Can someone "dumb down" what Obamacare really means?

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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? Particularly, for us nurses.

Specializes in Oncology; medical specialty website.
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.

Like insurance companies haven't been doing this for decades.

LOL...it took one post to resurrect the "death panels" boogeyman.

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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.

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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.

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.

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?

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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.

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.

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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.

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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.

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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,

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Specializes in Critical Care.
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.

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Specializes in Critical Care.
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.

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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!

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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?

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"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. :)

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