Can someone "dumb down" what Obamacare really means? - page 11

by EarthwormRN

21,179 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


  1. 0
    Quote from MunoRN
    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.
    Earlier you have also said that physicians will have to follow EBP to be reimbursed. So, they will have to follow EBP or not be paid, even though EBP isn't what is best for every patient circumstance. Or they will have the patient pay out of pocket. Of course, then wealthier people will get better care, and we can't have that can we? So, in essence the decison is out of their hands unless they want to provide care for free.

    So, assuming physicians want to be paid for their services, EBP will apply to every patient. What is good for the majority will be good for all. This IS cookie-cutter medicine.
  2. 0
    Quote from OCNRN63
    Like insurance companies haven't been doing this for decades.

    LOL...it took one post to resurrect the "death panels" boogeyman.
    Yeah, that is why I have even shared alternative ideas for healthcare and insurance reform.

    And, this is will be worse then what insurance companies do. In contrast to a board made of unelected gov't appontees making $160k plus/year whose sole job is to control Medicare spending, at least insurance companies have some incentive to keep customers and stay in business.
  3. 1
    I don't usually post on political areas of nursing but I did want to give you the website where the Affordable Care Act is pretty striaght-forward, just in case you weren't aware of it.

    Read the Law | HealthCare.gov

    Cheers,
    Elinor likes this.
  4. 0
    Quote from SC_RNDude
    It 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...
    If fewer people who need and would benefit from knee replacements would get them then that would be rationing and therefore outside of the IPAB scope, they are specifically prohibited from limiting access or decreasing services.
  5. 2
    Quote from SC_RNDude
    Earlier you have also said that physicians will have to follow EBP to be reimbursed. So, they will have to follow EBP or not be paid, even though EBP isn't what is best for every patient circumstance. Or they will have the patient pay out of pocket. Of course, then wealthier people will get better care, and we can't have that can we? So, in essence the decison is out of their hands unless they want to provide care for free.

    So, assuming physicians want to be paid for their services, EBP will apply to every patient. What is good for the majority will be good for all. This IS cookie-cutter medicine.
    EBP does not mean that we apply a practice to every patient even if we know it won't benefit them, in fact it's the opposite. EBP tells us which patient will benefit from a certain treatment as well as which subgroups won't. By definition, applying a practice to a patient who won't benefit from that is not EBP. EBP is how we know the best way to treat patients as individuals rather than applying old myths or generic ideas that are based on limited knowledge which tend to be broadly applied and generic (ie cookie-cutter).

    I understand your concern for rationing, I just don't see the risk of rationing being greatest with a better use of our healthcare dollars, in fact I see rationing as the natural progression of failing spend our money better. Our healthcare spending is, and has been, in a death spiral. If this continues we will have no other choices other than to ration, forms of straightforward rationing have already been proposed, such as the Ryan plan.
    Sisyphus and wooh like this.
  6. 0
    Quote from MunoRN
    If fewer people who need and would benefit from knee replacements would get them then that would be rationing and therefore outside of the IPAB scope, they are specifically prohibited from limiting access or decreasing services.
    But, they can decrease reimbursement rates. Which in turn will lead to providers providing fewer of whatever service they will be reimbursed less for.

    My mother just went to Medicare. On Friday she was told by her doctor of 20 years that she no longer can see him because he doesn't take new Medicare patients.

    Why doesn't he? Because they don't pay enough to make it worth it for him. She could benefit from a Dr. visit. She won't get it because Medicare doesn't pay enough.

    Also, she was willing to pay cash. But, a Dr. who still enrolled in Medicare can't take cash payments from patients who have Medicare. She now is trying to find a new doctor who takes new Medicare patients which is proving to be difficult.

    Change Medicare as we know it? YES PLEASE!
    Last edit by SC_RNDude on Aug 19, '12
  7. 0
    Quote from MunoRN
    EBP does not mean that we apply a practice to every patient even if we know it won't benefit them, in fact it's the opposite. EBP tells us which patient will benefit from a certain treatment as well as which subgroups won't. By definition, applying a practice to a patient who won't benefit from that is not EBP. EBP is how we know the best way to treat patients as individuals rather than applying old myths or generic ideas that are based on limited knowledge which tend to be broadly applied and generic (ie cookie-cutter).

    I understand your concern for rationing, I just don't see the risk of rationing being greatest with a better use of our healthcare dollars, in fact I see rationing as the natural progression of failing spend our money better. Our healthcare spending is, and has been, in a death spiral. If this continues we will have no other choices other than to ration, forms of straightforward rationing have already been proposed, such as the Ryan plan.
    Either we aren't understanding each other, or you are talking in circles. I'll go with the former.

    Anyway, I don't believe the Romney/Ryan plan is the best we can do, but it is better then the road we are going down right now. What about their plan is leads to rationing?
  8. 0
    "Uggghhh....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".

    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."

    One of the wonderful things about being in this great country of ours is a right to express our opinions, whether I agree or not. Please don't feel like you're picking on me, I'm an adult and I can handle it. The point is the effort, most miracles in medicine alone, have been done by sheer effort, even if it is powered by hamsters.
  9. 3
    Quote from SC_RNDude
    So, assuming physicians want to be paid for their services, EBP will apply to every patient. What is good for the majority will be good for all. This IS cookie-cutter medicine.
    They have to provide the standard of care OR they have to provide a rationale for why it doesn't apply to THIS patient. Which is exactly what MDs have to do now to get reimbursement for insurance companies. Perhaps you've never waited for an insurance company to approve a prescription for a particular antibiotic? Or to approve surgery? Or to approve anything out of the normal? But it happens EVERY SINGLE DAY at my job. I'm not sure why you think this will be some huge change in procedure.
    herring_RN, Sisyphus, and elkpark like this.
  10. 5
    "Although everything from homes prices to petrol increased a lot over the past half century, America's medical costs grew at an especially hefty rate, from 5% to 18% of GDP. Americans spend about twice as much as Canadians, Germans, French or British. Indeed, the federal government in recent years has begun to spend more on Medicare and Medicaid than on defence."

    - The Economist


    How much more evidence is needed that the current system has failed? Compared to other countries, we are spending vastly more, and receiving measurably less.

    To those that "disbelieve" basic, universally-accessible data and facts about infant mortality and life expectancy rates in the US vs. other post-industrial, economically-comparable countries... Obamacare should be the least of your concerns.

    Personally -- and this has nothing to do with the Affordable Care Act, which doesn't contain a public option -- I think a privatized, for-profit healthcare system with a million intermediaries between the patient and the health care professionals, each one with a hand out, is doomed to fail. Health care is inevitably going to be more expensive with health insurance companies, lawyers (see the UK for lawsuit comparisons -- public health care = fewer and cheaper), advertisers, massively bloated administrative overheads, etc. all need a profitable piece of the pie.
    elkpark, herring_RN, wooh, and 2 others like this.


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