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lol - toofache - Mark is an atty, not a doc. So, the q on comorbities/compliance, imaging equipment, etc wouldn't be something he'd know much about.
Exactly!! That's my point. As some have learned by now, many of my posts and questions are bait for further questions.
This is the classic case of someone raising their objections loudly and with "authority"......but when pushed to make a call they will say "but I'm not a doctor."
1. If the AMA does not represent the majority of physicians than does the AAFP (family doctors) or the AAP (pediatricians)? Both have issued statements in support of the ACA.
I know a number of physicians and I've discussed the ACA with them. I get a variety of reactions. On the negative side one of them calls it the "Unaffordable Care Act". However, I have a friend who practices family medicine in NY who thinks its wonderful. It turns out she has a child with a serious health problem. Another, sees both good and bad in it, but insists his clinic isn't turning away anyone with an ACA plan.
What these groups are advocating is revising the plan without completely scrapping it and starting over. The features they like are the ones that doctors like, primarily enabling patients who were uninsurable because they were sick to be able to get insurance at an affordable rate, like your friend. I can assure you that you would be hard pressed to find any docs who like the entire ACA.
Your friend who is not turning away people with those plans may have a relatively few patients using them or has not run into people skipping out on paying their share. In addition, high deductibles cause people to omit or delay care. Deductibles have always gone up, but now, paired with stagnant earning power, a tipping point has been reached.
2. Liability situation. You know where I stand on that. I don't ask you to agree with me. I do ask you to admit that its a fairly complicated issue and its uncertain exactly how much it does cost the health care system. I will admit that any reduction in unnecessary health care costs would be a good thing. The devil is in the details. I have some clients who go to the emergency room and given multiple CT scans. I'll see another client go to the emergency room complaining neck and back pain and get nothing more than one or two simple x-rays. Honestly, when I read medical records, I'm startled at the lack of uniformity in practices among different hospitals and different emergency rooms.
Hospitals and emergency rooms are different critters, and the people who run them can be ruthless in pursuit of profits. You might want to analyze the liability insurance rates and claims paid information side by side with the utilization.
"8. What is more powerful, state laws or state culture?
The answer, without a doubt, is state culture. Minnesota is devoid of tort reform, yet, physicians pay some of the lowest malpractice premiums in the country. I once asked a Minneapolis colleague why this is so, and he replied, “People here don’t sue. Some call it Minnesota Nice.” [32] On the other hand, while Florida has repeatedly tried to improve its medical liability system with reforms such as caps and expert witness reform, the state’s doctors actually pay some of the highest premiums in the country. It all boils down to state culture.
When a region, such as South Florida, evolves in this way, it is practically impossible to roll it back. The Florida trial lawyer lobby is simply too powerful, and any laws serving to protect physicians will be perpetually under fire.
The average malpractice premium in Minnesota is estimated at $8,500 while the average premium in Florida is estimated at $79,000! Why such an astronomical difference? Do Florida doctors make more mistakes than those in Minnesota? Of course not. In fact, Florida physicians are probably less risk tolerant and pressured to practice medicine more defensively. There are approximately 4,000 emergency physicians in Florida. If they were to convert their insurance to a Minnesota carrier, they would save $70,000 per doc for a total of $280 million! Where does this $280 million come from and where does it go? EPs in both states are paid approximately the same. However, Medicare spending is $6911 per capita in Minneapolis and $13,824 in Miami [81]. Put another way, each year we taxpayers make a $280 million donation to Florida’s trial lawyers.
The bottom line: It’s not about justice. It’s not about good medicine. It’s about money."
Quote:
3. EHR. You'd know more than I would about that. Still, it would seem to me this is a problem that could and should be fixed particularly if it is bad as you say it is. Are no doctors complaining to their Congressman about this aspect of the ACA? I've heard almost a complete silence literally until I came on this forum.
Doctors have no unified voice. They are complaining and no one is hearing them. Remember all those docs leaving the AMA? Some of the state societies are more vocal.
A somewhat snarky approach but this will give you an idea of some of the problems of electronic records
Notice the comments, including many saying the record costs them productivity
Quote:
4. Old insurance. Most policies that were eliminated by the ACA were bare bones policies that barely covered anything at all. It was health insurance without being health insurance.
I'm not saying you advocate any such thing. However, I get the idea that many ACA opponents think that if we don't provide health care for the uninsured, the problem they pose will simply "go away". That's magical thinking at its worst.
When you transition from an old system to a new system there are always problems. If reimbursement isn't adequate it can be raised. If doctors leave the profession because of low pay, than that sends a signal that higher fees are needed. Computer problems can be fixed over time as well. The difficulty is surviving them in the short run.
Here, in Utah, we have always had something of a shortage of primary care physicians. Yet, we seem to manage.[
No, perfectly good plans with reasonable copays, deductibles, and varying premiums disappeared because they did not conform to the ACA. My plan did that. Mr. Obama did lie about being able to keep your insurance if you wanted to. The idea that you could insure more people and spend less money doing so is ludicrous. The reason for mandating coverage was to get people into the system who were healthy and paying premiums but not using the coverage. That did not work.
As one of my links explained, the insurance does no good if you cannot pay the deductible and do not use it even when you need to. That is indeed health insurance without being health insurance. We have more people who are insured, but we have insured people who are not seeing doctors because it takes too big a chunk out of their income.
Sometimes I think the whole idea of the ACA is to get the system to implode so it can be replaced with a single payor plan, and that is an idea that more doctors are becoming comfortable with.
Eliminate all the mandates about electronic records and let the market fix the computer issues. Maybe at least one company will develop a system that works like an old fashioned paper chart. That and an awesome voice recognition feature would be a money maker.
What these groups are advocating is revising the plan without completely scrapping it and starting over. The features they like are the ones that doctors like, primarily enabling patients who were uninsurable because they were sick to be able to get insurance at an affordable rate, like your friend. I can assure you that you would be hard pressed to find any docs who like the entire ACA.
Your friend who is not turning away people with those plans may have a relatively few patients using them or has not run into people skipping out on paying their share. In addition, high deductibles cause people to omit or delay care. Deductibles have always gone up, but now, paired with stagnant earning power, a tipping point has been reached.
Hospitals and emergency rooms are different critters, and the people who run them can be ruthless in pursuit of profits. You might want to analyze the liability insurance rates and claims paid information side by side with the utilization.
"8. What is more powerful, state laws or state culture?
The answer, without a doubt, is state culture. Minnesota is devoid of tort reform, yet, physicians pay some of the lowest malpractice premiums in the country. I once asked a Minneapolis colleague why this is so, and he replied, “People here don’t sue. Some call it Minnesota Nice.†[32] On the other hand, while Florida has repeatedly tried to improve its medical liability system with reforms such as caps and expert witness reform, the state’s doctors actually pay some of the highest premiums in the country. It all boils down to state culture.
When a region, such as South Florida, evolves in this way, it is practically impossible to roll it back. The Florida trial lawyer lobby is simply too powerful, and any laws serving to protect physicians will be perpetually under fire.
The average malpractice premium in Minnesota is estimated at $8,500 while the average premium in Florida is estimated at $79,000! Why such an astronomical difference? Do Florida doctors make more mistakes than those in Minnesota? Of course not. In fact, Florida physicians are probably less risk tolerant and pressured to practice medicine more defensively. There are approximately 4,000 emergency physicians in Florida. If they were to convert their insurance to a Minnesota carrier, they would save $70,000 per doc for a total of $280 million! Where does this $280 million come from and where does it go? EPs in both states are paid approximately the same. However, Medicare spending is $6911 per capita in Minneapolis and $13,824 in Miami [81]. Put another way, each year we taxpayers make a $280 million donation to Florida’s trial lawyers.
The bottom line: It’s not about justice. It’s not about good medicine. It’s about money."
Doctors have no unified voice. They are complaining and no one is hearing them. Remember all those docs leaving the AMA? Some of the state societies are more vocal.
A somewhat snarky approach but this will give you an idea of some of the problems of electronic records
Notice the comments, including many saying the record costs them productivity
No, perfectly good plans with reasonable copays, deductibles, and varying premiums disappeared because they did not conform to the ACA. My plan did that. Mr. Obama did lie about being able to keep your insurance if you wanted to. The idea that you could insure more people and spend less money doing so is ludicrous. The reason for mandating coverage was to get people into the system who were healthy and paying premiums but not using the coverage. That did not work.
As one of my links explained, the insurance does no good if you cannot pay the deductible and do not use it even when you need to. That is indeed health insurance without being health insurance. We have more people who are insured, but we have insured people who are not seeing doctors because it takes too big a chunk out of their income.
Sometimes I think the whole idea of the ACA is to get the system to implode so it can be replaced with a single payor plan, and that is an idea that more doctors are becoming comfortable with.
Eliminate all the mandates about electronic records and let the market fix the computer issues. Maybe at least one company will develop a system that works like an old fashioned paper chart. That and an awesome voice recognition feature would be a money maker.
Then it wasn't a perfectly good plan! The basics in the ACA really are not out of line. Also, way before the ACA, insurance companies dropped or changed plans yearly. It is nothing new. Neither are plans with deductibles. Not to mention that the various savings plans, FSA's and HSA's are huge tax savers and VERY underutilized. For the average health insurance plan out there, families could save ALL of their deductibles in an HSA each year, with money to roll over, but they don't. No, not everyone could afford to do that, but on average, most families can, but they don't. With the tax savings for an average family, saving the $6650+ yearly, nets out about a $2800 tax savings. It's about $75/week net. Also figure that MOST families do not max out their deductibles every year, and with 100% preventive care, most won't spend anything extra outside of premiums.
The electronic record issue is just silly. All clinics have them now, eliminating them would just be money out the window. Plus, having used about 10 different online record systems, they work just fine--or as well as any other computer system. The mandate came out long before the ACA and it's a good thing. In the clinics, most offices I see use the EPIC system. It works like a paper chart because it is just their chart system now. Frankly, its far more functional than a paper chart anyway. I have yet to see a practitioner complain about the computerized system overall, and I unfortunately have to go to the doctor a lot.
A single payer option will NOT save money and the lack of access to good quality care will go away....
Then it wasn't a perfectly good plan! The basics in the ACA really are not out of line. Also, way before the ACA, insurance companies dropped or changed plans yearly. It is nothing new. Neither are plans with deductibles. Not to mention that the various savings plans, FSA's and HSA's are huge tax savers and VERY underutilized. For the average health insurance plan out there, families could save ALL of their deductibles in an HSA each year, with money to roll over, but they don't. No, not everyone could afford to do that, but on average, most families can, but they don't. With the tax savings for an average family, saving the $6650+ yearly, nets out about a $2800 tax savings. It's about $75/week net. Also figure that MOST families do not max out their deductibles every year, and with 100% preventive care, most won't spend anything extra outside of premiums.
The electronic record issue is just silly. All clinics have them now, eliminating them would just be money out the window. Plus, having used about 10 different online record systems, they work just fine--or as well as any other computer system. The mandate came out long before the ACA and it's a good thing. In the clinics, most offices I see use the EPIC system. It works like a paper chart because it is just their chart system now. Frankly, its far more functional than a paper chart anyway. I have yet to see a practitioner complain about the computerized system overall, and I unfortunately have to go to the doctor a lot.
A single payer option will NOT save money and the lack of access to good quality care will go away....
Yes, it was a perfectly good plan. The premium reflected my age, but the copay and deductible was reasonable. Fortunately, I was able to shift to Medicare at that time.
HSAs and such are tax savers only if you earn enough to pay taxes. Someone who could realize a $2800 savings on $6650 deduction would have to be in the top bracket for federal tax. In fact, it would mean a taxable income of over $440,000. Those are people who could also probably pay their high deductible without having to cut back on essentials like food. Far more people will meet a deductible of $500 than $3000 or $5000.
You may think the EHR issue is silly. It is not. Many are poorly functional, and the better ones are not much better.
Do not go to a hospital that is rolling out a new system. No one will know how to use it. A single payor system should offer a basic level of care with the opportunity to add options, just as dental and vision coverage can be added now. The current pricing of health care plans is not sustainable for a large portion of the population.
With the tax savings for an average family, saving the $6650+ yearly, nets out about a $2800 tax savings.
Wonderful if true. However, the actual numbers, for federal tax savings, is actually, in most cases, over $1,000 less.
Piggybacking on SuzyQ, here is the breakdown for people in the real world:
Marginal Tax Rates (after deductions and exemptions of at least $28,200):
$0-9,075 taxable income - 10% x $6,650 = $665.00 tax savings
$..73,801 taxable income - 15% x $6,650 = $997.50 tax savings
$100,001 taxable income - 25% x $6,650 = $1,662.50 tax savings
$148,501 taxable income - 28% x $6,650 = $1,862.50 tax savings
Add to that a possible state tax savings of 5%, or $332 (in the 47 states which have a state income tax). So, total tax savings - state and federal - assuming this is a higher income family with taxable income of OVER $100K - would be - at most - in the range of $1,995/$2,194.
But, only 20% of American households evenearn over $100k/year
Moreover, median family income in US is approx. $53,000,
$53,000 - gross income
$12,400 - standard deduction
$15,800 - personal exemptions (2 adults 2 children @ $3,950 ea) $24,800 - Taxable Income $x2,809 - Federal tax before credits
$x2,000 - child tax credit (@$1,000/per child) $xx 809 - Federal tax due
At best, that family's tax is reduced $809 - if it saves $5,400 into an HSA/FSA - at which point its taxable income is $19,400, tax is about $2k, child tax credit zeros out the tax liability.
For families at this income level, saving $450/mo is a nonstarter, although they certainly should try to save at least their copays, and something towards their deductible and out-of-pockets in an FSA. HSA's are better b/c the money is not use it or lose it - however, HSA plans also require higher deductibles which often are not appropriate for low-income people.
Quote:
Originally Posted by suzy_q2010
HSAs and such are tax savers only if you earn enough to pay taxes. .......The current pricing of health care plans is not sustainable for a large portion of the population.
I did extensive research on the various plans offered through healthcare.gov in NJ, and checked to make sure I chose a plan that all or most of my doctors took. All but one were listed as taking the plan. As it turned out, the only one of my doctors that takes it was the one not listed. As a result, I have had to put out hundreds of dollars for services this specific plan will not cover. I had to switch all my other doctors except one. Not the worst problem in the world, but it seems most of the doctors that take the insurance are concentrated in northern NJ, which would require an average drive of about 2 hours. There are tons of doctors in my area, but few specialists take the insurance.
In April, I was granted Medicare. I asked to be removed from the plan, because it is illegal to have Medicare and an ACA plan at the same time. I made sure that my family was still covered on the plan. I have been making payments on time since. UHC has been cashing my checks. The problem is, they kicked my entire family off the plan as of March 31, and I have been fighting ever since to get them put back on. According to the Health Insurance Marketplace people, my family is still on the plan, sans me, but UHC/Oxford does not acknowledge that the plan exists.
They've taken my money, but they can't find any record that the plan exists.
Going back on the phone and to writing to every agency I can, to try to resolve this nightmare.
In April, I was granted Medicare. I asked to be removed from the plan, because it is illegal to have Medicare and an ACA plan at the same time. I made sure that my family was still covered on the plan. I have been making payments on time since. UHC has been cashing my checks. The problem is, they kicked my entire family off the plan as of March 31, and I have been fighting ever since to get them put back on. According to the Health Insurance Marketplace people, my family is still on the plan, sans me, but UHC/Oxford does not acknowledge that the plan exists.
They've taken my money, but they can't find any record that the plan exists.
Going back on the phone and to writing to every agency I can, to try to resolve this nightmare.
Don't take this the wrong way, but in a strange way I am glad that consumers are finally having to deal with the same insurance BS that doctors have fought for years.
Don't take this the wrong way, but in a strange way I am glad that consumers are finally having to deal with the same insurance BS that doctors have fought for years.
toofache, as a doctor, do you think it would make your job easier to just switch to an all cash system? Could it save you money not to have to deal with insurance at all? If you had patients pay on the day of service would it save money in not having to bill? Could that savings be passed on to patients so that they could see you for roughly the same amount as they would pay with insurance? These are genuine questions. Just curious as to your thoughts.
toofache, as a doctor, do you think it would make your job easier to just switch to an all cash system? Could it save you money not to have to deal with insurance at all? If you had patients pay on the day of service would it save money in not having to bill? Could that savings be passed on to patients so that they could see you for roughly the same amount as they would pay with insurance? These are genuine questions. Just curious as to your thoughts.
Yes and this is what I do often. I am dropping medical insurance left and right because I no longer can afford to take them. They require me to hire multiple full-time staff to do all the paperwork and file the claims, sit on the phone and argue with the insurance companies after waiting on hold for sometimes over an hour, and to then file appeals when claims are denied. All this for the privilege of accepting much lower fees than I bill.
I have 3 offices and I rotate through them on different days of the week. In one office I am not in-network with any medical insurance plans. Everyone is seen out of network and they are told this when they schedule appointments, and they are told what the fees are. Cash patients are given a 5% discount for paying on the day of service (which is required to be treated anyway). We add on another 5% for senior citizens. For patients needing expensive procedures I will often discount WAY more simply because I no longer need the extra money to pay for additional staff. And also because I am paid up front instead of some insurance companies that wait months to pay (my record so far is I got paid for a surgery I did 1.5 years later).
The insurance companies are the only ones winning here. They are collecting premiums but not paying out to others. It's a bloated middle man that exists to serve itself, not patients or doctors.
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I've had the same problem
