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Podiatry's Future and Healthcare Reform Impact
- Thread starter JonScholl
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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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I don't think zombies have much use for podiatrists.. Maybe you could advertise the ability to make people run faster..lol
My point is simply this. People complain that they do not want the government running healthcare because it would be bad in many ways. Everything from poorly managed to rationing of care. Yet they have no problems with Medicare at 65. The least restrictive plan I deal with when ordering tests or performing surgery is Medicare. 66% of all healthcare is government run and really it's the 33% left that will be affected by any reform. These primarily younger and healthy people pay huge premiums for high co-pays and deductables. Someone who makes a gross salary of say 50,000 (family of 4) then has to pay 12,000 for family health insurance then has to cover housing, transportation, utilities, local taxes, auto insurance, food, etc. with the remaining 38,000. Forget about college funds or additional retirement. Hence why those under 50K pay little or nofederal taxes. So why not make Medicare available for all? Those who haven't paid up front (retirees) would pay for it as individuals or through employers. If this plan is good when you are 65 why is it bad at 35? If someone prefers BC/BS they can choose that over Medicare at 35. Choice remains.
As far as the Obama comment. No I was not one of the white coat people and my only reference is the Obamacare reference drives me crazy. If the plan eventually works will the Republicans still call it Obamacare? Hmmmmmm.
BTW it's the insurance companies who are the problem. I do believe in personal responsibility when it comes to health. However, if you flip your car, your child gets a rare cancer, your teenage son develops schizophrenia, or your wife breast cancer, you will soon see that it is the privates who ration care and also will see how fast even the biggest nest egg can vanish.
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Well stated! I think there would be a sudden increase in Republicans referring to it as the "bipartisan American Health bill".
I understand what you're saying, I suppose I just don't see a way to realistically expect such expensive treatment without losing so much money. Insurance is for a catastrophic event, and the more coverage you desire, the more you'll pay in premiums.
Is this not a reasonable expectation?
If you get a rare cancer that has a treatment that cost billions to develop, what is to be expected of the patient? This is a service, a product, and it's price reflects that, doesn't it?
Are you for a single payer system?
Thanks for your replies, podfather! You know more about the system than I do, and while we may or may not disagree with the role of government in health care, it's well known to me that many of my ideas are based in philosophy and ideology, without a firm understanding as to their implementation.
I do see the inefficiency of insurance companies, and how much frustration physicians have in dealing with them. I don't, however, see a reasonable way to provide such expensive coverage to people. This is a problem with pouring so much money into the health care system, is we wind up with the ability to treat a lot of things, and they all come with huge price tags.
Shouldn't it be up to the doctor to decide what tests should be done, and not up to the insurance to decide whether or not to reimburse them? Would pushing the system to be doctor-directed and not insurance-directed be possible? How do you prevent the insurance fraud that would inevitably become more commonplace with that approach?
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Are there any studies that show exactly how healthcare spending is happening? Say, percentages of costs sunk in long term treatments, emergency surgeries, etc... I was under the impression that a significant percentage stems directly from lack of personal responsibility to the patient? While I am in the infancy of tax paying, I would much rather pay for the healthcare of a little girl whose been affected with cancer (I volunteer regularly as well) than some lazy sack who eats potato chips and drinks soda all day and wonders how he got diabetes. Healthcare is designed to address the former. It SHOULD NOT be held accountable for the latter.
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This is where you get problems. People don't want the government to tell them how to live their lives (and they shouldn't), but think the government should have a role in dealing with the problems they face for living a dangerous lifestyle.
My views towards medicare and government involvement in healthcare would be radically different if people were eliminated from assistance programs by living in unhealthy ways. You're not required to live healthy, but if you want other people to be forced to cover the bills, there should be some accountability...
So many gray areas...
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What bob just said and the illusion that healthcare makes us healthier are my two main problems with government guaranteed care.
We can't have out cake and eat it too. I think that if we have universal healthcare, the government needs to start regulating lifestyles. Forced activity, fat-tax, stop risky behaviors like any dangerous sports, etc.
That being said, no one wants their lives regulated and so I think we cannot have healthcare. It's not my job or responsibility to pay for someones spinal injury because his parachute opened too late after skydiving, but that is exactly what government controlled care forces us to do.
I also think its silly to think that universal healthcare is something we need as a society. The option of going to a doctor won't make us healthy, but our lifestyles are what dictate our healthiness. I am willing to conceive that allowing everyone access to healthcare will actually promote more unhealthy lifestyles as those who are currently doing their best to take care of themselves because they don't have access will no longer have monetary incentive to eat right and excercise.
We can't have out cake and eat it too. I think that if we have universal healthcare, the government needs to start regulating lifestyles. Forced activity, fat-tax, stop risky behaviors like any dangerous sports, etc.
That being said, no one wants their lives regulated and so I think we cannot have healthcare. It's not my job or responsibility to pay for someones spinal injury because his parachute opened too late after skydiving, but that is exactly what government controlled care forces us to do.
I also think its silly to think that universal healthcare is something we need as a society. The option of going to a doctor won't make us healthy, but our lifestyles are what dictate our healthiness. I am willing to conceive that allowing everyone access to healthcare will actually promote more unhealthy lifestyles as those who are currently doing their best to take care of themselves because they don't have access will no longer have monetary incentive to eat right and excercise.
Look I am not arguing that you should not take Medicare. You are correct. You and I have paid into the system and should get what we paid for. My point is two-fold: One if you and others feel that government run healthcare is so bad then how in good conscious can you accept a bad health insurer at age 65? If it's not bad then why can't those under 65 buy it out of their own pockets. It would create more competition for one of the biggest problems; the cherry picking, fee slashing privates. The government would NOT pay for those under 65 and the system could attract younger, typically healthier people helping to offset the cost of the more senior, Perhaps some would chose to have Medicare for their entire life as a "personal choice".
I believe in personal responsibility and believe discounts should be given for behaviors that are healthy (I wouldn't get any, my choice). Yes you may decide to go without insurance but then who pays when you flip your car and end up with a 1,000,000 hospital bill? The tax-payers.
Finally let's tell the truth. How do doctors and hospitals make money? By testing and doing. Why do hospital's tout the doctor who seems to cut everyone and ignore the ethical one? Money. We should be paid fairly for hard work, but at what cost to people and society?
For those making $ 50,000 or less with a family of 4, health insurance eats up 15,000 of their income each year. Then when they get an employer plan today we have 5,000 dollar deductable and 50 dolar co-pays. Imagine living paycheck to paycheck. Someone who works hard, lives within their means, and keeps plugging away. Their child wakes up sick and you scrape enough together to take them to the doctor. Pay the entire visit (perhaps even with overtesting) because of a deductable and then borow money to pay for the latest greatest drug. Your child gets better and you manage by making chili 4 times this month. Your maxed out but making it and now you find a lump in your breast.......................................................................................
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Agreed. It's an unfortunate predicament in the U.S of A that generally the lowest of the lower class and middle-upper class have the luxury of headache free medical care.
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I think you need to inquire as to why our costs are so high, and also think about the quality of care we have available. I do not understand why obama wants to dock doctors salaries and continue to allow insurance executives to take multi-million dollar salaries and bonuses on top of that. That money is spent to fund the insurance pools and pay for care, not exotic cars and vacation homes for those working at the top of the insurance industry.
Being a science major, I relate it to common experiments I do. This problem can be assumed to have a theoretical yield of money spent on care being what the taxes and insurance bills add up to. The percent yield being how much money is actually spent on health care is much lower I assume. How can we raise our yield?
In my opinion, if the government wants to intervene, they should stop allowing insurance companies to set huge salaries for the people in control, stop illegal immigrants from sucking money out of the system intended to cover those who paid for it. Try to help hospitals and practices reduce their shrink or amount of loss. If the money that is spent for health car in the united states was not in a system diluted with so much fraud and greed we would not be ranked 27th.
To clarify, I am expressing the salaries of insurance company executives so strongly mainly because not many other people regularly do and it is something that needs to be given thought.
The government can not control the salaries at the publicly owned insurance companies. Even though I lean left,I feel that is not government's role. What we need is true health reform not insurance reform. If the privates had competition and were required to take on the sick like Medicare we would see change. If Medicare were offerred to all with those under 65 paying for it themselves we would see reasonable price plans coming out of the privates.
We not completely innocent either. Physician owned hospitals, MRIs, etc seem to increase utilization. Those who do more make more whether it's needed or not. The public is also spoiled. They can wake up with a mild pain in their fifth toe, can be seen almost immediately, request and get a MRI, and buy an expensive med with their plan. When in a day or two that pain would have been gone.
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Regardless of all of your opinions about the problems with the government health care plan/reform, change is definitely imminent.
In my opinion, ACO's will have the ability to save a large chunk of government money, and as a result their popularity and usage will increase. ACO's will eventually become a staple in the American healthcare system. With that being said, a specialists role in an ACO is relatively limited. This is simply due to the fact that PCP's will be in charge of allocating which patients actually "need" the expensive care of the specialist or not. Basically, the PCP's will treat the majority and the average patient, and the medical issues that PCP's cannot manage and treat will be sent off to specialists. In an ACO a dollar amount is allocated per patient and if the entire group spends less than that dollar amount indicated per patient, the extra money will be split among the physicians in the group at the end of the year in something called a shared savings program.
The main issue here is this, within the current ACO model a podiatrist is not looked at as a medical professional (MD, DO, PA, NP), instead a podiatrist is looked at as a provider/supplier (DPM, Chiro, etc). In an ACO, DPM's will not be allowed to influence the delivery of health care because only professionals will constitute the board of medical directors. The board will be the ones to decide where money will be allocated and decipher which specialities will be most useful. Without a podiatrist on the boards in ACO's, who will fight for our inclusion into an ACO? Additionally, physicians involved in a shared savings programs may look at things such as nail care and orthotics as expensive and unnecessary use of funding. Could this result in PCP's and Orthopedics do a majority of our caseload instead? This is a scary possibility, but ACO's are a subject that current and future podiatrists should start reading more about.
In my opinion, ACO's will have the ability to save a large chunk of government money, and as a result their popularity and usage will increase. ACO's will eventually become a staple in the American healthcare system. With that being said, a specialists role in an ACO is relatively limited. This is simply due to the fact that PCP's will be in charge of allocating which patients actually "need" the expensive care of the specialist or not. Basically, the PCP's will treat the majority and the average patient, and the medical issues that PCP's cannot manage and treat will be sent off to specialists. In an ACO a dollar amount is allocated per patient and if the entire group spends less than that dollar amount indicated per patient, the extra money will be split among the physicians in the group at the end of the year in something called a shared savings program.
The main issue here is this, within the current ACO model a podiatrist is not looked at as a medical professional (MD, DO, PA, NP), instead a podiatrist is looked at as a provider/supplier (DPM, Chiro, etc). In an ACO, DPM's will not be allowed to influence the delivery of health care because only professionals will constitute the board of medical directors. The board will be the ones to decide where money will be allocated and decipher which specialities will be most useful. Without a podiatrist on the boards in ACO's, who will fight for our inclusion into an ACO? Additionally, physicians involved in a shared savings programs may look at things such as nail care and orthotics as expensive and unnecessary use of funding. Could this result in PCP's and Orthopedics do a majority of our caseload instead? This is a scary possibility, but ACO's are a subject that current and future podiatrists should start reading more about.
ACOs are in fact already organizing and awaiting what they will be mandated to do. Hospital sgetting the pie is a potential issue. Ask DPMs how many get paid to take ER call? There is a silver lining. When specialties get carved out we will take over some traditional ortho (at a reduced cost) and ethical, cost conscious docs will now be the super stars vs. Joe cut everybody.
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That's a good read Jon, thanks for your input on this. However, isn' it also true that we don't have enough primary care physicians to serve the population? Given that tuition is increasing every year and recently the med school debt just hits the $200,000 mark, less and less students will be interested in primary care. As my econ professor puts it, the healthcare reform will only be "minimal attempts around the fuzzy edges", unless the midlevel providers gain more access and authorities. In which, of course, seems unlikely due to the powerful physician union (hence the AMA). Considering how even professionals with comparable medical education are struggling for years with the AMA (first DOs, now DPMs), midlevel providers will not gain much prevalence over the future healthcare "industry".
What do you guys think, both current students and attendings, is the healthcare reform an opportunity or a death penalty for DPMs?
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Ding ding ding
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I was hoping to hear from some attendings as well.
Everyone can argue what's wrong with the system, society, et cetera. Meanwhile, we should be focusing on what WE can do if the bill sticks. First, if insurance becomes interstate, we need to band together as a profession to negotiate rates. Second, a HUGE part of our profession is preventative medicine. Personally, I want to take advantage of that with PCMH and ACO's. WE can help primary care meet five star measures and P4P. They need us and we need them. IMHO.
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Agreed
I would also like to hear from some Practicing Pods like the people who posted above me. What would be the plan of action if this took place? Is it certain doom or would we be able to capitalize on the new boom of patients that would be flocking to the health care providers.
Im hoping we will know the supreme court verdict in the next week or sooner.
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The arguments against single payer don't make sense to me. Countries like Australia and France seem to have a way better system than we do in the USA. Less expensive, more effective, and covers everyone. Our system leaves 50 million+ people out. It's not acceptable.
Obamacare shouldn't be confused with single payer though. It seems like a gift to insurance companies.
Obamacare shouldn't be confused with single payer though. It seems like a gift to insurance companies.
We are not Australia or France. Healthcare is not a bureaucracy unto its own. You cant just say "they have a good system lets copy it." their system works in a larger framework of government. That larger framework is vastly different from ours. Socialism...vs relatively free market capitalism
. Just made that up.
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We are not Australia or France. Healthcare is not a bureaucracy unto its own. You cant just say "they have a good system lets copy it." their system works in a larger framework of government. That larger framework is vastly different from ours. Socialism...vs relatively free market capitalism
Excatly, And some of these Countries have programs to where students go to medical/pod/dental school after high school, most of them dont have to pay for this schooling either. Granted they do not recieve the pay American Doctors may expect but there is an equalizer in a sense for them. If we try to revert to their ways without certain implementations (the one I mentioned and many others) we could shoot ourselves in the foot.
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http://www.nydailynews.com/news/nat...blicans-promise-full-repeal-article-1.1103195
Update: We should know the status of our futures tommorow.
sorry to double post but I found the information pretty useful maybe someone else will also.
Update: We should know the status of our futures tommorow.
sorry to double post but I found the information pretty useful maybe someone else will also.
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I'm crossing my fingers.
