Views on Obamacare

[wondergirl3]

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Do you guys think that Obamacare is just a temporary thing or do you believe it is here to stay?

Sincerely,
wondergirl3

(All of the doctors I shadowed over the past few week couldn't stop b**ching about it!)

 

[Pacna]

Oh, it's here to stay. Once a group of people are benefiting from a public policy, it becomes much harder to repeal, and there are a lot of people benefiting from the ACA (probably you if you're planning to stay on your parents' insurance into med school!).

 

[WingedOx]

The average physician's opinion about the ACA has a near perfect correlation with said physician's political leanings prior to the ACA ever being proposed.

 

[Psai]

The average physician's opinion about the ACA has a near perfect correlation with said physician's political leanings prior to the ACA ever being proposed.

Not a physician yet but I'm a registered democrat and I'm definitely against the ACA

 

[Banco]

I shadowed a doctor that hated obama and naturally hated obamacare. She was also really greedy and thought that the entire 2012 election was rigged. She also was too old to implement EHR correctly so she kept venting it to all her patients. I would seriously cringe.

 

[Jedqui]

Not a physician yet but I'm a registered democrat and I'm definitely against the ACA

Why? Just wondering

 

[aedie]

It's called the Affordable Care Act, or ACA, not obamacare.

 

[Lysinee]

Obamacare is the best thing that could have happened in the medical field.

Obamacare will be switched to Hillarycare in 2016.

 

[mik30102]

The physicians ive worked with seemed to be about 50:50 on the issue. I personally think it will stay, but hope it is replaced with a single payer option 😛.

 

[cidem2065]

...to make a bad situation worse.

 

[mimelim]

I will make a ton less money over my career because of the ACA. On the other hand, my first hand impression of it is only good. Drastically reducing costs for people that need costs reduced and somewhat of a step toward fixing issues. I know several people, personally as well as my patients that it has helped enormously. Is it great? Not really, but anyone that champions our current system as a whole as not needing to drastically change needs to have their head examined.

 

[allantois]

I will make a ton less money over my career because of the ACA. On the other hand, my first hand impression of it is only good. Drastically reducing costs for people that need costs reduced and somewhat of a step toward fixing issues. I know several people, personally as well as my patients that it has helped enormously. Is it great? Not really, but anyone that champions our current system as a whole as not needing to drastically change needs to have their head examined.

Which specialties do you think the change will affect most financial-wise?

 

[NickNaylor]

I think things like the exchanges/marketplaces and increasing the ease with which people can purchase insurance is a good thing. Not so convinced it's actually going to do much in terms of reducing costs, but I suppose we'll see. If the goal is to reduce costs, improving insurance coverage is only a bandaid and not a true solution.

Re: the above, procedural fields are the ones most likely to be hit heavily. As the payment begins to switch from fee-for-service to quality- and capitation-based models, things like primary care will likely see increases in reimbursement.

 

[MajorBubblez]

I don't think it was the right way to go. With that being said, I think it's obvious that our national healthcare needed significant improvement as the United States is hemorrhaging money. And while I don't agree with the ACA, I don't envy the people who have develop a solution.

 

[WingedOx]

I think things like the exchanges/marketplaces and increasing the ease with which people can purchase insurance is a good thing. Not so convinced it's actually going to do much in terms of reducing costs, but I suppose we'll see. If the goal is to reduce costs, improving insurance coverage is only a bandaid and not a true solution.

Re: the above, procedural fields are the ones most likely to be hit heavily. As the payment begins to switch from fee-for-service to quality- and capitation-based models, things like primary care will likely see increases in reimbursement.

Plus compensation for procedural specialties has been on an inevitable decline since before the ACA ever went into effect anyway.

My patient population is pretty heavily medicaid anyway, so with expanding medicaid coverage we now have a longer wait list for appointments with the same number of physicians. It creates an administrative headache, but it would take some serious mental gymnastics to say that the alternative was better.

 

[noleknight16]

They should repeal it and expand medicaid instead. But it's clear the president wanted to leave a legacy instead of doing the practical thing. Not sexy enough to expand a half-century old entity I guess.

 

[AM508]

While I don't particularly care to get involved in a big political debate today, I will address my opinion of whether it is temporary or here to stay. Realistically, I think that it would be extremely hard to repeal it in whole as some people call for. The popular elements such as covering pre-existing conditions, staying on parental insurance until 26, etc... will stay. I do think over the years the core of the law will be substantively changed, however. I wouldn't bet on grossly unpopular items like the individual mandate, employer mandate et al remaining unchanged. Because the law was passed in such a unilateral and haphazard closed-door manner, there is bound to be significant changes as administrations and congresses change over the next 10 years or so. There are also a number of court challenges still in progress, and assuredly more coming down the line, whose decisions will also alter the shape of the course of the law. In short, the law as it exists today will substantively change but I doubt it will go away completely.

 

[WingedOx]

They should repeal it and expand medicaid instead. But it's clear the president wanted to leave a legacy instead of doing the practical thing. Not sexy enough to expand a half-century old entity I guess.

😵

 

[noleknight16]

😵

Is there something wrong with the suggestion of only expanding medicaid?

 

[jqueb29]

Good: no denying for pre-existing conditions; chain restaurants having to post calorie counts; Medicare reimbursements being more focused on quality over quantity

Bad: robs Peter to pay Paul (more people have insurance now, but there has been an increase in premiums that greatly strains those lower middle class people who had insurance already and were struggling to afford it); decreasing the overall percentage of Medicare reimbursement; pretty much absolutely every single other thing related to economics and the ACA is a disaster

 

[DrBowtie]

Is there something wrong with the suggestion of only expanding medicaid?

Medicaid doesn't reimburse enough to continue seeing them.

 

[DoctorSynthesis]

Good: no denying for pre-existing conditions; chain restaurants having to post calorie counts; Medicare reimbursements being more focused on quality over quantity

Bad: robs Peter to pay Paul (more people have insurance now, but there has been an increase in premiums that greatly strains those lower middle class people who had insurance already and were struggling to afford it); decreasing the overall percentage of Medicare reimbursement; pretty much absolutely every single other thing related to economics and the ACA is a disaster

Not having pre existing conditions has its positives and negatives contray to popular belief.

Also its not robbing peter its called living in a society. Sometimes in a society people band together to help their neighbors. Crazy I know. And saying pretty much everything else is a disaster sounds like something fox news would say. You just listed talking points and made generalizations.

And OP its here to stay its the law get over it. Once people have it they will like it. If you try and take it away you will get voted out. And its the affordable care act not Obamacare. We aren't fox news here.

😛

 

[noleknight16]

Medicaid doesn't reimburse enough to continue seeing them.

I'd rather fix the issues with medicaid than start a whole new bureaucratic nightmare. Social security/medicare/medicaid is bad enough.

 

[DrBowtie]

I'd rather fix the issues with medicaid than start a whole new bureaucratic nightmare. Social security/medicare/medicaid is bad enough.

So you acknowledge it's bad but want to add more people to its cost?

 

[ruedjgtc]

We've had the equivalent in MA years before ACA, Romneycare (Mass Health), and medicine didn't burn down and residents/attendings are whining about it, so I'm okay with it.

ACA will be good or bad depending on the state that decides to implement it.

 

[sat0ri]

Not having pre existing conditions has its positives and negatives contray to popular belief.

Also its not robbing peter its called living in a society. Sometimes in a society people band together to help their neighbors. Crazy I know. And saying pretty much everything else is a diseater sounds like something fox news would say. You just listed talking points and made generalizations.

And OP its here to stay its the law get over it. Once people have it they will like it. If you try and take it away you will get voted out. And its the affordable care act not Obamacare. We aren't fox news here.

😛

Right? I wonder if they're pissed their money/taxes goes to fund public education despite not having children, or to support the police/fire department even though their house isn't on fire right now, or any socialized institution for that matter. (Though there is a vertiable philosophical camp, "Nozickean", that considers even taxes stealing).

Obamacare is a nickname for the ACA (originally pejorative, but Obama liked the name and it stuck), so it's not "wrong" any more than calling someone nick instead of nicholas, or more analgous, using the "new deal" to refer to FDR's bills. That's just pedantic; you're not the first to do it, but it I was already commenting so I thought I'd mention it, thought it is minor.

 

[TheRhymenocerous]

So you acknowledge it's bad but want to add more people to its cost?

Perhaps they really mean expand Medicare? Medicare is the most cost-efficient medical insurance out there, whereas Medicaid is a trainwreck that hardly even counts as insurance since its reimbursements are so low no one will even treat people on it.

 

[Gilakend]

And OP its here to stay its the law get over it.

While I won't comment on your views, I do not agree with this statement. I don't believe he/she should "get over it" just because it's currently a law. This line of thinking is exactly what causes people not to be civically involved. If he/she doesn't agree with a law we should encourage him/her to share his/her opinions and view points. Especially on this particular topic and especially on a forum dedicated to current and aspiring healthcare professionals.

Just my two cents.

 

[Flashfan]

I live in an area that had high numbers of uninsured, low income and no expansion of Medicaid. We have high infant mortality rates are generally considered the most backward state in the Midwest. Our residents are fat, unhealthy and staunchly conservative. The doctors that I shadowed have seen a lot more business since the middle group got insurance through the exchange. They don't seem too unhappy. What they would like to see is either better insurance options in our state in general since one company practically has a monopoly.
I would still like to see something closer to Canada or Australia for health plans. I think making companies fund healthcare makes our businesses less competitive on the global scale. I would gladly pay more taxes for a minimum of care, comprehensive preventative care and individual mandate for at least catastrophic care. If I want to invest in private insurance in addition, that could be scaled based on risk factors, years in plan, etc. It may take a few years, but I think costs will go down once the penalty is fully implemented. 3% of household income is the equivalent of the silver plan. Once it is just as expensive to have healthcare, we will see the benefits of scale come into play.

 

[plumazul]

Is there something wrong with the suggestion of only expanding medicaid?

I think what you are talking about is the "public option". This was part of the ACA up until it was forced out by a few Senators who made clear that they would block the bill otherwise. I believe a public option would have made the ACA better.

 

[WingedOx]

Perhaps they really mean expand Medicare? Medicare is the most cost-efficient medical insurance out there, whereas Medicaid is a trainwreck that hardly even counts as insurance since its reimbursements are so low no one will even treat people on it.

Yeah, I'm going to make that assumption about his/her post.

You can't really "fix" medicaid at the federal level. It's essentially a series of state-level programs, that vary extensively in the way they're run.

 

[WingedOx]

Hopefully John Roberts doesn't make the same mistake twice and guts the bill when he has the chance to this summer. At least now, when we actually have a legislative branch that serves as a check against the executive branch as opposed to a rubber stamp Congress, we can get an actual bipartisan bill through.

...and what would differ in a "bipartisan" bill?

 

[Beargryllz]

We could probably scrap it and put every person in America on Medicare to achieve much more coverage for the population while decreasing costs. We already all have to pay for it, so we might as well get some benefit from it instead of distributing the spoils to a select minority of the population. This is probably just a matter of time though.

 

[noleknight16]

So you acknowledge it's bad but want to add more people to its cost?

I'm acknowledging it's a bureaucratic headache and would rather the government be out all together. However if the government has to be involved, don't create a program to fix a problem we already have a program for. Fix that program instead.

 

[ridethecliche]

Hopefully John Roberts doesn't make the same mistake twice and guts the bill when he has the chance to this summer. At least now, when we actually have a legislative branch that serves as a check against the executive branch as opposed to a rubber stamp Congress, we can get an actual bipartisan bill through.

I'm acknowledging it's a bureaucratic headache and would rather the government be out all together. However if the government has to be involved, don't create a program to fix a problem we already have a program for. Fix that program instead.

Just checking to see if you guys know your history and realize that the origins of the ACA are pretty much as bipartisan as you can get. It was a republican idea and democrats were pretty shocked that it was met with such vitriol when the other party had suggested some of the basis for the legislation. Also hilarious to hear people complain that congress' elected officials actually did the job they were elected to do because house majorities are so evil and have never been seen before in the history of our government.

Kind of hilarious to see that people want the government out of healthcare entirely, because what could possibly go wrong with unchecked capitalism for inelastic goods. How many other western nations have a system as messed up and antiquated as ours?

Have you guys looked at data of care access for states that joined the exchange vs those that opted out? It's pretty remarkable.

 

[WingedOx]

There a lot of "I regurgitate my opinions from cable news" going on this this thread.

 

[moop]

I'm acknowledging it's a bureaucratic headache and would rather the government be out all together. However if the government has to be involved, don't create a program to fix a problem we already have a program for. Fix that program instead.

And you know the ACA expands Medicaid, right? Expands the eligibility, that is. What's your point on Medicaid again?

 

[moop]

There a lot of "I regurgitate my opinions from cable news" going on this this thread.

This is what we asked for when we complained that premeds don't know the policy side of medicine. What, did we expect them to take time off of prereqs to take legit econ and poli sci courses? No, they read snippets of news stories before an interview and buy supplements to sound informed. Ha

 

[touchpause13]

Very unlikely it's going anywhere

 

[ridethecliche]

This is what we asked for when we complained that premeds don't know the policy side of medicine. What, did we expect them to take time off of prereqs to take legit econ and poli sci courses? No, they read snippets of news stories before an interview and buy supplements to sound informed. Ha

Outside of some good posts on reddit and that Kaiser video, do you have a good link for a coherent write up? I want to read a chunk of info from the same source instead of piecemeal if possible regarding the law, what states have the option to implement/not implement etc.

 

[Lysinee]

I asked a similar question 2 years ago. Have fun reading the 857 replies LOL.

From a doctor's perspective, is it better to repeal or keep healthcare reform

http://forums.studentdoctor.net/thr...r-to-repeal-or-keep-healthcare-reform.893665/

 

[WingedOx]

This is what we asked for when we complained that premeds don't know the policy side of medicine. What, did we expect them to take time off of prereqs to take legit econ and poli sci courses? No, they read snippets of news stories before an interview and buy supplements to sound informed. Ha

No, but for a "professional" forum, I'd prefer if people were more willing to acknowledge the fact that they don't know enough about a topic to intelligently comment. You don't need to be stating your opinion when you don't know the difference between Medicare and Medicaid.

 

[Lysinee]

No, but for a "professional" forum, I'd prefer if people were more willing to acknowledge the fact that they don't know enough about a topic to intelligently comment. You don't need to be stating your opinion when you don't know the difference between Medicare and Medicaid.

Dude, chill!

Why don't you be a little more helpful and clarify the difference between Medicare and Medicaid since this is a "professional" forum? This is what a "professional" SDN member would have done.

 

[The_Sunny_Doc]

In my area, most physicians are now refusing to take new Medicare patients. Florida isn't one of the few states (I think Alabama is one of them) that provides state funding to make up for the cut in compensation physicians are getting for Medicare patients as of this year. My 70 year old uncle had to find a new physician since his closed up shop, and it's been tough to find anyone who'll take him.

The Democrats reneged on their promise to not cut physician compensation. It seriously made me doubt my political affiliation.

If you want to read about a viable plan for health care reform, check out The Innovator's Prescription. It was written by MDs.

 

[noleknight16]

And you know the ACA expands Medicaid, right? Expands the eligibility, that is. What's your point on Medicaid again?

Yes but I would like that to be the sole focus and on a larger scale.

 

[noleknight16]

Kind of hilarious to see that people want the government out of healthcare entirely, because what could possibly go wrong with unchecked capitalism for inelastic goods. How many other western nations have a system as messed up and antiquated as ours?

Why is another point of view hilarious? I hope you are open to another point of view than your own. You could actually learn a lot from a libertarian perspective on how to approach health insurance.

On another note, I am not moved by argumentum ad populum. The best answer to healthcare may be used by no nation.

 

[ridethecliche]

Dude, chill!

Why don't you be a little more helpful and clarify the difference between Medicare and Medicaid since this is a "professional" forum? This is what a "professional" SDN member would have done.

There is way too much out there on this for someone to have to type it up on here. Even wiki is a good source for starters.

Yes but I would like that to be the sole focus and on a larger scale.

And why is that?

Why is another point of view hilarious? I hope you are open to another point of view than your own. You could actually learn a lot from a libertarian perspective on how to approach health insurance.

On another note, I am not moved by argumentum ad populum. The best answer to healthcare may be used by no nation.

I actually agree with libertarians on many issues, especially social issues, but in the end our system is one of the most inequitable in the world. Saying that the best answer to healthcare might not exist is also hilarious because that implies that you might as well not even try.

Perfect is the enemy of good.

Slightly less dysfunctional is quite a bit better than totally effed up.

Also, what could possibly go wrong with no regulatory oversight of an inelastic good. The difference of opinion is a fundamental one since I see healthcare as a right not a privilege. That view is incommensurable with libertarianism, which also seeks to deregulate healthcare entirely and disband the FDA.

Oh that sounds lovely, where do I sign up?

 

[noleknight16]

No, but for a "professional" forum, I'd prefer if people were more willing to acknowledge the fact that they don't know enough about a topic to intelligently comment. You don't need to be stating your opinion when you don't know the difference between Medicare and Medicaid.

Are you saying I don't know the difference between medicare and medicaid?

 

[noleknight16]

And why is that?

As I said before, it makes more sense to tune the program designed for the issue that has been in place for a half century than to add more redundant bureaucracy. We're affecting all policy holders with the ACA when it makes more sense to just expand medicaid. (Assuming the notion that the main concern of the ACA is insuring poor Americans)

 

[noleknight16]

I actually agree with libertarians on many issues, especially social issues, but in the end our system is one of the most inequitable in the world. Saying that the best answer to healthcare might not exist is also hilarious because that implies that you might as well not even try.

Perfect is the enemy of good.

Slightly less dysfunctional is quite a bit better than totally effed up.

The current system isn't a libertarian one.

You made an appeal to the masses in your previous post, a logical fallacy. I said the correct answer may be used by no country currently. I didn't say the answer did not exist. Just because most countries use a system doesn't mean it is best. That's my point which I think you missed there.