Can someone "dumb down" what Obamacare really means? - page 12

by EarthwormRN

21,477 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. 1
    Quote from SC_RNDude
    But, they can decrease reimbursement rates. Which in turn will lead to providers providing fewer of whatever service they will be reimbursed less for.
    If it results in cuts to services then they would be going against their legal restrictions and a court could reverse it. Not all cuts to services are rationing however, long ago we stopped doing lobotomies on everyone we suspected of being mentally ill, does that we we have unfairly rationed lobotomies?

    Quote from SC_RNDude
    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?
    Your right, I'm still not understanding. How does basing decisions on evidence harm patients or prevent personalizing care? Evidence not only tells us some patients with A-fib benefit from anti-coagulation, evidence based tools such as CHADS scores help us clarify the risks and benefits in a specific patient given their individual characteristics. The choice is still up to the patient, but at least they have reliable information to refer to, rather than a doctor essentially just flipping a coin, which hardly helps personalize care in a way that's best for that patient, rather it just randomizes it.

    We don't know the Romney/Ryan plan since they've stated they won't reveal anything about their plans on healthcare until after they are elected. The Ryan plan was based on changing Medicare from an entitlement to block grants and then eventually to a voucher system. Block grants means once the money runs out for that year it's gone until the new year starts, which means if you need a knee replacement in September your provider will not be reimbursed and is free to refuse you the operation. Vouchers limit your care to whatever you can afford (since the vouchers themselves would not cover "full-service" care) and puts your care into the most prolific rationers around; private insurers.
    Elinor likes this.
  2. 4
    Quote from Sensibility
    ...I am amazed at how people believe this stuff like the mortality rate of babies is high in America. How ridiculous. The only reason for that is probably abortion. When the government becomes socialist/communists it creates slavery. You can't prosper. Already so many of our freedoms have been abolished because of government control. You can't do anything anymore without jumping through a million hoops to get there per government regulations and if you forget to check the box, oopsy, you have to come back and start again. When the wheel rolls off and there is no money left, you can say you heard it here first.
    Like most I wasn't sure where to even begin with your posts, but I couldn't avoid these two points. "The only reason for that is probably abortion" displays an impressive lack of interest in even attempting find actual facts. At least tntrn used an often quoted (though still false) claim that the statistics of other countries are counted different than ours (They're all calculated using the same WHO definitions). Debunk - 'US infant mortality rates aren't so bad' - Managed Care Matters - Joe Paduda

    I'm also a little astounded at your claim that and bureaucracy and getting punished for not checking a box is somehow something we would only have to deal with if we used the government as our insurer. After my first child was born, I asked for all the forms I needed from my private insurer to get her on my plan. I filled out the forms and sent them back. I checked online and she had been added to my plan so I figured all was good. When she was 2 and a half months I got a letter saying she had been dropped because they didn't receive the "notification of birth" form (they did however receive numerous other forms including a signed letter from her MD that she had in fact been born). They wouldn't let me enroll her from that point forward because I had missed open enrollment and newborns can only be added within 60 days of birth outside of open enrollment, so I had to buy a plan off the internet to cover her for the next 16 months, which was expensive in itself but even more expensive since my insurer was still charging me for the "employee plus child" plan, even though they refused to cover the child in question.
    herring_RN, Elinor, Sisyphus, and 1 other like this.
  3. 4
    Quote from MunoRN
    I'm also a little astounded at your claim that and bureaucracy and getting punished for not checking a box is somehow something we would only have to deal with if we used the government as our insurer. After my first child was born, I asked for all the forms I needed from my private insurer to get her on my plan. I filled out the forms and sent them back. I checked online and she had been added to my plan so I figured all was good. When she was 2 and a half months I got a letter saying she had been dropped because they didn't receive the "notification of birth" form (they did however receive numerous other forms including a signed letter from her MD that she had in fact been born). They wouldn't let me enroll her from that point forward because I had missed open enrollment and newborns can only be added within 60 days of birth outside of open enrollment, so I had to buy a plan off the internet to cover her for the next 16 months, which was expensive in itself but even more expensive since my insurer was still charging me for the "employee plus child" plan, even though they refused to cover the child in question.
    But in CANADA or England you would have had to wait until the next day to get your well baby appointment. Don't you see how inconvenient that would be?????
    elkpark, MunoRN, Elinor, and 1 other like this.
  4. 1
    I think everyone should have access to affordable health care but I also think I should eat without gaining weight. There are ideals and then there are realities. Unfortunately, politics plays on the ideals. I wouldn't mind paying so everyone could get free or equal care but that would mean cutting from somewhere else. It isn't an easy fix and no side has the answer. There are just too many variables. I am from a depressed rural community and worked as an urban teacher, I know first hand what dependence to governmental assistance does to people. It can help but others just come to depend on it for everything. Why work to pay for food when you get money? Why work to get insurance when you'll get it for free? Then people on the bubble trying to get by, trying to pay for school, etc etc cannot. Aid is great but easily abused. Especially by my alcoholic neighbors that can roof their house in August but can't work a job.
    eleectrosaurus likes this.
  5. 0
    Actually, that is assuming you were even able to find a PCP. Most MDs arent taking any more patients, they have more than is deemed safe. People just getting their MD pretty much have a full patient load within a year of graduating. And if you think getting an appointment is a next day thing, you are pretty seriously delusional. I think someone needs to lay off the Stalin Koolaid, eh comrade!?
  6. 1
    Ok, maybe the Stalin comment went a little too far. But still, seriously, until you have lived and worked in the socialist healthcare system, you have NO idea how it is. What you read and what is reality are two different things. The complete lack of organization. The lack of funds. The sense of entitlement. The misuse of facilities and services. Just you wait...
    eleectrosaurus likes this.
  7. 0
    Quote from Susie2310
    You really have no clue.
    Textbook projection.
  8. 0
    Quote from MunoRN
    If it results in cuts to services then they would be going against their legal restrictions and a court could reverse it. Not all cuts to services are rationing however, long ago we stopped doing lobotomies on everyone we suspected of being mentally ill, does that we we have unfairly rationed lobotomies?



    Your right, I'm still not understanding. How does basing decisions on evidence harm patients or prevent personalizing care? Evidence not only tells us some patients with A-fib benefit from anti-coagulation, evidence based tools such as CHADS scores help us clarify the risks and benefits in a specific patient given their individual characteristics. The choice is still up to the patient, but at least they have reliable information to refer to, rather than a doctor essentially just flipping a coin, which hardly helps personalize care in a way that's best for that patient, rather it just randomizes it.

    We don't know the Romney/Ryan plan since they've stated they won't reveal anything about their plans on healthcare until after they are elected. The Ryan plan was based on changing Medicare from an entitlement to block grants and then eventually to a voucher system. Block grants means once the money runs out for that year it's gone until the new year starts, which means if you need a knee replacement in September your provider will not be reimbursed and is free to refuse you the operation. Vouchers limit your care to whatever you can afford (since the vouchers themselves would not cover "full-service" care) and puts your care into the most prolific rationers around; private insurers.
    Do you not agree that if they cut reimbursement rates for x procedure because it is determined that the rates are too high that x procedure will be performed less often? And I'm not talking about lobotomies, but about something that still has benefits.

    I want my physician to use evidence-based guidelines as a guide. I don't want him/her to be forced to follow it. I want a doctor to use his/her education, training, and experience to practice medicine.

    There are many problems with evidence-based guidelines.

    1) For one, there are no treatment guidelines for many areas of medicine.

    2) How about where the evidence is not clear, or is conflicting? The controversary over when is the best time to start and how often a woman should get mammograms comes to mind. When Medicare or a insurance company has a choice, it will be the cheapest option that evolves into evidence-based guidlines.

    3) Much research that evidence-based guidelines (again, in the minority of areas of medicine they exist) is flawed. Consider heart-failure. Much of the research that heart failure guidelines are based on excluded elderly patients. Some studies exclude people with co-morbidities. One study showed that 40% of patients who survived a hospitalization for HF would have been excluded from many of the studies that heart failure guidelines are based on. http://theincidentaleconomist.com/wo...eralizability/

    4) True random trials are almost impossible, and very expensive in themselves.

    5) People writing the guidelines often have a conflict of interest. http://online.wsj.com/article/SB1000...121858250.html

    I know you may be about to say that providers don't have to follow guidelines as long as they document why. I will address that in my reply to wooh.
    Last edit by SC_RNDude on Aug 22, '12 : Reason: typo
  9. 1
    Quote from wooh
    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.
    True. I'm not advocating that things stay the same. I want something better they what we have, and definately better then what is coming with the ACA.

    I want physicians to use their education, training, and experience to discuss a care plan for me. Using research is part of this, but I don't want them to be under heavy pressure to stick to a guideline that may or may not be in my best interest. Making physicians jump through hoops my dissuade them from doing what is best for me.

    And with the ACA, the hoops for them to jump through are only going to increase.

    A health care system in which physicians can practice medicine without heavy gov't interference (and I'm not saying ZERO regulation) and in which consumers control how their health care $$$ is spent is what we need.
    Szasz_is_Right likes this.
  10. 5
    Quote from Jeweles26
    Actually, that is assuming you were even able to find a PCP. Most MDs arent taking any more patients, they have more than is deemed safe. People just getting their MD pretty much have a full patient load within a year of graduating. And if you think getting an appointment is a next day thing, you are pretty seriously delusional. I think someone needs to lay off the Stalin Koolaid, eh comrade!?
    Jeweles, coming from England, I know that the problems you mention exist there too. In England, some people, who can afford to do so and are fortunate enough to be accepted by insurers, take out private health insurance. I believe there are a lot of problems with the way the health service is run, and with providing a uniformly good level of care. In the English system there have been problems with lack of organization and funding too, and other abuses. But in spite of the many problems with the service, I still believe that a taxpayer funded health service is a good thing, and I support it because I want everyone to have access to health care throughout their lives.
    Sisyphus, wooh, laborer, and 2 others like this.


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