of us without paying us more (they would), but honestly, I think I would grow really bitter being pushed around for someone else's profit, and I don't feel that way at the VA. The VA is not exactly nimble, but they're trying to instill some private/industrial improvement frameworks, and I think it helps. They're also great at the kinds of things that are hard to make money on in the private world (primary care and mental health). You're always going to hear about the (too large) number of people who fail or are failed by the system, but there are a lot more wins than losses. The VA has been measuring its performance long before it was cool, and when it comes to quality for a population, they're at or near the top.

Now, to be sure, the administrative hurdles to things like equipment purchases, hiring, etc are unbelievable. Literally, my success rate of having a piece of paperwork succeed at whatever it was meant to do without tons of additional leg work is ZERO percent.

But all that being said, it's not a bad place to work.

Some things I have noticed about the VA:
1-Overbearing administration with endless policies actively transforms good workers into crap ones. Nurses that are used to doing things on their own, taking verbal orders, etc are forced to do nothing/transfer to ICU/call physician for inane crap because of this.
2-Admin salaries are completely bogus--80k+ a year for a high school graduate with no performance expectations. You might get angry about working for an exec in a suit but I get angry working for a government employee parasite. At least the exec in a suit answers to someone.
3-The response to political turmoil is more drastic than a private hospital. Our VA was sued by the family of a gomer who got pneumonia and died from improper treatment. As a result EVERY SUSPECTED pneumonia has a reflexive ID consult. The workload on the ID physicians is significant and their pay didnt change. You better hope your field isnt the focus of some political fiasco or you'll find yourself quickly screwed.