Can someone "dumb down" what Obamacare really means? - page 10
by EarthwormRN 21,896 Views | 138 Comments
I don't have time to watch the news or read articles so I don't understand much of what is being talked about. Can someone explain to me how it changes for citizens and what it will do to the future of our healthcare system?... Read More
- 2Aug 18, '12 by MunoRNQuote from RN-CardiacHow we come up standards, and more importantly how we measure their reliability is a good question. What's been suggested so far for coming up with these standards has been sources such as Cochrane Collaboration, AHRQ, IHI, and well established highly regarded practice organizations such as AHA/ACC. These groups make recommendations based on overwhelming and time-tested evidence. There's always a chance some of what we thought we know may not be true, but it's still far better than the current system in which, for instance, 15 year after we knew that beta blockers cut the risk of death following an MI there were still only half of patients for whom this mortality reduction measure was even considered.Muno,...I'm going to sort of play devils advocate for a second. I am not affiliated with any particular political party, and to be honest I'm very ill informed about political issues in general,...however I am a nurse and for the last 6 years of my career I've been in a level I Trauma ED. One of my biggest frustrations at work is waste of resources! I understand that your example is an extreme exaggeration,..but what about the not so extreme cases? Who decides what is ignorant waste and what is necessary? How will that decision be made and made in a timely manner? For instance I frequently see people in the ED who have abdominal pain. They have seen their PCP and are scheduled for a CT/HIDA scan/US (whatever) next week,..."but I just can't wait that long!" They have been seen by a doctor who thought they could wait that long. These tests through the ED are very expensive, and take time/resources from true emergencies. How do we decide what gets paid for? What if the ED doc disagrees with the PCP? Better yet,...what happens when we miss a hot appy, AAA etc? I personally think we need fewer lawyers, and and a greater sense of personal responsibility, but as I don't see that happening anytime soon,...how will we make this cost cutting plan work?
For those who don't trust the evidence and the diagnostic tools that these produce (which help us rule out a AAA or hot appy and therefore make a CT elective rather than emergent) there will always be those willing to perform tests or procedures in a very short period of time providing they are willing to pay the cost of that option.Last edit by MunoRN on Aug 18, '12
- 1Aug 18, '12 by FuzzyQuote from MoosesNurseHealth care is not a capitalistic enterprise in the US. If it was capitalistic, health care would be treated like a business. People would be expected to pay at the time of service. Essentually health care would be like Wal-Mart or your hair dresser. People would not get service unless their cash was on the counter. The prices would have to be more affordable to the general public. Most likely the government, lawyers, insurance comapanies and other enities would not be as involved as they are.@MBarnBSN-Those OTHER countries are considered SOCIALIST not Capitalist!!!
If you want to see capitalistic health care, visit your local veterinarian. Veterinarians have to price thier services so that they are affordable to their clients. There are no government programs for pet owners and there is very little insurance. Vets can also turn people away who cannot pay. Many will provide stabilizing care or euthanasia for those people who cannot afford the care.
- 3Aug 18, '12 by malamud69Quote from Jeweles26Scary at best...ignorant more than likely...so if one is going to need to be tested to receive government assistance, then we must also test those that get tax breaks ex:like all married couples, absurd religious organizations that get exemptions...test the whole "herd", states that offer "no-tax" days etc...etc...sounds like you are saying anybody that gets any help from the government (our) government, should be tested...hmmm did we forget about the banks? Maybe we should test them and oh yeah- every person on medicaid...they must be getting high? Right? Oh yeah how about students receiving Pell grants and the like...wow I suspect very few of them would pass a urine test? Do you? Or have you not quite thought this out??? One of the other posters made a great point...so they did this in Florida and something like 96% of the people tested were clean...and they really need OUR help! And besides what about all of the doctors gaming the system that are responsible for driving up costs in the first place...you are seemingly on the side that likes to blame the victim...Yes, I agree that not everyone who gets government healthcare is a layabout or deadbeat. However, there ARE a lot of them. Or maybe its just where I am located. Maybe its also where I grew up. Dont get me wrong, I am far from having grown up to a wealthy family. We were lower middle class at best. But my mother taught me to work hard and make something of myself. Yes, she taught me to share. And I do, for those who help themselves. How many people sell their foodstamps to buy things they shouldnt? How many people on welfare have under the table jobs and net more money than I do? How many people who are completely ABLE to work just stay home having more babies to get a bigger check in the mail? How many people who are CURRENTLY receiving medicare benefits completely abuse it? This is all stuff I saw growing up, and I am seeing a lot of it here. And judging from posts Ive seen on here, Im not the only one who has noticed it.
If all people were deserving of welfare and social aid, why would there be such a fuss made about mandatory drug testing and all?
Its just so funny you know. I used to be pretty liberal. Then I opened my eyes and saw it just doesnt work. Now I see how so many liberals treat those who are more conservative. They insult, make assumptions. Mind you, not all of them. Maybe just those Ive been exposed to...
- 5Aug 18, '12 by malamud69Quote from SensibilityDo you have retrograde amnesia??? Amazing how "all of this stuff" just seemed to happen during the Obama administration??? Your continuum of contradictory statements born of some primal fear are astounding...I wonder how you will feel when the day comes that this all nurturing "republican" government you speak so highly of pulls the rug out from under you (or you simply begin to use your frontal lobe) and you are now one of these people that doesn't have any money and might possibly need help for any number of later life reasons, what then??? No man is an island.You don't necessarily need to be a nurse to be a member of this board. Nobody checks to make sure. Please be careful of people that might very well be plants who are obviously giving fallacious information to support socialized medicine. The one guy that said that we have 700 billion dollars in reserve for this is flat out lying. Jeweles26 is giving the right information. We are going to see huge cuts in our salaries and our taxes will go out of the stratosphere meaning less money. Will we be able to reverse this once we're in? Probably not. Most people who support the democratic agenda are constantly arguing that republicans put money into the pocket of the rich. I am sick to death of that argument because it is not true. What a system like the republicans propose does is allow people to prosper, which then causes others to prosper. It means that those people have ability to hire other people and more and more money is available to spend on the things we like. It is just a fact of life that some folks are have more money than others but those people generate jobs for others and hire small businesses to do work etc. My husband's small business is nearly going under with this democratic government especially because of food and gas prices and taxes. See, if you start out with a small business idea, you can prosper under a republican government. Often those who don't have money are the ones who don't want to work. Technically, you could get by in this world with just a few basic items and they want the government to provide those things instead of working hard and making something of themselves. Under a democratic government, it is impossible to prosper because if you make more money, it is less because it places you in a tax bracket where you have to pay more out. So in essence, your situation hasn't changed even though you are supposedly making more. Can you see that? The socialized health care will only further that agenda. Eventually, some treatments will be denied and people will die. Why? Simply because there is not enough money for chronic illnesses that might burden the system. Guess who will survive those things? People who happen to have money. So again, the rich are the only ones who prosper under this where today, those same people get excellent care.
- 3Aug 18, '12 by OCNRN63Quote from SC_RNDudeLike insurance companies haven't been doing this for decades.There are many ways to answer that question. Since in the last few days there has been a lot in the news about how Paul Ryan wants to change Medicare, let's look at home Obama has already changed Medicare.
Obamacare emphasizes control of healthcare by the government. By law, a panel of government officials will be empowered to make changes to Medicare that will reduce Medicare spending by 716 billion dollars in the next 10 years. They will do this by paying physicians and hospitals less. To do that, the panel will determine what procedures will and will not be paid for by medicare. In other words, healthcare wil be rationed.
Supposedly, this will lead to better healthcare for all.
LOL...it took one post to resurrect the "death panels" boogeyman.
- 2Aug 18, '12 by determined2doitHancock330, thank you so much for your clarification, dedication, and response to the op. I can certainly sense your passion, and drive not only for the career of Nursing which you have so lovingly dedicated 40 years to, but your eagerness for overall equity for mankind. Is it so wrong for human beings to want affordable healthcare? Is is so wrong for human beings not to have to accept charity and be treated as such, just to survive inevitable illness? I think not! No the ACA may not be perfect, but show me something created by mankind that is? We as human beings are not perfect, so perhaps the bar is set a little to high for ANYONE to expect absolute perfection. My hat goes off to the President who is at least trying. Nothing ventured, nothing gained. Again, thank you Hancock330 and thank you all for your thoughts. God bless.
- 0Aug 19, '12 by SC_RNDudeQuote from MunoRNIt doesn't matter the stated reason behind cutting reimbursement rates for knee replacements, the net result will be fewer people getting knee replacements. That's what I mean by "indirect" rationing.My example is only black and white because we have sufficient knowledge to say that a head MRI will not aid in the treatment of a stubbed toe, with enough evidence every other decision can be just as black and white; obvious is determined by amount of knowledge.
Yes, that would be rationing. Cutting reimbursements for knee replacements in general based on a finding that we are over-paying would not be rationing, that would be just trying not to get ripped off.
I disagree that EBP takes decisions out of the hands of patients and doctors, rather it gives them evidence to make an informed decision and helps protect the patient from inept practitioners who essentially have no idea what they are doing.
EBP does not create cookie-cutter medicine, in fact it does quite the opposite. It's evidence that reveals how differences in patients require different approaches.
Suppose the Independent Payment Advisory Board cuts down reimbursement rates for a CABG because they determine that Medicare is overpaying (how they would determine this is a whole other issue). In your words, this would not be considered rationing as they are "trying not to get ripped off".
So, now the hospital and physician are faced with being paid less for a CABG. You don't think this will effect how many and what patents get a CABG? For example, there is research that shows that being obese does not effect CABG mortality rates. However, it also shows that the hospital stay for a obese CABG patient is longer. The hospital has to control it's costs for a CABG to coincide with what it will be reimbursed for. The surgeon has to care for a obese patient longer post-op. Can you see how fewer obese people will be getting a CABG?
- 0Aug 19, '12 by SC_RNDudeQuote from determined2doitUggghhh....not to pick on you, but I am tired of hearing that the ACA "may not be perfect.....", and that "at least he (Obama) is trying" (which is debateable), or that it is "better then nothing".Hancock330, thank you so much for your clarification, dedication, and response to the op. I can certainly sense your passion, and drive not only for the career of Nursing which you have so lovingly dedicated 40 years to, but your eagerness for overall equity for mankind. Is it so wrong for human beings to want affordable healthcare? Is is so wrong for human beings not to have to accept charity and be treated as such, just to survive inevitable illness? I think not! No the ACA may not be perfect, but show me something created by mankind that is? We as human beings are not perfect, so perhaps the bar is set a little to high for ANYONE to expect absolute perfection. My hat goes off to the President who is at least trying. Nothing ventured, nothing gained. Again, thank you Hancock330 and thank you all for your thoughts. God bless.
To me it's like 200 people are stuck on an island, and they have a submarine that fits 50 people. Obama has spent trillions to build a new submarine. However, it holds only 150 people, has a screen door, and is powered by hamsters running on a wheel. It's nowhere near perfect, is not better then nothing, and "trying" isn't much consolation.
I'm willing to keep working on a better solution before I get into that submarine.