Interesting article on Obama health care plan

Jolie, BSN · May 12, 2009

Interesting piece on the possible effects of Obama's proposal:

How ObamaCare Will Affect Your Doctor

Expect longer waits for appointments as physicians get pinched on reimbursements.

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals....

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice....

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy....

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level....

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients....

full piece: http://online.wsj.com/article/SB124208383695408513.html

allnurses Guide · May 13, 2009

when a family member gets cancer or is an accident premiums will be raised. those people too will join the elderly and permanently disabled in medicare.

healthy people will pay for their insurance and then join the public system when they need the most healthcare.

if we achieve single payer everyone with an income will pay and all americans will have the same insurance. coverage.

i doubt congress will vote for low quality care when they will have the same.

opinion
how obamacare will affect your doctor expect longer waits for appointments as physicians get pinched on reimbursements.
at the heart of president barack obama's health-care plan is an insurance program funded by taxpayers, administered by washington, and open to everyone. modeled on medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. it will restructure the practice of medicine in the process
http://online.wsj.com/article/sb124208383695408513.html

SuesquatchRN, BSN, RN · May 13, 2009

Sue,
There are plenty of us who do the same who oppose mandatory taxpayer-funded healthcare.
It is hardly a sign of lack of compassion that people oppose further government intrusion into their pocketbooks and lives.

I don't doubt that, Jolie. But we can't pay the kids' medical bills. Shouldn't we, as a society, take care of them? I certainly understand not wanting government intrusion, but one can, in the UK, certainly, supplement the NH with private insurance.

Somewhere between the NH model and what we have now is a solution, because this is sure broken.

Hushdawg · May 14, 2009

What the Obama plan boils down to is ensuring that every American has equal access to quality health care.

I don't understand why this is a problematic concept. Part of the American Dream as outlined by our Founding Fathers is that all are created equal and that we all have equal right to life, liberty and the pursuit of happiness.

For many Americans this American Dream has been derailed by substandard health care delivered because of medical insurance altering medication prescriptions and giving generics whose inactive ingredients cause severe reactions with other medications. Substandard health care because they are turned away from doctor's offices and forced to pay much higher rates at a hospital and must opt-out of expensive procedures that they cannot afford but may save their lives.

Derailing the pursuit of happiness because the rising costs of medical insurance means more and more people are becoming uninsured and thereby racking up huge charges and debt in order to take care of simple procedures.

This is not about upsetting the American Way by replacing Capitalism with Socialism; it isn't about "isms" at all. This is about fulfilling the promise that was given to all Americans and those who would become Americans at the very establishment of our nation.

Any patriot should be able to see that.

Hushdawg · May 14, 2009

If we achieve Single Payer everyone with an income will pay and all Americans will have the same insurance. coverage.
I doubt Congress will vote for low quality care when THEY will have the same.

:yeah:

Actually as I recall the debates, it was clear to me that the current health care that Congress enjoys is the benchmark for what the universal health care is supposed to meet.

So any talk about reducing the level of care is based on misinformation.

Hushdawg · May 14, 2009

all the mony obama is talking about is gona come from nurses and probably doctors pay . nurses seems to be a little be" to expensive" for obama socialist era .

Actually the overall cost is going to be about $2,500 per household. This amount can easily be taken from federal budget already allocated for programs which are defunct, no longer work and are simply drains on the economy. This is precisely what the plan is. Obama's complete plan is to isolate programs that can be cut out that will pay for this so that nobody feels any greater tax impact from the universal health care implementation.

Check out the Obama perspective instead of listening to what Rush Limbaugh has to say:

http://healthreform.gov

Honnête et Sérieux · May 14, 2009

one can, in the UK, certainly, supplement the NH with private insurance.

Only if they can afford private insurance after paying for NHS...which if folks would take a moment to look at the news, you'd know that the NHS deficit is growing at only a somewhat slower pace than what we've jumped into under the Obama 'commitment to spending' over the past four months.

wowza · May 17, 2009

What the Obama plan boils down to is ensuring that every American has equal access to quality health care.
I don't understand why this is a problematic concept. Part of the American Dream as outlined by our Founding Fathers is that all are created equal and that we all have equal right to life, liberty and the pursuit of happiness.
For many Americans this American Dream has been derailed by substandard health care delivered because of medical insurance altering medication prescriptions and giving generics whose inactive ingredients cause severe reactions with other medications. Substandard health care because they are turned away from doctor's offices and forced to pay much higher rates at a hospital and must opt-out of expensive procedures that they cannot afford but may save their lives.
Derailing the pursuit of happiness because the rising costs of medical insurance means more and more people are becoming uninsured and thereby racking up huge charges and debt in order to take care of simple procedures.
This is not about upsetting the American Way by replacing Capitalism with Socialism; it isn't about "isms" at all. This is about fulfilling the promise that was given to all Americans and those who would become Americans at the very establishment of our nation.
Any patriot should be able to see that.

You are misinterpreting what the found fathers had in mind and our constitution as a whole. The founders wanted a country free from the intervention of the gov't so they created certain rights that could not be taken away. These ensured a bubble into which the gov't was not allowed to penetrate. Looking at the context in which the constitution was created plus the numerous documents which explicitly state this, including the constitution, it is clear the constitution is a document meant to protect the people from the government.

The American dream is not guaranteed. It is a concept that came to fruition centuries after the constitution because of the freedom from intervention that our constitution allowed. The American Dream was not outlined by our founding fathers; it had nothing to do with our founding fathers- outside of the fact that they created a system that allowed people to prosper. It is an illusory connection you are making.

To reiterate: our constitution is meant to keep the Gov't from intervening and subverting inalienable rights:

For instance, you have a right to life such that the gov't or another citizen cannot TAKE your life from you. It makes no mention nor any inference that anyone, especially the gov't needs to keep you alive. You have a right to life such that it cannot be taken away not such that it needs to be provided.

Furthermore, you cannot have a right to health care because that would force others to provide the health care and the rest to pay for it. This subjugates both the right to liberty and the right to property. I cannot think of a more un-American concept than this... especailly since it is so clearly laid out in the constitution.

The socialization of health care and other social programs are the antithesis of the ideas that the constitution puts forth- any patriot should be able to see that. :cool:

SuesquatchRN, BSN, RN · May 17, 2009

Only if they can afford private insurance after paying for NHS...which if folks would take a moment to look at the news, you'd know that the NHS deficit is growing at only a somewhat slower pace than what we've jumped into under the Obama 'commitment to spending' over the past four months.

They're still better off than many Americans, who don't have health care at any cost. Not the old, not the poorest of the poor, but the working not-quite-poor and middle class.

Magsulfate, BSN, RN · May 17, 2009

I could not have said it better.

From my viewpoint, and it goes along with this quote below... Is that my rights to earn my own living and take care of myself will be knocked down because I'll be paying 60% of my pay to taxes.. just like these other countries who have "free" healthcare. It is NOT FREE. It will cost the middle class an enormous amount of money.. as it will hit us the hardest.

Sure, find a way that I won't have to pay for everyone that doesn't work, for whatever reason (I'm sure everyone who doesn't have a job has a VERY GOOD reason to not have one).. But, I think that taking so much from me by taxing the heck out of me is against everything that this country was founded on.

You are misinterpreting what the found fathers had in mind and our constitution as a whole. The founders wanted a country free from the intervention of the gov't so they created certain rights that could not be taken away. These ensured a bubble into which the gov't was not allowed to penetrate. Looking at the context in which the constitution was created plus the numerous documents which explicitly state this, including the constitution, it is clear the constitution is a document meant to protect the people from the government.
The American dream is not guaranteed. It is a concept that came to fruition centuries after the constitution because of the freedom from intervention that our constitution allowed. The American Dream was not outlined by our founding fathers; it had nothing to do with our founding fathers- outside of the fact that they created a system that allowed people to prosper. It is an illusory connection you are making.
To reiterate: our constitution is meant to keep the Gov't from intervening and subverting inalienable rights:
For instance, you have a right to life such that the gov't or another citizen cannot TAKE your life from you. It makes no mention nor any inference that anyone, especially the gov't needs to keep you alive. You have a right to life such that it cannot be taken away not such that it needs to be provided.
Furthermore, you cannot have a right to health care because that would force others to provide the health care and the rest to pay for it. This subjugates both the right to liberty and the right to property. I cannot think of a more un-American concept than this... especailly since it is so clearly laid out in the constitution.
The socialization of health care and other social programs are the antithesis of the ideas that the constitution puts forth- any patriot should be able to see that.

Koyaanisqatsi-RN · May 17, 2009

I could not have said it better.
From my viewpoint, and it goes along with this quote below... Is that my rights to earn my own living and take care of myself will be knocked down because I'll be paying 60% of my pay to taxes.. just like these other countries who have "free" healthcare. It is NOT FREE. It will cost the middle class an enormous amount of money.. as it will hit us the hardest.

What people like you never seem to understand is how a risk-pool works. If we are all paying into the same system, the risk/cost goes DOWN. Have you ever worked for a small company? Did you notice how sky-high the insurance cost was? There's a reason for that.

Yes, I know you want to be selfish and care only about yourself and your family. Fine. At least be smart about it. I am not knocking selfishness, I'm just saying that it is in our best interest to cover everyone and keep costs DOWN.

The system we have right now is broken, and I am sick of argung with people who say stuff like "MY MONEY" all the while offering zero alternatives or ideas. The system right now is completely worthless, and some people are too ideological to see it.

wowza · May 17, 2009

What people like you never seem to understand is how a risk-pool works. If we are all paying into the same system, the risk/cost goes DOWN. Have you ever worked for a small company? Did you notice how sky-high the insurance cost was? There's a reason for that.
Yes, I know you want to be selfish and care only about yourself and your family. Fine. At least be smart about it. I am not knocking selfishness, I'm just saying that it is in our best interest to cover everyone and keep costs DOWN.
The system we have right now is broken, and I am sick of argung with people who say stuff like "MY MONEY" all the while offering zero alternatives or ideas. The system right now is completely worthless, and some people are too ideological to see it.

Your logic is flawed.

When you pool a group of people, the cost to the individual goes down because the medical costs of the sick can be buffered by the premiums of more healthy people. 1 guy out of 10 who gets sick makes premiums go up significantly more than 1 guy out of 100 who gets sick. The population size is too small so that the costs cannot be sucessfully buffered.

Unfortunately this idea doesnt work for decreasing the costs of the whole country. If you are part of a smaller group- you will be paying closer to the actual cost of your actual care because your costs cannot be buffered by healthy people. It doesnt increase the cost of your care- just the costs you see. If we pool the entire country into 1 plan, it is not going to decrease the cost OF THE SYSTEM; that is fixed based on prevalence of disease and the cost of treating disease. Thus the average cost to the individual is not going to change we will just be re-distributing costs.

Second- the system is not broken. People get timely care- they just have to pay for it. You just dont agree with that idea.

If you want a solution i have one that involves a national health care plan for those uninsured:

Create a national health care plan that has certain restrictions-

1) if you currently smoke or use illegal drugs you are not eligible. Evidence of either of these disqualifies you for 2 years.

2) If you are obese by body fat measurements (not BMI) and not handicapped or elderly, you are not elligible.

3) As an adult if you did not graduate from high school and do not have a valid excuse- you are not eligible.

4) If you are non-compliant with your medications and not from side effects, you are kicked out

5) Only US citizens or those who have green cards are eligible.

Those who are not eligible and those who want to pay for it, can always get private insurance.

Then people would have some motivation to stop all these crappy lifestyle habits and lose some weight. We almost overnight would have a healthier, more compliant population and a better educated populace in one foul swoop.