Podiatry's Future and Healthcare Reform Impact

[JonScholl]

"Obamacare" has slowly become less of a possibility and more of a reality recently. With that being said, healthcare reform is looming over all aspects of medicine, including podiatry. I am very interested in hearing from some practicing podiatrists impact of the bill and what does the future hold for us as a profession.

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[podo trest]

I'm also interested in hearing experiences or thoughts about ACOs from those currently practicing.

 

[347932]

"Obamacare" has slowly become less of a possibility and more of a reality recently. With that being said, healthcare reform is looming over all aspects of medicine, including podiatry. I am very interested in hearing from some practicing podiatrists about the financial impact that they have endured so far with the new mandates that have already been put into effect over the past several years. Additionally, what does the future hold for us as a profession with the way the current reform bill is structured? I have listened to the perspectives of several practicing podiatrists and from what I have been told, the consensus is negative. It sounds like the option of a small group of physicians (in our case podiatrists) owning and running a surgical center seems to be something that will not exist in the future. Additionally, the option of practice ownership in general may be in jeopardy as well.

Obviously as a student I am looking very far down the road, however I would appreciate hearing the perspective from several physicians (whether negative or positive) regarding this issue.

Change is constant. As long as you are at the forefront of the changes and can adapt accordingly, it will be business as usual.

I think the small solo practice will be a thing of the past (if not already). Power in numbers. The difficulty is getting along which has crutched our profession (and other medical professions) more than it should. The future is up to you to make.

 

[Feli]

Change is constant. As long as you are at the forefront of the changes and can adapt accordingly, it will be business as usual.

I think the small solo practice will be a thing of the past (if not already). Power in numbers. The difficulty is getting along which has crutched our profession (and other medical professions) more than it should. The future is up to you to make.

I would agree here. More and more pod offices need to start making supergroups for purposes of negotiating with payer plans. The good thing is that it's already going on in a lot of metro areas.

 

[bobdolerson]

Let's just hope that the Supreme Court decides the individual mandate is unconstitutional, and the entirety of the bill must be struck down for lack of funding without that integral means of "revenue".

Whole thing makes me sick. Since when does anyone, anywhere at any point have a "right" to someone else's labor and livelihood.

For the sake of at least a tiny bit of limiting the increasing role of government in our everyday lives, please, please, God please let this bill be struck down.

 

[Sig Savant]

Let's just hope that the Supreme Court decides the individual mandate is unconstitutional, and the entirety of the bill must be struck down for lack of funding without that integral means of "revenue".

Whole thing makes me sick. Since when does anyone, anywhere at any point have a "right" to someone else's labor and livelihood.

For the sake of at least a tiny bit of limiting the increasing role of government in our everyday lives, please, please, God please let this bill be struck down.

I'm going to assume that you've always had health insurance, and that you've never had to worry about medical costs being covered. When you are put in a position where you don't have coverage, yet should probably see a doctor, a lot of people aren't getting the help they need.

A video summary of the health care bill: http://healthreform.kff.org/The-Animation.aspx

 

[bobdolerson]

Regardless of what needs a person has, you fundamentally cannot call a "right" something that would be violated constantly without the intervention of another person.

For instance, say there existed no doctors (ie, tribal areas, third world countries), their rights would be in a state of perpetual violation.

If you want to say someone has a fundamental right to something by nature of being alive, that's fine, and as a civilized society that's something that is required for harmony, but for the reasons I just said, health care isn't one of them. You don't have the right to be healthy, you don't have the right to a job, you don't have the right to anything but life, liberty and property, and those can be taken away if you violate the rights of another as per our constitution.

Another persons medical problems do not entitle them to my labor or my livelihood. If you truly think it does, I would expect you to additionally be in favor of mandatory drafts to aid people in areas of natural disaster. What's that? Hurricane? Sorry, buddy, I don't care that you have a job and other things you'd rather be doing, these people are in need and you're now required by law to aid them...

Please don't mistake this for a lack of sympathy or empathy. I don't come from an entitled home, and have given several paychecks to my sister and brother-in-law to help them pay for medical bills when my nieces needed help.

At the same time, I don't expect nor do I think it's the governments role to put a gun to someone's head or threaten them with jail time if they don't step in and help my sister out.

This is life, and it isn't fair to everyone, otherwise we'd all be Lebron James.

I have absolutely no problem with helping a person in need, and I am looking forward to being able to assist people who need medical help when I have the capacity for it, but don't take that to mean that I think it's their right.

After 200 thousand in debt, years away from my family and not being able to spend the time I want with them, more years of residency, no...nobody has a right to my service. As a matter of fact, it is entirely my right after I become a DPM to decide that I don't want to be a physician, and instead be a stocker at Best Buy again. Should the government step in and force me to practice if there becomes a shortage of doctors? I don't see how you could oppose that, but I do and will.

No, health care is not an entitlement, it's not a right, it's a service provided by a person who deserves compensation for their work, and has no obligation but to themselves and whatever guild they decide to join.

I definitely get tired of people acting as though they're more sympathetic than me, or that I've been coddled, or that I'm not sympathetic to my fellow man or somehow a lesser person because they think they're charitable and kind by forcing someone else to give their life (ie, time), acting as though their forced and legislated demands for charity are in fact charitable. It's not charity, it's just coercion.

Insurance is also not a right. It's a service provided by a company that is out to make money. It's a gamble on your part, and in fact they use some of the same statistical measures to determine premiums as Vegas. Demanding insurance companies provide everyone, regardless of preexisting conditions, with health care without raising premiums past a ceiling is in effect the same thing as heading to Vegas and altering slots in the favor of customers. There would be no Vegas, and there will be no insurance companies. Don't like it? Don't get insurance.

It's annoying that people expect trillions of dollars to be spent researching health care to find the best procedures, diagnostic tools and equipment, and then also expect the service to be free or cheap. If you want cheap service, go to a place with cheap equipment and outdated tools and practices, and you'll get your money's worth. Or, just maybe, don't buy that new iPad, new car, that house you can't afford and that Xbox for your kids, and you'll have the money when you need it.

 

[SuperFeisty]

I'm too tired to read it now, but bob, rest assured, you are my bedtime reading tonight!

Read it... I am Libertarian soo... And Siggie, yes, I have had a part of my life where I was basically not covered. The costs were ridiculous. 6 months later I was still paying the bills for it. You have to keep in mind, the world is not all flowers and daisies.

BAD things happen to GOOD people. While you can help to a degree with free clinics and what not, ultimately hospitals and healthcare providers are a business like bobeh says.

 

[flyhi]

I'm too tired to read it now, but bob, rest assured, you are my bedtime reading tonight!

It's good stuff and I feel as strongly on the subject matter.

 

[newankle]

I'm going to assume that you've always had health insurance, and that you've never had to worry about medical costs being covered. When you are put in a position where you don't have coverage, yet should probably see a doctor, a lot of people aren't getting the help they need.

A video summary of the health care bill: http://healthreform.kff.org/The-e Animation.aspx

Give me a break... This is going to destroy healthcare in the US and this damn 'entitlement' mindset of the current administration corrupts everything they try to do, not just healthcare 'reform'. And you cite a video summary from KP which is where this model for healthcare reform originated from. They have been rationing healthcare for years. Makes me ill.

 

[Sig Savant]

Have you ever traveled outside the US or studied other country's healthcare systems? I'm curious to see how you think the US compares, considering we rank like 27th in the world and spend more than many other countries to be so bad.

 

[347932]

Have you ever traveled outside the US or studied other country's healthcare systems? I'm curious to see how you think the US compares, considering we rank like 27th in the world and spend more than many other countries to be so bad.

The US has the best healthcare in the world imo. Growing up in Canada and studying healthcare in European countries has led me to this conclusion. Access in the US is second to none and the technology available is unparalleled. Even for the under privileged.

It is expensive in the US because of litigation. Plain and simple. I order testing for CYA quite a bit and wish I didn't have to but I.

One thing that is supremely frustrating to me is how much WE as a population pay for the healthcare of people who have no business in this country to begin. Billions are spent on health care for illegals who not only shouldn't be hear but should have no access to the systems they abuse. If you're not a legal landed immigrant (or here legitimately i.e. on a student visa) of some kind or a citizen why should I pay for your health care?

 

[bobdolerson]

Ranked 27th in terms of what, specifically?

You think longevity has anything to do with the fact that we also have more people stuffing their face with McDonalds than anywhere else in the world?

Or maybe that the entire reason other countries enjoy such nice health care is because of the advances and innovations that our evil capitalistic society made? Let's go ahead and remember the entirely disproportionate spending on health care research between the US, and any other country. So...we go ahead and spend billions and billions more than all other countries, and then they swoop in and get to use the advances that we made. There's a reason people from other countries often come to the US for care, and it's not because we're behind the times.

Correlation does not imply causation, my friend.

Also, Kidsfeet is spot on regarding both tort reform being an issue that needs to be dealt with, and that millions of illegal immigrants are leeching off the system.

Seriously, stop requiring hospitals to care for everyone already, because many of them aren't citizens of this country and don't have our constitutional rights (well, in theory...obviously they do because they can sue people, get free health care, enjoy our police/fire systems and our schools). We have enough to worry about without footing the bills for them.

 

[Sig Savant]

I'm not saying I have answers, just want to have a professional and informed discussion.

http://www.nejm.org/doi/full/10.1056/NEJMp0910064

" It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.3 These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?"

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

" EMTALA requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. "

I could never refuse care to people that need it. I am under the impression that all doctors do some pro bono work - obviously you can't spend all day treating patients for free, but seeing a patient every now and then for free seems like a good balance to me.

 

[bobdolerson]

Again, I think it may have something to do with us being ranked number 1 (but a large margin at 6%) in obesity.

It doesn't matter how much you spend on health care if people are the fattest and least healthy in the world, don't exercise, smoke and drink and then go to the doctor. I recall shadowing at hospitals in San Antonio and seeing an entire family of incredibly obese people, including their 8 and 10 year old children, and hearing the mom tell the doctor that "no, my kids run around all day, and eat vegetables and no candy."

Seriously? Haha, the man is a doctor, he's not stupid and doesn't believe your lies, and he isn't there to judge you anyway, just tell the truth that you all eat way too much and watch TV all day, and maybe you'd get some better advice.

Either way, it doesn't matter in terms of this discussion. Being one of the most affluent and "entitled" countries in the world seems to coincide with people sitting around watching TV all day, drinking beer, smoking, and eating potato chips. It doesn't matter how much you spend if the people you're spending it on refuse to take care of themselves, which then begs another discussion...

...If you're telling me that I'm required as a citizen of this country to foot the bills for those who "need" my money (not that they really do....what they "need" to do is stop paying for cable, stop buying big screen TVs and save their money), then it only makes sense to then have tax credits for the healthy, and increased taxes by a huge margin for all those who refuse to be healthy.

If someone can't pay for health care, then they shouldn't weigh 300 pounds, and if they do, I shouldn't be required to pay for their exorbitant fees because they can't figure out how to take care of their own body. I go biking a few dozen miles a week, watch my weight, and avoid things like smoking, drinking and eating McDonalds specifically because i want to live longer. Why should I be required to take care of someone who specifically decided not to do these things?

If you mandate citizens to take care of other citizens, it only makes sense to mandate being healthy, and punish those that aren't.

As far as infant mortality, I don't have an answer, and apparently nobody does, but considering that nobody with infants is turned away from hospitals, it would seem it has nothing to do with our expensive health care, and doesn't really have a place in this discussion of a government-funded health care system.

When the government funds things, you don't get efficiency. That's basically the fundamental guarantee you get when you involve the government, so go ahead and scratch that off of the list of things you'll gain from their taking over the industry. They have a history of redundancy, inefficiency and bloated bureaucracy with money going to the privileged (the only difference is, these people are tied to who's in office and not random chance or genetic disposition).

They've failed time and time again to find things to invest in (*cough* Solyndra), have demonstrated absolute incompetency in all things financial, and still seem to have this idea that money can be spent with reckless abandon without having any means to pay for it.

With government running health care, especially with the sense of entitlement that's running rampant throughout the country, you will have even more expensive health care with less efficiency, less desire for personal innovation and invention in the field, and a select few making billions because they donated to the party in charge.

Capitalism > Socialism.

 

[bobdolerson]

I could never refuse care to people that need it. I am under the impression that all doctors do some pro bono work - obviously you can't spend all day treating patients for free, but seeing a patient every now and then for free seems like a good balance to me.

I agree, but I also don't think the government's role is to require doctors to do this.

there's a difference between legitimate charity and forced charity, and one is good for the community, and the other makes people resentful towards those their required to take care of for free.

As far as trying to find out why some of these statistics are so poor for our country, I agree that this is a big deal and should be a primary concern stepping forward. The big difference seems to be I don't think this should be left up to the government, and that the guilds of doctors should take this on as a focus moving forward.

Comparing to other countries, I think we would find similar rankings between mortality and the level of exercise. I noticed Sweden is pretty high up as far as life expectancy, and low in mortality among younger folks, and I've also seen that they have a habit of riding bicycles /everywhere/. Perhaps citizens should just get off their fat butts and go play outside, and stop playing so much Call of Duty.

 

[MaxillofacialMN]

I agree with BD completely. Healthcare is a privilege, not a right.

It's also imperative to note that healthcare and access to it DOES NOT mean health. If my seminars at the Mailman School of Public health has taught me anything, it's that.

 

[347932]

It's also imperative to note that healthcare and access to it DOES NOT mean health.

 

[bobdolerson]

My wife's job is in insurance sales, and finding appropriate supplement plans for people on medicare and medicaid.

She comes home every day frustrated by people that, first of all, have much better belongings than we do (bigger TV, new fridge, new etc...) despite being on government assistance programs. It's frustrating to see people who claim to require assistance from me and other productive people while wasting their money on things they don't require. We don't go out to eat, we buy off-brand groceries,and the only time we've ever upgraded a phone was when we were allowed a free one with an extension of our contract. We don't have cable (I love sports and TV, so this sucks!) so we can have internet.

Granted, I have student loans, but these are strictly going to my supplies, and our rent, insurance and luxury items are from her income. If we can't afford it, I don't take out new loans, we just don't have it.

She also sees people day after day that don't have to pay for the vast majority of their medical bills, and seem to do everything they can to destroy their bodies by smoking, drinking and eating. She found it a bit funny that people often have signs that say "No Smoking! Oxygen-assisted homeowner inside" only to see a half-empty pack of cigarettes on the table.

It would seem that the biggest health care problem facing people in the US are the people in the US, and not problems with the industry.

I think one of the most beneficial things we could do to contribute to the good of the nation would be better education at the elementary, middle school and high school levels regarding proper care of the body, basic health risks and avoiding them, and how to balance a checkbook.

Seriously, how can we expect people to take responsibility for themselves and delay instant gratification for the sake of financial security when the government puts itself into trillions more dollars of debt every year (at this point surpassing our GDP) with no plans for the future to pay it off? That's supposed to be our example?

Why would you take care of yourself if you can just vote yourself benefits from a public treasury that you don't even pay into?

 

[347932]

I had a family of patients and the kids were all on Medicaid. When Mom brought them she always gave the staff a hard time about paying the $1 co-pay required for each child.

I felt bad for them at first until I saw what kind of clothing the children were wearing, the jewelery Mom had on and the nice Black Hummer she drove them to the appointment in with custom 21" chrome wheels.

Shirking the system much?

 

[bobdolerson]

I think the worst thing about it is the attitude i now have towards all of the welfare recipients that's hard to suppress, even for those I wouldn't mind helping, even if it wasn't forced upon me.

There are some people that legitimately have a bad rap in life and I would like to help.

I remember a homeless man with a sign that said he needed food when I was a kid, so my mom stopped and told him to meet her a few yards away at a restaurant. She went in, told him to order whatever he wanted, and when she took out her money to pay for it, he grabbed it from her hand and ran out.

Those sorts of things make me callous towards the system as a whole, and though I know that not everyone takes advantage of it like many do, the experiences I've had so far have made it hard for me not to have a negative attitude towards everyone that uses it.

To be honest, at this point, unless I have to do it for lack of better paying clients, I have no intention of ever taking medicaid patients. I would like to help people who need it, and plan on going to outreach events where I can be of service to the community, but I've had too many bad experiences with people that are part of the system to want to deal with it anymore.

 

[newankle]

Kidsfeet,
So the reason you don't see Medicaid patients is your perception of their attitude OR is it the reimbursements OR both?

 

[bobdolerson]

I was the one who said I didn't intend on seeing them unless it was necessary to keep a practice solvent. I don't think Kidsfeet said anything about that.

 

[newankle]

Sorry, you are correct. In my area Medicaid actually pays better than Medicare but not as good as most private insurers. Medicaid pays decent for fractures and surgery/procedures but poorly for E&M. This population is only going to increase and there is opportunity especially when some practitioners don't want to see them.

 

[347932]

Kidsfeet,
So the reason you don't see Medicaid patients is your perception of their attitude OR is it the reimbursements OR both?

I do seem them regardless. My one example is a minority of the ones I see, but still not right.

 

[PADPM]

My biggest issue with the Medicaid system is that members of society who are NOT productive, are rewarded for their non-productive status. (I'm not referring to those who are ill, handicapped, etc., I'm talking about those who KNOW how to beat the system). A great ,majority do not contribute anything to society, pay for NOTHING and expect EVERYTHING.

I had a returning "foreign" patient in our office. He came in saying "I'm here for my free shoes". I asked if he had any aches, pains, problems, discomforts, etc., and he said "no, I just need a prescription for my free shoes, just like my other foot doctor gave me". To make matters worse, he brought 2 of his friends who are new to this country, and there were ALL there for their "free shoes". None were diabetic. None had PVD. None had any systemic illness. None had ANY foot deformity. None had any legitimate problem. But each had a high tech phone, including the new iphone 4S, two were wearing high end blue tooth earpieces and one had an iPad3.

The Medicaid system in our state pays for shoes, not only for diabetics qualify for shoes, but also those with "deformities", such as severe bunions, hammertoes, etc. The system also pays for custom orthoses for almost anything.

Needless to say, I let each one of these patients know very clearly that I would not be writing them an RX for shoes, but did recommend a very high end, expensive shoe store!

Then I have a patient who was BORN in the U.S.A., has worked a factory job for 20 years AND moonlighted at a second job. The guy works about 90 hours a week for YEARS. His job cut back benefits, and now he has to contribute a lot of the insurance premium. He has legitimate problems AND works 90 hours a week despite those problems. He has been contributing U.S. taxes on his earnings for all these years. He's a volunteer fire fighter at his local firehouse. And HE has no coverage for special shoes, he has no coverage for orthoses, he has a large/$45 co-pay.

What's wrong with this picture????

When you reward those who aren't productive, you give them no incentive to ever become productive. When you penalize those who work (high taxes), you discourage people from working. It's senseless. Keep rewarding people who don't contribute and they won't. Keep holding things from those who ARE productive, and you will discourage their desire to produce.

It's senseless.

 

[JonScholl]

This issue involves more than just the healthcare system in general, its a nationwide problem that involves many different policies which have been put into place. Giving extra hand-outs to immigrants who have put basically nothing into the system yet while taking away from the people who have put a lifetime of work into the system is simply wrong. It is also a nationwide mental defect and sense of entitlement that has put this country into the gutter financially. I honestly don't see these issues being resolved with healthcare reform, there needs to be a massive policy overhaul involving medicaid, medicare, welfare, immigration laws, etc. Complaining about a $1 co-pay makes me disgusted with those individuals to their absolute core.

If healthcare reform is going to cut physicians salaries by a certain percentage, I do believe that something needs to be done with our student loans/tuition costs. Lets say the average physician salary drops by 25% in the next 5 years, the United States needs to pay AT LEAST 25% of our student loans, and honestly much more. They also need to also give students tax breaks while in residency or re-allow deferment of loans through the length of residency.

 

[347932]

Giving extra hand-outs to illegal immigrants who have put basically nothing into the system yet while taking away from the people who have put a lifetime of work into the system is simply wrong.

Fixed that for you. I'm an immigrant and get NOTHING handed to me. Also, one thing you need to be aware of is that while I was on a Work Visa and now currently on a Green Card, I DO pay into the system and getting NOTHING out of it. I've been working hard in this country since 1999 (yes, residency is considered work) and have been paying taxes out of my paycheck since then and have NO access to any benefits from those taxes (maybe better roads but that's it). Those benefits ONLY start coming to me after I've become a citizen and they are NOT retroactive. So the pot starts filling up only AFTER I become a citizen and I've been paying for all those illegals' benefits just like you all this time.

Be careful with the information you think you know.

 

[SuperFeisty]

My biggest issue with the Medicaid system is that members of society who are NOT productive, are rewarded for their non-productive status. (I'm not referring to those who are ill, handicapped, etc., I'm talking about those who KNOW how to beat the system). A great ,majority do not contribute anything to society, pay for NOTHING and expect EVERYTHING.

I had a returning "foreign" patient in our office. He came in saying "I'm here for my free shoes". I asked if he had any aches, pains, problems, discomforts, etc., and he said "no, I just need a prescription for my free shoes, just like my other foot doctor gave me". To make matters worse, he brought 2 of his friends who are new to this country, and there were ALL there for their "free shoes". None were diabetic. None had PVD. None had any systemic illness. None had ANY foot deformity. None had any legitimate problem. But each had a high tech phone, including the new iphone 4S, two were wearing high end blue tooth earpieces and one had an iPad3.

The Medicaid system in our state pays for shoes, not only for diabetics qualify for shoes, but also those with "deformities", such as severe bunions, hammertoes, etc. The system also pays for custom orthoses for almost anything.

Needless to say, I let each one of these patients know very clearly that I would not be writing them an RX for shoes, but did recommend a very high end, expensive shoe store!

Then I have a patient who was BORN in the U.S.A., has worked a factory job for 20 years AND moonlighted at a second job. The guy works about 90 hours a week for YEARS. His job cut back benefits, and now he has to contribute a lot of the insurance premium. He has legitimate problems AND works 90 hours a week despite those problems. He has been contributing U.S. taxes on his earnings for all these years. He's a volunteer fire fighter at his local firehouse. And HE has no coverage for special shoes, he has no coverage for orthoses, he has a large/$45 co-pay.

What's wrong with this picture????

When you reward those who aren't productive, you give them no incentive to ever become productive. When you penalize those who work (high taxes), you discourage people from working. It's senseless. Keep rewarding people who don't contribute and they won't. Keep holding things from those who ARE productive, and you will discourage their desire to produce.

It's senseless.

Hey PADPM, if you're going to emphasize non productive, don't put foreign in quotations or capitalize born. Your first paragraph voices the frustrations of NON productive individuals. Immediately afterwards, you associate foreign with cheating the system and american born with honest hard worker. This is simply not true. The point could have easily been made without knowing their origin. I know you didn't mean it that way, but as an immigrant myself, I am a little ticked off by that rather insensitive comment.

 

[footfan34]

Not to detract from the previous comments, but to respond to the original post; I think there very few who know EXACTLY what will happen with the healthcare reform. I am majoring in healthcare administration and for my entire undergrad we have tried to digest what Obamacare really entails but it is rather complicated and long. The general consensus is that it will not be good for practitioners of all sorts. In a recent visit I had with a private practicing DPM, he basically said it was a mystery to him as well concerning the legislation. He also said that without Medicare it would be extremely difficult to stay afloat as a Pod so whatever changes come, we all are keeping our fingers crossed that it doesn't leave our patient base unable to receive our medical services.

There does need to be change in our system and I think we (future DPM's) and all other practitioners need to make sure that we are vocal with our concerns and opinions with state leaders. I feel like I am reading my own posts from kidsfeet and bobdolerson. My wife works in the ER at a regional hospital and all day people with iPhones and iPads come in with Medicaid as their primary insurance while we are scrimping by to stay out of debt and independent of outside help. No way in heck am I going to work my whole life, going through years and years of school and accumulating hundreds of thousands of dollars in debt, to watch my money and the government pay for people who are working the system.

I don't mean to pull a William Wallace on you all but the future of our careers is in our hands and the hands of those that are currently practicing. It will be interesting to see the changes that are forthcoming.

 

[bobdolerson]

As far as illegal/legal immigrants, I always get frustrated when people don't like immigrants by and large because of the illegal population and the problems associated. (not saying PADPM or anyone else was saying this, it just sparked the thought in my head).

I worked construction with many /legal/ immigrants in San Antonio, and they were some of the hardest working people I've ever had the pleasure of working with. Additionally, you won't find many people that absolutely /hate/ illegal immigrants like a legal Mexican immigrant does.

Nothing pisses them off more, after jumping through so many ridiculous hoops to get here legally to work here and pay taxes, than a fellow who crossed the border without papers and works some of the same jobs without paying taxes. They also don't appreciate that it took some of them years to get approved to come here, and see other people that just came across without having to wait.

They also appreciate the opportunities in this country more than most natural born citizens I've met, because they've lived in a place that didn't have them.

Not quite the same scenario as Canadians, etc., who didn't exactly come from a third world country, but still the point is the same...legal immigrants are what made this country the place it is, and we're better for it. My beef will never be with you fine folks

 

[Podmeister]

Let's say that Obamacare goes through and everyone must buy health insurance. Now what happens to the 20 million illegal immigrants here in the US? Since they are illegal, the government can not force them to buy into the system ....so guess who will be paying for all those free clinics for the illegals.

 

[bobdolerson]

The same people already paying for their roads, education, and military/police/fire protection.

Oh...I see what you were doing there...

...nice.

 

[RockFoot]

The same people already paying for their roads, education, and military/police/fire protection.

Oh...I see what you were doing there...

...nice.

lol

Sent from my SPH-D600 using SDN Mobile

 

[NeilD]

Regardless of what needs a person has, you fundamentally cannot call a "right" something that would be violated constantly without the intervention of another person.

For instance, say there existed no doctors (ie, tribal areas, third world countries), their rights would be in a state of perpetual violation.

If you want to say someone has a fundamental right to something by nature of being alive, that's fine, and as a civilized society that's something that is required for harmony, but for the reasons I just said, health care isn't one of them. You don't have the right to be healthy, you don't have the right to a job, you don't have the right to anything but life, liberty and property, and those can be taken away if you violate the rights of another as per our constitution.

Another persons medical problems do not entitle them to my labor or my livelihood. If you truly think it does, I would expect you to additionally be in favor of mandatory drafts to aid people in areas of natural disaster. What's that? Hurricane? Sorry, buddy, I don't care that you have a job and other things you'd rather be doing, these people are in need and you're now required by law to aid them...

Please don't mistake this for a lack of sympathy or empathy. I don't come from an entitled home, and have given several paychecks to my sister and brother-in-law to help them pay for medical bills when my nieces needed help.

At the same time, I don't expect nor do I think it's the governments role to put a gun to someone's head or threaten them with jail time if they don't step in and help my sister out.

This is life, and it isn't fair to everyone, otherwise we'd all be Lebron James.

I have absolutely no problem with helping a person in need, and I am looking forward to being able to assist people who need medical help when I have the capacity for it, but don't take that to mean that I think it's their right.

After 200 thousand in debt, years away from my family and not being able to spend the time I want with them, more years of residency, no...nobody has a right to my service. As a matter of fact, it is entirely my right after I become a DPM to decide that I don't want to be a physician, and instead be a stocker at Best Buy again. Should the government step in and force me to practice if there becomes a shortage of doctors? I don't see how you could oppose that, but I do and will.

No, health care is not an entitlement, it's not a right, it's a service provided by a person who deserves compensation for their work, and has no obligation but to themselves and whatever guild they decide to join.

I definitely get tired of people acting as though they're more sympathetic than me, or that I've been coddled, or that I'm not sympathetic to my fellow man or somehow a lesser person because they think they're charitable and kind by forcing someone else to give their life (ie, time), acting as though their forced and legislated demands for charity are in fact charitable. It's not charity, it's just coercion.

Insurance is also not a right. It's a service provided by a company that is out to make money. It's a gamble on your part, and in fact they use some of the same statistical measures to determine premiums as Vegas. Demanding insurance companies provide everyone, regardless of preexisting conditions, with health care without raising premiums past a ceiling is in effect the same thing as heading to Vegas and altering slots in the favor of customers. There would be no Vegas, and there will be no insurance companies. Don't like it? Don't get insurance.

It's annoying that people expect trillions of dollars to be spent researching health care to find the best procedures, diagnostic tools and equipment, and then also expect the service to be free or cheap. If you want cheap service, go to a place with cheap equipment and outdated tools and practices, and you'll get your money's worth. Or, just maybe, don't buy that new iPad, new car, that house you can't afford and that Xbox for your kids, and you'll have the money when you need it.

Just read this Bob. That was great! Someone drinks, smokes, dopes, eats, doesnt exercise their whole life nor buy health insurance and 30 years later says, hey, I want the same benefits as someone who paid premiums and took care of themselves all these years even though I didn't bother to sacrafice? WTF

 

[Sig Savant]

their whole life nor buy health insurance and 30 years later says, hey, I want the same benefits as someone who paid premiums and took care of themselves all these years even though I didn't bother to sacrafice? WTF

The keystone of the Patient Protection and Affordable Care Act is that all people must buy insurance. In the future, you will not have people that didn't have insurance for 30 years and now want it. It will fix that problem by making everyone pay insurance.

The same is true for preexisting conditions - if you aren't required to buy healthcare, no one will buy it until they are standing in the ER. That is why everyone must buy the healthcare now. Say what you want about rights, the constitution, etc - this plan will fail if not everyone buys insurance.

If people shouldn't be forced to buy insurance, we surely shouldn't control peoples' exercise and eating habits. That is an unarguable infringement of their rights. However, insurance companies already reimburse people that go to the gym. If I work out 50 times in 6 months, I get a check for a few hundred bucks. I wonder if the same could be done for smoking, drinking, etc, but again the same argument about human rights comes up.

 

[FiveOVicryl]

If people shouldn't be forced to buy insurance, we surely shouldn't control peoples' exercise and eating habits. That is an unarguable infringement of their rights. However, insurance companies already reimburse people that go to the gym. If I work out 50 times in 6 months, I get a check for a few hundred bucks. I wonder if the same could be done for smoking, drinking, etc, but again the same argument about human rights comes up.

 

[dyk343]

However, insurance companies already reimburse people that go to the gym. If I work out 50 times in 6 months, I get a check for a few hundred bucks.

What insurance company do you go through? I could use a few hundred bucks back from my overpriced health insurance...

 

[Sig Savant]

http://m.guardian.co.uk/society/201...denial-smokers-obese?cat=society&type=article

A majority of doctors support measures to deny treatment to smokers and the obese, according to a survey that has sparked a row over the NHS's growing use of "lifestyle rationing".

 

[dtrack22]

"giving up nicotine would not necessarily enhance an operation's chance of success."

I missed that part in all of our wound healing lectures...

 

[Podfather]

To all of the Obama bashing, anti-government health care, business driven medicine fans: Please do one thing for me to prove you are sincere. Turn down your Medicare at age 65. 66% of all health care in this country is run by the government. The 33% percent that is left is cherry picked by some of the richest corporations in America.

Who are the biggest fans of Medicare? Aetna, BC/BS, etc. Why? Because the government and the tax payers pick up the tab on the sickest. 60-70% of all health dollars are spent on the last 6 months of life. The privates insure the healthy and when they get sick deny coverage, throw them out, or worse say the treatment is experimental so as you watch your love one die you spend your kid's college fund, your nest egg and go bankrupt.

While we blame the patients for not having their 50 dollar co-pay and can't cover their 5,000 deductable and they claim we are ****** that charge too much the companies just smile and figure out the bonuses for the executives.

The solution has been simple offer Medicare to all. Those under 65 have to pay for it themselves (or their employer) then the healthy can offset some of the costs of the sick. Then the privates will have to offer a similar plan to compete and we start moving in the right direction. Oh I forgot Medicare sucks some will say. Until they are 65.

 

[bobdolerson]

The keystone of the Patient Protection and Affordable Care Act is that all people must buy insurance. In the future, you will not have people that didn't have insurance for 30 years and now want it. It will fix that problem by making everyone pay insurance.

I wonder how many other problems of personal responsibility could be fixed by mandating under threat of either taxation or jailtime that people change their habits?

As of now, the way the bill stands as far as I understand it, you aren't really "forced" to buy it. You would simply pay a penalty for not having insurance.

I don't know about any of you, but I have every intention of /not/ paying for insurance and just paying the penalty every year. What does it matter, if insurance companies can't turn you away for pre-existing conditions, and can't raise premiums past a ceiling?

What they're in essence doing is begging me to not pay for insurance until I get some serious illness, and then just go and get some insurance when I need it, when insurance companies would normally turn me away (and they should).

The same is true for preexisting conditions - if you aren't required to buy healthcare, no one will buy it until they are standing in the ER. That is why everyone must buy the healthcare now. Say what you want about rights, the constitution, etc - this plan will fail if not everyone buys insurance.

I guess to me the plan is a failure, so it's success...is just more failure to me. Just a failure of the right to our own responsibility.

If people shouldn't be forced to buy insurance, we surely shouldn't control peoples' exercise and eating habits. That is an unarguable infringement of their rights. However, insurance companies already reimburse people that go to the gym. If I work out 50 times in 6 months, I get a check for a few hundred bucks. I wonder if the same could be done for smoking, drinking, etc, but again the same argument about human rights comes up.

Exactly! I didn't mean at all that people should be taxed for enjoying their bad habits. I think that's a pretty egregious use of government coercion, and I said it more to illustrate how ridiculous any of this is.

I'm a Libertarian, and a morose one at that. What I want is to be left alone, and to be allowed to enjoy both the fruits of my labor, and the consequences of my stupidity.

I want to be allowed to decide for myself what to purchase, and not be forced to pay for something that I don't want to use.

I want to be allowed to decide what I put into my own body, because I think there's little difference between the illegal and the legal drugs (except, I suppose, that alcohol is far more dangerous than the vast majority of illegal substances). No...no, thank you, my kind benevolent tyrants. I /don't/ need you to threaten prison time if I smoke weed. The influence of my social circles and local community is a far better method of keeping kids off drugs. Beyond that, who cares if adults use? It's their body, let them abuse it however they want. As the great Dr. Hendrix (PhD in shredding) once said, "I'm the one who's got to die when it's time for me to die, so let me live my life the way I want to".

I want to stop being punished for taking responsibility for myself, and stop seeing situations where people "need" to go out and buy a new TV and new living room furniture, because they have too much in the way of liquid assets for them to get government aid. So...the solution is to waste the money and take mine!? No...I think not. This isn't some abstract scenario, either, this was a situation faced by my wife not a week ago (she sets people up with supplemental plans for medicare, and adjusts their current government plans)

the problem we Libertarians have is being in a society where people think it's never okay for anyone to suffer, and anyone else's suffering necessitates both government and community intervention. I disagree. I think life isn't fair, and everyone should play the cards they are dealt.

A lot of people think that's callous and heartless, but I'm not either of those. I simply think that private charities with infinitely more oversight, and far more efficient than government bureaucracy do a much better job of taking care of people, and can do it with less money, and do a better job of eliminating the leeches.

I suppose it's a bit of a pipe-dream at this point. If people at large were actually subjected to the consequences of their stupid decisions, there would be a mortality rate the likes we haven't seen since the black plague. A friend of mine refers to this period as "chlorinating the gene pool". A bit crude, I admit, but at any point in a civilization, will it ever be okay to allow the motivated innovators rise, and let the people who specifically work to accomplish nothing fall? This isn't cruel, it's simply life, and I don't think that every measure should be done to equal all playing fields, because some of them have a disparity due to the individual's motivations and nothing more.

When you punish hard work, people work less hard.

When people realize they can vote themselves benefits for a treasury they don't contribute to, a democracy begins to fall.

This is a long rant, I know, and I may have gotten off topic. Long story short, after seeing things like Project MKULTRA (look it up, great stuff!) and other ways the federal government has done everything in their power to con and manipulate it's constituents, I have lost all trust in them. It has a bit to do with having absolutely no oversight, and a bit to do with being lied to over and over. I've yet to see a well-run department of the government, and would prefer it if they kept their stingy little greedy little corrupt little hands out of my life, off of my paycheck, and out of my health decisions.

As far as decreasing the cost of health care? I think that's a huge issue, and something not to be ignored. I wish I knew more of the reasons behind it, but I have often found myself playing guitar or watching TV instead of looking into the problem. I'm not saying there isn't a problem, I really think there is, and I don't understand all of the facets of it. I do know that dealing with insurance companies has become a huge hassle for physicians, and many groups have to hire individuals who do nothing more than deal with insurance companies.

Here's an interesting article about physicians who have started trying a practice with /no/ insurance (none at all, they don't take it). Interesting read.
http://www.mysanantonio.com/news/lo...tus-quo-doctors-test-no-insurance-3500678.php

 

[JonScholl]

I'm trying to get back to the main purpose of the thread. In an ACO based system, the PCP's will be doing a majority of the legwork and decision making for patients, treatment options, where they will allocate the funding (which will be an average dollar amount per patient and decreasing spending will increase their year end bonus). PCPs will try to handle a majority of ailments which will ultimately leads to decreased referrals to specialists, especially since specialists cost more. In this system, specialists are pushed to the side.

Do podiatrists even have a role in ACOs?

 

[bobdolerson]

I was under the impression that we would have to pass the bill and allow it's infiltration before we understood what was in it. That's what the legislators said, anyway...

 

[heybrother]

For everyone's amusement - the Supreme Court has actually already reached their decision on the bill ie. whether they can rule on it, the mandate, severability. They likely decided the bill the Friday after the arguments. The decision isn't released until the writeup. We'll know soon enough.

 

[NeilD]

To all of the Obama bashing, anti-government health care, business driven medicine fans: Please do one thing for me to prove you are sincere. Turn down your Medicare at age 65. 66% of all health care in this country is run by the government. The 33% percent that is left is cherry picked by some of the richest corporations in America.

Who are the biggest fans of Medicare? Aetna, BC/BS, etc. Why? Because the government and the tax payers pick up the tab on the sickest. 60-70% of all health dollars are spent on the last 6 months of life. The privates insure the healthy and when they get sick deny coverage, throw them out, or worse say the treatment is experimental so as you watch your love one die you spend your kid's college fund, your nest egg and go bankrupt.

While we blame the patients for not having their 50 dollar co-pay and can't cover their 5,000 deductable and they claim we are ****** that charge too much the companies just smile and figure out the bonuses for the executives.

The solution has been simple offer Medicare to all. Those under 65 have to pay for it themselves (or their employer) then the healthy can offset some of the costs of the sick. Then the privates will have to offer a similar plan to compete and we start moving in the right direction. Oh I forgot Medicare sucks some will say. Until they are 65.

Doctor, you sound like you are working on the Obama campaign? Were you one of those doctors in the white coats at the White House?

 

[bobdolerson]

To all of the Obama bashing, anti-government health care, business driven medicine fans: Please do one thing for me to prove you are sincere. Turn down your Medicare at age 65. 66% of all health care in this country is run by the government. The 33% percent that is left is cherry picked by some of the richest corporations in America.

Who are the biggest fans of Medicare? Aetna, BC/BS, etc. Why? Because the government and the tax payers pick up the tab on the sickest. 60-70% of all health dollars are spent on the last 6 months of life. The privates insure the healthy and when they get sick deny coverage, throw them out, or worse say the treatment is experimental so as you watch your love one die you spend your kid's college fund, your nest egg and go bankrupt.

While we blame the patients for not having their 50 dollar co-pay and can't cover their 5,000 deductable and they claim we are ****** that charge too much the companies just smile and figure out the bonuses for the executives.

The solution has been simple offer Medicare to all. Those under 65 have to pay for it themselves (or their employer) then the healthy can offset some of the costs of the sick. Then the privates will have to offer a similar plan to compete and we start moving in the right direction. Oh I forgot Medicare sucks some will say. Until they are 65.

Why would I turn down something automatically provided upon turning age 65, considering that I'll have been paying more than my share for 40 years?

If that weren't the case, I'd say, "will do" and have every intention of keeping free of government ties.

I don't want their hands in my pocketbook, and I do everything I can to take care of myself. It's nobody's responsibility but mine to be healthy at 65, and I think the same regarding the costs of my health care.

None of this would be an issue if the incredible and incredibly expensive technology to diagnose and treat people didn't exist.

So....if someone invents something that's ridiculously expensive, and provides something with a longer life, they are entitled? Makes no sense to me.

If a cure for cancer gets developed, do people suddenly have a right to it? Did they have it before, and were just having their rights constantly violated? Who goes to jail for not inventing the cure? If nobody, then it would seem that human innovation subsequently provides greater entitlements, and I think that's a stretch, and I don't really see the logic behind it.

If I invent an iPad, the technology is mine to sell (at whatever ridiculous price), so why is the same not true for health? Isn't life a bit easier and more efficient with a smart-phone and a working car? Why are these not rights?

My issues with the current president go way beyond his political ideology, but that's a discussion for another place. I care little about political affiliation, I simply am voicing my disagreement with "entitlement" and idea of health care and health insurance as a "right".

I don't think it's society's responsibility to provide equality, nor do I think it's the government's role to keep people healthy, make people healthy, or give them longer lives.

If I wasn't paying for this health care for the next several decades, I would be the first to say I didn't want it, just like I won't take food stamps or government charities now (thought I had 2 years of very little money and every opportunity to take them).

I would rather not have the nice car, not have the nice TV, not have cable and exercise regularly to avoid extraneous medical bills than take someone else's handouts.

 

[SuperFeisty]

Yes bob, but we are 1 in 10,000... Healthcare isn't the specific problem. We grew up in a weak generation, with no challenges to overcome and family values that are declining faster than the Aral Sea's water table. As an immigrant myself, I look around at all the amazing opportunities the US offers and how few people actually utilize these chances. Our generation has become filled with hand outs that tell us, "hey, its ok to do nothing or screw up, we will bail you out." What you and I see as responsibilities to yourself, millions blame someone else. Only if this mentality is gone can we Americans really move forward. Yes, I understand that I am generalizing, but due to my all nighter, I lack the elocution and researching tools to support this claim.

 

[bobdolerson]

Yes bob, but we are 1 in 10,000... Healthcare isn't the specific problem. We grew up in a weak generation, with no challenges to overcome and family values that are declining faster than the Aral Sea's water table. As an immigrant myself, I look around at all the amazing opportunities the US offers and how few people actually utilize these chances. Our generation has become filled with hand outs that tell us, "hey, its ok to do nothing or screw up, we will bail you out." What you and I see as responsibilities to yourself, millions blame someone else. Only if this mentality is gone can we Americans really move forward. Yes, I understand that I am generalizing, but due to my all nighter, I lack the elocution and researching tools to support this claim.

This is exactly what I mean when I say that Libertarianism is a fantasy that can never come to fruition. It necessitates personal responsibility the likes of which millions and millions of citizens don't have, aren't willing to have, and don't even know how.

Depressing, really.

 

[RockFoot]

perhaps if the gene pool were chlorinated by some terrible catastrophe and the survivors had to pull themselves up by their boot straps, perhaps then a libertarian society could be achieved. Bring on the zombies!

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