Obama's New Tax & Psych

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TexasPhysician said:
Run for the hills or embrace more socialism? 🙂
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I think psych is one of the few fields that actually is safer from this whole conundrum. They can see patients who pay cash, and dictate what they will charge with very little overhead and with never seeing the inside of a hospital.
 
Don't know myself. I think the law can cause a lot of good but I do think the reasoning that it's not constitutional has merit.

I haven't read the entire report (and I feel cheap for not doing so having read so many Supreme Court cases in fellowship), but I do agree with this one comment from the Chief Justice

"The federal government does not have the power to order people to buy health insurance. ... The federal government does have the power to impose a tax on those without health insurance."
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The law was written as if it's not a new tax, but if it's not, you just can't make someone buy something even if it's for their benefit. That IMHO IS unconstitutional. The conservative wing of the court cited that the new law isn't a tax and to claim it's such is wrong, and therefore is unconstitional.

Oh well....The more I think about it, the more I get nowhere in trying to decide to be against it or not.
 
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whopper said:
Don't know myself. I think the law can cause a lot of good but I do think the reasoning that it's not constitutional has merit.
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I fully admit, and am embarrassed to say, that I don't really understand the details of this new law or how it will end up looking to us in a practical sense. I also may have a completely different view point about this after I learn more. But I have to agree with you, whopper. Do I think everyone should be able to have health care? Yes! Do I think the government should find ways to help those on a low socioeconomic status obtain health care? Sure...as long as it's done in an economically responsible way. But the idea of mandating citizens to have health care seems like a different matter. I can, however, understand the argument that mandating health care is necessary because eventually someone is going to end up paying for those without health care at some point whether by covering their visit to the ER or paying for their COPD treatment. I just don't know...
 
I guess the law is trying to get people to pay for their fair share and take responsibility for our healthcare system. Clearly giving us the freedom of choice has not demonstrated that we can have this type of fiscal responsibility. Although taxing those who do not have insurance, I presume, will only place more economic burden on families that are struggling to get their basic needs met.
 
I'm surprised. I didn't think the individual mandate would be constitutional. Other than that, I'm pretty indifferent to the whole thing. I don't think ACA goes nearly far enough. Mandating healthcare coverage becomes a non-issue if everyone is already automatically covered. Moving to Canada would be cool with me. 🙂

I'm a bit more concerned with SCOTUS' upholding of Citizens United earlier in the week and that isn't getting nearly the same coverage.
 
DrAwsome said:
I think psych is one of the few fields that actually is safer from this whole conundrum. They can see patients who pay cash, and dictate what they will charge with very little overhead and with never seeing the inside of a hospital.
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THIS. Initially I was thinking that at some point I may be forced to take insurance, but this seems unlikely in the near future, as even in cash practice most people get SOME out of network benefits--you can't really make an argument that people aren't using their insurance. And even if we end up in a british system (which we never will) there's no reason to believe that a regular doctor wouldn't enjoy a nice life and extremely good job security. THOUGH, in such a scenario, likely the med school tuition thing might have to be drastically reduced.

Given that our expected value in psych is a roughly pretty low $200k, adjusted for inflation, of purchasing power in the long run, I don't think there is a whole lot to worry about. The more procedurally heavy specialties and hospital dependent specialties likely will experience more cuts as reimbursement rates go down with more people signing up for more competitive semi-public options. Which, in some ways, is great for psych because all your friends are now getting paid less. :laugh: I honestly doubt that any legislation will reduce the overall cost of care, however, even if physician salary per se is reduced dramatically. Most of cost of care has to do with things that are just really expensive no matter how you cut it. Plus, given that the economy is in the gutter right now and healthcare is 1/6th of the economy, do we really want to cut medical spending? Shouldn't we deficit spend on medicare, if anything?
 
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sluox said:
THIS. Initially I was thinking that at some point I may be forced to take insurance, but this seems unlikely in the near future, as even in cash practice most people get SOME out of network benefits--you can't really make an argument that people aren't using their insurance. And even if we end up in a british system (which we never will) there's no reason to believe that a regular doctor wouldn't enjoy a nice life and extremely good job security. THOUGH, in such a scenario, likely the med school tuition thing might have to be drastically reduced.

Given that our expected value in psych is a roughly pretty low $200k, adjusted for inflation, of purchasing power in the long run, I don't think there is a whole lot to worry about. The more procedurally heavy specialties and hospital dependent specialties likely will experience more cuts as reimbursement rates go down with more people signing up for more competitive semi-public options. Which, in some ways, is great for psych because all your friends are now getting paid less. :laugh: I honestly doubt that any legislation will reduce the overall cost of care, however, even if physician salary per se is reduced dramatically. Most of cost of care has to do with things that are just really expensive no matter how you cut it. Plus, given that the economy is in the gutter right now and healthcare is 1/6th of the economy, do we really want to cut medical spending? Shouldn't we deficit spend on medicare, if anything?
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Schaden the freude :meanie:
 
sluox said:
THIS. Initially I was thinking that at some point I may be forced to take insurance, but this seems unlikely in the near future, as even in cash practice most people get SOME out of network benefits--you can't really make an argument that people aren't using their insurance. And even if we end up in a british system (which we never will) there's no reason to believe that a regular doctor wouldn't enjoy a nice life and extremely good job security. THOUGH, in such a scenario, likely the med school tuition thing might have to be drastically reduced.

Given that our expected value in psych is a roughly pretty low $200k, adjusted for inflation, of purchasing power in the long run, I don't think there is a whole lot to worry about. The more procedurally heavy specialties and hospital dependent specialties likely will experience more cuts as reimbursement rates go down with more people signing up for more competitive semi-public options. Which, in some ways, is great for psych because all your friends are now getting paid less. :laugh: I honestly doubt that any legislation will reduce the overall cost of care, however, even if physician salary per se is reduced dramatically. Most of cost of care has to do with things that are just really expensive no matter how you cut it. Plus, given that the economy is in the gutter right now and healthcare is 1/6th of the economy, do we really want to cut medical spending? Shouldn't we deficit spend on medicare, if anything?
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I thought psychiatrists in pp usually earned around 300k? I personally don't understand why other staff's salaries are not getting cut.

CRNA/PA/NPs make almost as much as some docs. Why are their salaries not getting cut? I think there should be an immediate push back of this bill. I say start striking and walking out tomorrow.
 
TexasPhysician said:
Germany - I'm not sure that's any better though. 🙂
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I haven't looked at this in over a year, but I remember Germany being fairly similar to what's going to happen with the health insurance exchanges, mixed payer system, etc. Germany with some additional disincentives to seek care (i.e. to counteract people in Germany scheduling PCP visits just to chat, which happens) doesn't seem like such a bad set up
 
loveoforganic said:
I haven't looked at this in over a year, but I remember Germany being fairly similar to what's going to happen with the health insurance exchanges, mixed payer system, etc. Germany with some additional disincentives to seek care (i.e. to counteract people in Germany scheduling PCP visits just to chat, which happens) doesn't seem like such a bad set up
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Are you really worried that psych salaries are going to drop any lower than the 200's? Even in Canada and the UK they make about the same, even with their national healthcare.
 
Psych will become alot more popular when the other specialties salaries come down to mid to high 200s. It's hard picking psych against another specialty you like as much when they were making more than double than psych.

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I predict that we will wind up with a 3-tiered system. Gov't healthcare for the poor. Private insurance for the middle class. Cash pay for the upper class.

I actually think psych will likely fall somewhere in the middle. More psychiatrists will forgo insurance headaches in favor of a cash up front practice where the patient has to recoup the funds from the insurance company themselves. This trend will increase unless the gov't high incentivizes psychiatric care by greatly increasing reimbursement rates (which is also possible, but less likely IMO). Access problems for the poor will, of course, continue, and will worsen, if that's possible (it is).

Oddly enough, if the current medicare physician payment system isn't reformed, and soon, we could see the majority of out patient medicine going the cash route. I know many, many FM docs who have already dropped medicare and insurance, or are about to. Many more are giving it another year or two. If that trend is allowed to continue, having coverage won't help you.

Interestingly, most rates I'm seeing for these types of FM practices are fairly reasonable. $50-100 per month, per patient.
 
DrAwsome said:
Are you really worried that psych salaries are going to drop any lower than the 200's? Even in Canada and the UK they make about the same, even with their national healthcare.
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??? Where'd you get that idea? At any rate, isn't psych already pretty much right at 200k?
 
loveoforganic said:
??? Where'd you get that idea? At any rate, isn't psych already pretty much right at 200k?
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Point is that I don't think salaries in this range will drop so no need to run to Canada. Concern is mostly for higher paid specialties.
 
DrAwsome said:
Point is that I don't think salaries in this range will drop so no need to run to Canada. Concern is mostly for higher paid specialties.
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I agree with your point that the bigger earners are likely to drop more. I just don't understand where you seem to have gotten the idea that I was saying anything relevant to this topic? Or salaries of anyone for that matter? I only made a comment on the German system (and even said it was similar to where we seem to be headed)
 
splik said:
wtf are you talking about this is the current system!!!
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:laugh: Hopefully it will be non-ER-based care for the poor (with some actual funding for providers who see them), and pretty much the current system for the other two, with more stable insurance coverage. That hopefully won't cost the country too much. Wait and see I suppose
 
F0nzie said:
I guess the law is trying to get people to pay for their fair share and take responsibility for our healthcare system. Clearly giving us the freedom of choice has not demonstrated that we can have this type of fiscal responsibility. Although taxing those who do not have insurance, I presume, will only place more economic burden on families that are struggling to get their basic needs met.
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"Pay their fair share"; then "redistribution of wealth"? I am a cash-pay patient, and, as I pay my bills, I AM paying my "fair share" already. Then, it will be the redistribution, as I clearly have "too much".
 
loveoforganic said:
I agree with your point that the bigger earners are likely to drop more. I just don't understand where you seem to have gotten the idea that I was saying anything relevant to this topic? Or salaries of anyone for that matter? I only made a comment on the German system (and even said it was similar to where we seem to be headed)
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I thought that's what you meant. Sorry if I misunderstood.
 
the point of the individual mandate is not simply a cheeky way to expand coverage without the government digging their hands too deep, is that insurance and healthcare costs are greater when healthy people are not included to reduce the risk/costs. so by not being part of this you are increasing the costs for others/
 
DrAwsome said:
I thought that's what you meant. Sorry if I misunderstood.
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It wasn't, no problem though

splik said:
the point of the individual mandate is not simply a cheeky way to expand coverage without the government digging their hands too deep, is that insurance and healthcare costs are greater when healthy people are not included to reduce the risk/costs. so by not being part of this you are increasing the costs for others/
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Err, an individual mandate seems exactly like a way to expand coverage without overspending, unless I'm not catching the point you're making. The whole point of an individual mandate with penalty / single payer system is to get money from the low risk population to pay for the expected cost of the high risk population. The alternative is to either go broke or let the high risk shovel money in the boiler for insurance. Maybe it isn't "cheeky," but I'm not really sure what you mean by that
 
splik said:
wtf are you talking about this is the current system!!!
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Haha. Kind of, I guess. :laugh:

Nothing in this law does anything to get rid of our current "3 tiered" system. I'm saying that these distinctions will become more apparent moving forward, and the cash pay segment will grow exponentially. Right now this is a very, very small part of the market, especially in primary care. Without meaningful physician payment reform, I'd expect the number of PCP's participating in medicare (or any insurance, honestly) to drop drastically.
 
Bernardo_11 said:
I always thought that the PPACA would be of benefit to Mental Health providers because it increases the parity of mental health conditions with the more "conventional" medical ones.

http://www.benefitmall.com/News-and-Events/Industry-Insights/Mental-Health-Provisions-in-PPACA

Nardo
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small but important point: the act under discussion is not called PPACA, nor is it "obamacare" (an insult to all those who actually worked on it). it is it the ACA. PPACA was amended by the education and healthcare reconciliation act (also known as the sidecar bill) in march 2010.
 
One thing that can come of this that is good whether or not you like Obama's health care plan is that it has once again thrust healthcare to the forefront of issues, and it puts an impetus for the GOP to offer a better alternative if they're going to repeal the existing law.
 
whopper said:
One thing that can come of this that is good whether or not you like Obama's health care plan is that it has once again thrust healthcare to the forefront of issues, and it puts an impetus for the GOP to offer a better alternative if they're going to repeal the existing law.
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You reckon? That impetus has been there for years and no one has stepped up to the plate. They'll keep talking about repealing Obamacare (or is it Extended Romneycare) without offering new alternatives. Because proposing solutions is a political liability....
 
You could be right. If it is repealed, the GOP may simply do nothing. The winds though, IMHO, are blowing in the direction of someone needing to do something Healthcare expenses are going up and the baby boomers are all needing treatment.

IMHO, the political fallout of taking out the healthcare bill without addressing what to do to improve the current situation will be worse than it was in the 90s, but history could still repeat itself because the stupidity in Washington never fails to surprise me.
 
whopper said:
You could be right. If it is repealed, the GOP may simply do nothing. The winds though, IMHO, are blowing in the direction of someone needing to do something Healthcare expenses are going up and the baby boomers are all needing treatment.

IMHO, the political fallout of taking out the healthcare bill without addressing what to do to improve the current situation will be worse than it was in the 90s, but history could still repeat itself because the stupidity in Washington never fails to surprise me.
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Unless our whole government collapses before then (not sure what that would look like haha), I don't see any way that we don't have a UHC semi-european model within 40 years, b/c what we are doing now is not financially sustainable. We already spend a greater percent of our government budget on healthcare than european countries do, but we don't get any of the benefits of actually having a cohesive healthcare system that they do.

So we are already spending a greater percent of our budget & GDP (and several times more per capita) on healthcare than the "socialist" model. At this point we would need to either get rid of medicaid and tell old folks folks "tough luck, hope you saved up enough, we will be checking your bank balance before we admit you" (which is obviously political suicide) OR we would need to go to a system that is more financially similar to the european systems. Because as it is we have the "worst of both worlds" because the government is footing the bill for all the sickest people.
 
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