Can someone "dumb down" what Obamacare really means? - pg.9 | allnurses

Can someone "dumb down" what Obamacare really means? - page 9

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... Read More

  1. Visit  MunoRN profile page
    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.
  2. Visit  SC_RNDude profile page
    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
  3. Visit  SC_RNDude profile page
    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?
  4. Visit  determined2doit profile page
    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.
  5. Visit  wooh profile page
    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.
  6. Visit  Elinor profile page
    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.
  7. Visit  MunoRN profile page
    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.
  8. Visit  MunoRN profile page
    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.
  9. Visit  wooh profile page
    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.
  10. Visit  ShinyRedGloss profile page
    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.
  11. Visit  uRNmyway profile page
    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!?
  12. Visit  uRNmyway profile page
    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.
  13. Visit  tyvin profile page
    0
    Quote from Susie2310
    You really have no clue.
    Textbook projection.

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