Feb 27, 2010
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Let me state that I am an independent voter. I watched a Glen Beck episode featuring practicing physicians, and medical students. I was quite surprised to see that the majority of medical students appear to favor versions of the current healthcare legislation which is being considered in congress.

I think that all future physicians should be aware that under current reform plans your reimbursement by Medicare will be determined by a independent government panel. As a matter of reality, when the government reduces reimbursement, private payors also tend to follow suit.


I copied a post from a medical student from the Anesthesiology forum and repost it here because it does an excellent job of summarizing this plan.

Independent Medicare Advisory Board
"The Senate bill would establish an Independent Medicare Advisory Board, which would be required to recommend changes to the Medicare program to limit its spending growth. Its recommendations would go into effect automatically unless Congress votes to block them. Such changes would be required if the Medicare trustees projected that the program’s spending per beneficiary would grow more rapidly than the medical inflation rate or the growth in per capita medical spending. The board couldn't change eligibility or benefits, so its recommendations would likely focus on Medicare Advantage plans and on payments to medical providers." (http://www.msnbc.msn.com/id/31389142...h-health_care/)

We're going to be indentured servants for our careers!! Under Obamacare this government appointed panel of 5-physician experts are in charge of lowering medicare reimbursements. We've been straddled by medical school debt and are being forced into lower salaries, the next few decades are gonna be rough if you're not 65+.

White House version of this new panel - it's a Trojan Horse.
http://www.whitehouse.gov/omb/blog/09/07/17/IMACUBend/

Folks I feel fortunate to be on the tail end of my career. If you want the government to have such a large control over your life, then by all means support this bill. If you dont want a government panel reducing your income simply based on a need to cut costs, then call your congressman and tell them to vote no.
 

IMDoc607

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Let me state that I am an independent voter. I watched a Glen Beck episode featuring practicing physicians, and medical students. I was quite surprised to see that the majority of medical students appear to favor versions of the current healthcare legislation which is being considered in congress.

I think that all future physicians should be aware that under current reform plans your reimbursement by Medicare will be determined by a independent government panel. As a matter of reality, when the government reduces reimbursement, private payors also tend to follow suit.


I copied a post from a medical student from the Anesthesiology forum and repost it here because it does an excellent job of summarizing this plan.

Independent Medicare Advisory Board
"The Senate bill would establish an Independent Medicare Advisory Board, which would be required to recommend changes to the Medicare program to limit its spending growth. Its recommendations would go into effect automatically unless Congress votes to block them. Such changes would be required if the Medicare trustees projected that the program’s spending per beneficiary would grow more rapidly than the medical inflation rate or the growth in per capita medical spending. The board couldn't change eligibility or benefits, so its recommendations would likely focus on Medicare Advantage plans and on payments to medical providers." (http://www.msnbc.msn.com/id/31389142...h-health_care/)

We're going to be indentured servants for our careers!! Under Obamacare this government appointed panel of 5-physician experts are in charge of lowering medicare reimbursements. We've been straddled by medical school debt and are being forced into lower salaries, the next few decades are gonna be rough if you're not 65+.

White House version of this new panel - it's a Trojan Horse.
http://www.whitehouse.gov/omb/blog/09/07/17/IMACUBend/

Folks I feel fortunate to be on the tail end of my career. If you want the government to have such a large control over your life, then by all means support this bill. If you dont want a government panel reducing your income simply based on a need to cut costs, then call your congressman and tell them to vote no.
I am with you 100%. Sometimes I wish I was on the tail end of my career before this was to happen. :mad::scared:
 

robrobbberts

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so its recommendations would likely focus on Medicare Advantage plans and on payments to medical providers.
Recommendations. So what they say, won't necessarily happen.

According to your second link, the board is:

empowering an independent, non-partisan body of doctors and other health experts to make recommendation about Medicare payment rates and other reforms
So who decides the payments right now? Bureaucrats. I personally would rather have people in the field making those decisions.
 

robrobbberts

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The reason that we go into medicine is not just to help people. If physicians were not one of the best paid and most respected professions, the best and brightest students would not be attracted to it. It does not make any sense to cut back on physician salaries without cutting back on nurses and assistants as well. I would defiantly not donate some of the best years of my life to toil away in school, then residency if I could make more, doing something less demanding and much easier. Something does need to happen, but cutting back on physician salaries is not it. If salaries are cut back you are going to get less qualified people to be your doctor since all those that would have formerly have gone into something else entirely. :eek:

Who says physician salaries are going to be cut? It's all unconfirmed conjecture at this point.
 

Excelsius

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... I am an independent voter. I watched a Glen Beck episode ...
Folks I feel fortunate to be on the tail end of my career. If you want the government to have such a large control over your life, then by all means support this bill. If you dont want a government panel reducing your income simply based on a need to cut costs, then call your congressman and tell them to vote no.
I have to say: it doesn't add much credibility to you when you are a doctor at the end of your career yet get your news from a self-proclaimed entertainer and still don't know the difference between "affect" and "effect."
 

Climberak

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I have to say: it doesn't add much credibility to you when you are a doctor at the end of your career yet get your news from a self-proclaimed entertainer and still don't know the difference between "affect" and "effect."
seconded.
 

EastofEden

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I have to say: it doesn't add much credibility to you when you are a doctor at the end of your career yet get your news from a self-proclaimed entertainer and still don't know the difference between "affect" and "effect."
not to mention...how exactly is one "straddled" by medical school debt? Did he mean "saddled"?

We're going to be indentured servants for our careers!! Under Obamacare this government appointed panel of 5-physician experts are in charge of lowering medicare reimbursements. We've been straddled by medical school debt and are being forced into lower salaries, the next few decades are gonna be rough if you're not 65+.

White House version of this new panel - it's a Trojan Horse.
http://www.whitehouse.gov/omb/blog/09/07/17/IMACUBend/

Folks I feel fortunate to be on the tail end of my career. If you want the government to have such a large control over your life, then by all means support this bill. If you dont want a government panel reducing your income simply based on a need to cut costs, then call your congressman and tell them to vote no.
From the perspective of a Canadian very willing to enter a *socialized* medical system, I find this whole health care debate very reminiscent of me as a five year old, refusing to have a splinter pulled out! You know you have to reform, so quit stalling and getting hung up on details and do it already! Lols at those people who think you don't need health care reform...I bet they think you can just keep a 2 inch splinter in your foot and it will all turn out okay too!:laugh:
 

chessknt87

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Who says physician salaries are going to be cut? It's all unconfirmed conjecture at this point.
Ah, another acolyte of Pelosiism--pass it to find out what happens! Its like a box of cracker jacks that costs 1/6 of the GDP, so lets not bother conjecturing about it. Just pass it and deal with the consequences later, because 'reform' cant possibly make anything worse right?
 

strv04

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i was going to post some reasonable argument and attempt to convince my colleagues against supporting the current reform but i'm beginning to realize that it would be better not to argue with my brainwashed liberal future colleagues and instead learn to exploit/manipulate their lunacy as my career moves forward
 

coldweatherblue

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i was going to post some reasonable argument and attempt to convince my colleagues against supporting the current reform but i'm beginning to realize that it would be better not to argue with my brainwashed liberal future colleagues and instead learn to exploit/manipulate their lunacy as my career moves forward
X2.. an attending presents an issue that will negatively affect all physicians and the primary response is grammatical critiques and pre-meds from Canada who claim to know what's best for US health-care.
 
Feb 14, 2010
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i was going to post some reasonable argument and attempt to convince my colleagues against supporting the current reform but i'm beginning to realize that it would be better not to argue with my brainwashed liberal future colleagues and instead learn to exploit/manipulate their lunacy as my career moves forward

I completely agree. The overwhelming majority of my class is full of liberals and it seems that there is no talking to them. Yes, it would be nice for "universal healthcare" but no one seems to understand the negative aspects of the proposed plan. *sigh*
 

Climberak

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There's enough of this healthcare debate bullcrab in the pre-allo forum (see "don't go to medical school if the healthcare bill passes"). Don't let it spill into here as well. Mods, is this thread really related to discussions pertaining to allopathic medical schools?
 
OP
O
Feb 27, 2010
66
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Attending Physician
I have to say: it doesn't add much credibility to you when you are a doctor at the end of your career yet get your news from a self-proclaimed entertainer and still don't know the difference between "affect" and "effect."
Firstly, where did it state that I get news from Glen Beck? I stated that I watched an episode of Glen Beck. I get my news from a variety of sources and am an avid reader from all sources both liberal Democratic and conservative Republican. Secondly, my error in using "effect" rather than "affect" reflects an attempt to bemean or belittle based on a grammatical error is an effort to deflect from the primary topic of discussion and the relative merits or deficits of my viewpoint. Yes one day young future doctors, you will also make such mistakes as you get older.

Next IMHO it is naive to believe that any panel of "independent" advisors on a government panel are actually independent. They will reflect the bias of the people (politicians) selecting them. For example, the Supreme court is an independent branch of government but I seriously doubt anyone would argue that the Supreme court justices selections are not biased by the President selecting them.

Lastly, I totally respect the moderator's right to move the topic to a different forum, although I would argue that this topic is indeed probably one of the most important topics in medicine today, and should be in an allopathic medical student's forum. This topic is indeed of critical importance to medical students whether they agree or disagree with my particular viewpoint.
 
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robrobbberts

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Ah, another acolyte of Pelosiism--pass it to find out what happens! Its like a box of cracker jacks that costs 1/6 of the GDP, so lets not bother conjecturing about it. Just pass it and deal with the consequences later, because 'reform' cant possibly make anything worse right?

That is not at all what I said. I pointed out a few fallacies in his logic. My minute points have yet to be refuted. I have yet to see any actual proof that physician salaries will be affected at all.


X2.. an attending presents an issue that will negatively affect all physicians and the primary response is grammatical critiques and pre-meds from Canada who claim to know what's best for US health-care.

I'm not Canadian, and while I am a 'pre-med,' I am also a 32 year old engineer who has been working for quite some time now. I have a clear idea of how the world works and I'd like to think I can sift through obvious political garbage in order to clarify some points. I also don't claim to know what is best, but it is quite clear that the current insurance system is not working.

....and for the record, I am not entirely happy with this piece of legislation, I just wish the fear-mongering would stop, and this country would have some straight forward discourse on the subject. The whole health-care debate has been nothing but political games from both sides, it's quite disgusting.
 
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chessknt87

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I just wish the fear-mongering would stop, and this country would have some straight forward discourse on the subject. The whole health-care debate has been nothing but political games from both sides, it's quite disgusting.
Amen, but the Dems have made it their god-given duty to ram this bill through when nobody even knows what the hell is in it. Pelosi even said wed jsut find out, like it was some sort of gift she was giving to us.
 

robrobbberts

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Next IMHO it is naive to believe that any panel of "independent" advisors on a government panel are actually independent. They will reflect the bias of the people (politicians) selecting them. For example, the Supreme court is an independent branch of government but I seriously doubt anyone would argue that the Supreme court justices selections are not biased by the President selecting them.

I think that is quite obvious, but who decides on Medicare payments to medical providers right now? Also, what exactly would a group of doctors and health care workers gain from recommending the lowering of salaries for other health care workers?
 

thedrjojo

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Amen, but the Dems have made it their god-given duty to ram this bill through when nobody even knows what the hell is in it. Pelosi even said wed jsut find out, like it was some sort of gift she was giving to us.

more fear mongering. Ram it through after a year of debate, townhalls, endless floor debate, and simple republican saying No instead of discussion of what is in it. Yeah, ramming it through...

That being said, I am with Kusinich on this one and don't like this bill...
 

coldweatherblue

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I'm not Canadian, and while I am a 'pre-med,' I am also a 29 year old engineer who has been working for quite some time now. I have a clear idea of how the world works and I'd like to think I can sift through obvious political garbage in order to clarify some points. I also don't claim to know what is best, but it is quite clear that the current insurance system is not working.
read the thread again, I wasn't referring to you.
 

chessknt87

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more fear mongering. Ram it through after a year of debate, townhalls, endless floor debate, and simple republican saying No instead of discussion of what is in it. Yeah, ramming it through...

That being said, I am with Kusinich on this one and don't like this bill...
It is ramming it through when you use an underhanded maneuver that circumvents a constitutional measure that enables the unified minority to block laws they dont like (has it occurred to you there may be a reason why EVERY REPUBLICAN has said no besides the perception that they are terrible politicians?). It is also ramming it through when the leader of the House tells everyone to pass it in order to find out what is actually in it. I try not to play too much partisan politics, but the democrats are spitting on the Constitution and the American people by trying to pass the healthcare bill via reconciliation without even KNOWING WHAT IS IN IT!
 

MedicineDoc

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It's funny how the specialist decry an independent committee when the AMA specialist dominated committee to advise the center for medicare services grossly inflated specialist services at the expense of primary care leaving the current mess with nurse practitioners and primary care in shambles. If primary care had been given representation equal to it's ranks and the ama had acted responsibly everyone would have a much better functioning medical system and doctors wouldn't feel the need to become glorified techs who are best at wasting money.
 
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I completely agree. The overwhelming majority of my class is full of liberals and it seems that there is no talking to them. Yes, it would be nice for "universal healthcare" but no one seems to understand the negative aspects of the proposed plan. *sigh*
Medical school admissions committee select for bleeding heart liberals as best they can because the tortuous and torturous process of medical school with its endless hours of studying and then the privilege of paying a tuition to work in a hospital; residency with its insane hours and abusive nature; and then getting out into the real world and getting hit with litigious and ungrateful patients, sacrifices to personal and family life, difficult hours, endless paperwork, and declining reimbursements would make anybody jaded. If you don't start at the far left of the spectrum, the finished product (ie, fully-trained doctors) would be so cynical as to boggle to mind.
 

thedrjojo

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It is ramming it through when you use an underhanded maneuver that circumvents a constitutional measure that enables the unified minority to block laws they dont like (has it occurred to you there may be a reason why EVERY REPUBLICAN has said no besides the perception that they are terrible politicians?). It is also ramming it through when the leader of the House tells everyone to pass it in order to find out what is actually in it. I try not to play too much partisan politics, but the democrats are spitting on the Constitution and the American people by trying to pass the healthcare bill via reconciliation without even KNOWING WHAT IS IN IT!
If there were any issues, any whatsoever, that the republicans voted not as a unified party of no, but actually on their own independent thought, then your argument would have some validity, but since they obstruct every piece of legistlature (the "stimulus plan" had to be watered down so much and then only 1 republican who is considered a liberal republican was able to cross over).

And where in the constitution is the filibuster? It aint in there. http://www.usconstitution.net/constfaq_a7.html and search for filibuster (its near the bottom of the page... you could also find it on many other websites). Nope, nothing in the constitution. The founders wanted everything to have a simple majority of votes to pass it. So why do republicans hate the founders and won't give the healthcare bill the vote that the founders wanted?!?
 

chessknt87

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If there were any issues, any whatsoever, that the republicans voted not as a unified party of no, but actually on their own independent thought, then your argument would have some validity, but since they obstruct every piece of legistlature (the "stimulus plan" had to be watered down so much and then only 1 republican who is considered a liberal republican was able to cross over).

And where in the constitution is the filibuster? It aint in there. http://www.usconstitution.net/constfaq_a7.html and search for filibuster (its near the bottom of the page... you could also find it on many other websites). Nope, nothing in the constitution. The founders wanted everything to have a simple majority of votes to pass it. So why do republicans hate the founders and won't give the healthcare bill the vote that the founders wanted?!?
Our Consitution is largely derived from the Roman Republic constitution with British influences. The Romans had a practice of unofficial filibuster, so the founding fathers were clearly aware of it and did not explicitly try to stop it (but rather gave the Senate the power to make its own rules).

Even so, the way in which Reconciliation is being utilized for such a significant bill is a horrible contortion of its original function.
Under the original design of the Budget Act of 1974, reconciliation had a fairly narrow purpose--It was to apply to a single fiscal year and be directed primarily at spending and revenue legislation. Reconciliation has been abused ever since (by BOTH parties) and now it appears it will be used to pass on the biggest, most contentious law in the history of the country, Obamacare. In other words, it will now only take a majority (51 votes) to end debate and pass bills into law.

Democrats should be very worried about this as well, as it sets a precedent for Republicans to wreak havoc later this year when they dominate Congress again. I dont think anyone besides Rush Limbaugh wants them to have full power, we need the balance between stupid and stupider.

BTW the stimulus plan was one of the worst pieces of legislation ever passed. If you honestly think the government can stimulate the economy without massive adverse effects, I suggest you look at how capitalism (NOT socialism) works.
 

DoctwoB

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Our Consitution is largely derived from the Roman Republic constitution with British influences. The Romans had a practice of unofficial filibuster, so the founding fathers were clearly aware of it and did not explicitly try to stop it (but rather gave the Senate the power to make its own rules).

Even so, the way in which Reconciliation is being utilized for such a significant bill is a horrible contortion of its original function.
Under the original design of the Budget Act of 1974, reconciliation had a fairly narrow purpose--It was to apply to a single fiscal year and be directed primarily at spending and revenue legislation. Reconciliation has been abused ever since (by BOTH parties) and now it appears it will be used to pass on the biggest, most contentious law in the history of the country, Obamacare. In other words, it will now only take a majority (51 votes) to end debate and pass bills into law.

Democrats should be very worried about this as well, as it sets a precedent for Republicans to wreak havoc later this year when they dominate Congress again. I dont think anyone besides Rush Limbaugh wants them to have full power, we need the balance between stupid and stupider.

BTW the stimulus plan was one of the worst pieces of legislation ever passed. If you honestly think the government can stimulate the economy without massive adverse effects, I suggest you look at how capitalism (NOT socialism) works.
To be fair, many prominent economists agree that government-based expansionary fiscal policy is exactly what is needed to help counteract a recession. The problem then becomes that gov't is very willing to spend their way out of a recession, but not perform contractionary fiscal policy (cut spending) during boom times. That and politicians often use stimulus money as a way to lather pork on their district, which is far from the most efficient use of said stimulus.

Now back on topic, I'd hardly say that this is the most important piece of legislation ever passed. At its core, all this does is expand medicaid coverage, reorganize the panel that decides medicare reimbursements (bc the current system of giving specialists the dough while sh**ing on primary care is broken), mandate coverage, prohibit denying coverage based on pre-existing conditions, and create accessible marketplaces for insurance (increasing efficiency and choice among insurers).

Now physician salaries may go down because of this (more people on medicaid = more medicaid patients = less revenue), but on the whole theres nothing terribly radical about this bill. At its core it comes down to whether you agree with expanding medicaid or not.
 

Dr Oops

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If there were any issues, any whatsoever, that the republicans voted not as a unified party of no, but actually on their own independent thought, then your argument would have some validity, but since they obstruct every piece of legistlature (the "stimulus plan" had to be watered down so much and then only 1 republican who is considered a liberal republican was able to cross over).

And where in the constitution is the filibuster? It aint in there. http://www.usconstitution.net/constfaq_a7.html and search for filibuster (its near the bottom of the page... you could also find it on many other websites). Nope, nothing in the constitution. The founders wanted everything to have a simple majority of votes to pass it. So why do republicans hate the founders and won't give the healthcare bill the vote that the founders wanted?!?
if you don't think the dems spout as much political and rhetorical bs as the repubs u r a moron. The dems would filibuster just as much if they were in the other position get a clue look past the party line garbage.
 

badasshairday

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To be fair, many prominent economists agree that government-based expansionary fiscal policy is exactly what is needed to help counteract a recession. The problem then becomes that gov't is very willing to spend their way out of a recession, but not perform contractionary fiscal policy (cut spending) during boom times. That and politicians often use stimulus money as a way to lather pork on their district, which is far from the most efficient use of said stimulus.

Now back on topic, I'd hardly say that this is the most important piece of legislation ever passed. At its core, all this does is expand medicaid coverage, reorganize the panel that decides medicare reimbursements (bc the current system of giving specialists the dough while sh**ing on primary care is broken), mandate coverage, prohibit denying coverage based on pre-existing conditions, and create accessible marketplaces for insurance (increasing efficiency and choice among insurers).

Now physician salaries may go down because of this (more people on medicaid = more medicaid patients = less revenue), but on the whole theres nothing terribly radical about this bill. At its core it comes down to whether you agree with expanding medicaid or not.
Good summary. However, they should have added a provision to all for interstate competition. By mandating coverage and no denials for preexisting conditions, the insurance bizzness is just going to charge an arm and a leg for coverage. We need competition to drive down premium prices. This won't happen as long as 1-2 insurance companies running 80% or more of the business in each state.
 

xrevision

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Exactly badasshairday, we haven't done anything by passing this bill because there are existing insurance monopolies in each state. And thank you AMA for selling us out to this "plan". We didn't even get tort-reform out of it.
 

bronx43

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Good summary. However, they should have added a provision to all for interstate competition. By mandating coverage and no denials for preexisting conditions, the insurance bizzness is just going to charge an arm and a leg for coverage. We need competition to drive down premium prices. This won't happen as long as 1-2 insurance companies running 80% or more of the business in each state.
I agree. They'll either cut reimbursement rates, or jack up coverage prices (probably a combination of both), neither of which will make the public happy.
 

Lokhtar

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Bingo, those on the right don't realize how much rejoicing the Liberals will do if the individual mandate goes away. You know who lobbied the hardest for the mandate? The insurance companies. Why? If they don't have healthy young people in the group that can subsidize coverage for those with pre-existing conditions, they won't stay in business very long. So they'll jack up prices so high, the government will have to step in and provide an alternative, or they'll go under and the government will have to step in and provide an alternative. It's that simple.

And in the interest of full disclosure, I support a Single Payer system (but I'm trying to stick to the facts). But I've actually studied this bill in detail (and read all of it - taking a health policy class, and 100% of it was focused on reading and discussing this bill)....