ObamaCare

[lennie]

Here is a practical example of how it does not work.
I work at a physicians office (and by the way we are one of the few in our community who accept Tricare, because we think it is the right thing to do). When ACA became law we signed up thinking, again, it was the right thing to do. We got stung badly in several ways.
1. Several patients paid their first months premium, continued to see us for a few months, then the gummint came back to us and asked for all their payments back because the patients had not paid their premiums and I guess had forgotten to mention that to us.
2. We are a specialist office and refer out for second opinions, diagnostic testing etc. Guess what. Few other physicians or imaging locations in our town accept the plan. So now we are stuck with a patient who needs treatment but as we cannot find out what is really wrong with them we are relegated to prescribing pills to mask their symptoms. Yea, that will make them better.
3. There was one patient who agreed to go for a diagnostic injection (to help work out why his back hurt) and his copay and deductibles were so high he could not afford the test.

Not good for the physicians or the patients. Bad all round.


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[Se7en62]

Lox, your over-informed rebuttal?

 

[zx9rt1]

It wouldn't matter what I posted, you guys don't understand the benefits of the program anyway, and because it was by a president you don't like, it will always be something to rally against. Just like the current bunch of elected Republicans, you offer criticisms and no solutions.

The program is here to stay, so you might as well deal with it.

I'll tell you what I understand and know. This ACA bullshit has a strong arm to enforce it. It's called the IRS. Give this thing a couple of years to settle down, let the IRS start coming down really hard on those who work hard for their money to get audited and you will see a change. Just give it a few years to destroy the ones that get audited by the IRS.

 

[lennie]

I'll tell you what I understand and know. This ACA bullshit has a strong arm to enforce it. It's called the IRS. Give this thing a couple of years to settle down, let the IRS start coming down really hard on those who work hard for their money to get audited and you will see a change. Just give it a few years to destroy the ones that get audited by the IRS.

That is even more scary for the public. Once physicians and healthcare facilities are "forced" to accept the low rates, and retraction of payments (see my prior post) you will see a number of experienced providers retire or go into other non-patient contact, or cash pay, services.
The long term effect will be a change in the demographic of those entering medical school and the medical profession. Look at England where I cannot pronounce the names of many (most) of the physicians. Not that there is necessarily anything wrong with the care those physicians provide, but I sure would like a choice of which "origin" of physician I want to see.
The nationalization of healthcare in the UK created a two tier system. The majority of citizens get care from the NHS (National Healthcare System) and the wealthy or those in critical job functions, use the second tier "self pay" or private insurance system.
My father was in the NHS system and it took 18 months to remove a cancerous kidney. He was 82 when they removed the kidney and 84 when he died of wide spread cancer. Call me a cynic but the "system" did not prioritize the removal of the initial finding of cancer. That would never occur in the U.S. system today, but in 5 years????


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[TheDan]

1. Several patients paid their first months premium, continued to see us for a few months, then the gummint came back to us and asked for all their payments back because the patients had not paid their premiums and I guess had forgotten to mention that to us.

You were held liable for their lack of payment? wtf...

 

[lennie]

Absolutely. It is a hidden (pass it and we will see what is in it Pellosi moment). We cannot even, by law, get confirmation that a patient is current on their policy payment in the ACA. With regular commercial insurance we can and will delay treatment if not life threatening.
The reason is that the patient under ACA is not considered delinquent for 3 months, giving them the opportunity to "catch up" which on the face of it is a good gesture. However during that period we get paid, pay our staff and overhead, then get demand for restitution to the ACA plan. Talk about a cash flow nightmare. Or is that insensitive to some group or another!!!!


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[Mreed911]

You were held liable for their lack of payment? wtf...

And then have to send a notice/bill to the patient, hope to get that recovered, follow all the collections process specific to medical bills, etc.

 

[The Lox]

Lox, your over-informed rebuttal?

One example is not enough to do anything other than fire up you guys. We all learned that in elementary school when we had basic algebra. Get real dude.

 

[The Lox]

You were held liable for their lack of payment? wtf...

No, the insurance company asked for its payments made to the doctor because the patient had not paid the premium. Standard practice since insurance was invented. How do you not get that? Now the practice goes back to the individual for payment, again, as it happened since insurance was invented.

 

[The Lox]

We didn't become a nation with some of the best healthcare available with the most modern hospitals and equipment because we had some form of national healthcare. We have those things because we didn't.

Thats funny, because we aren't ranked as high as you have stated. Go do your homework instead of spouting a wild generalization such as the one above.

 

[Sugar Land]

It is all about tax.

Everyone pays tax to fund it. Even if you don't want it.
Pay a little more and you get it with tax included in the price.

It cost a lot to live in a free country.

IMO

 

[The Lox]

Speak for yourself, Lox isn't middle class! He wears a tie everyday and has multi degrees! !

Lol

I even have all my teeth, fingers and toes if you can believe it...

 

[lennie]

No, the insurance company asked for its payments made to the doctor because the patient had not paid the premium. Standard practice since insurance was invented. How do you not get that? Now the practice goes back to the individual for payment, again, as it happened since insurance was invented.

Sorry Lox you are not getting the point. I did not explain well. In treating a patient we have to recognize that this is the business of medicine. If the Doctor does not get paid then eventually he/she goes out of business and cannot treat patients. In the case of ACA we cannot determine if the patient has paid premiums and therefore we cannot ensure we get paid.
Let me give you an example (I know it is only one, but if you read as many national medical journals as I do you would realize it is generalized nationwide).
ACA patient goes to see orthopaedic surgeon because of knee pain in month 1 (premium paid). Surgeon tries minimally invasive stuff like cortisone shot. Two weeks later patient returns saying not effective. Surgeon orders MRI. Few MRI facilities accept ACA so the wait is a week (now early in month 2). MRI shows damage requiring a knee surgery (not replacement but maybe cartilage repair). Surgery scheduled for early in month 3. Medical insurance does a great thing at this point (I mean that). It requires the surgeon to care for the patient for a period of time, in this case 90 days in what is called the global period if for the same issue. This is intended to cover post surgical pain, minor infections and the like, so is understood and reasonable.
Patient did not mention, and ACA will not tell, that the patient paid premiums in month 1 but then did not subsequent to that. So MRI facility, hospital or surgery center, anesthesiology, lab if needed, and the surgeon have to return the payments made for all services save the initial office visit. To add insult the surgeon is medically required to continue to take care of the patient until they are medically stable (I do not argue with that as a sound medical responsibility).
How is that fair, or conducive to a long term working system? Ever heard on "once bitten, twice shy". Not going to get too many professionals tolerating not getting paid by many patients. One may be called charity, and again we do pro bono work so I am in principle ok with that, but on an ongoing basis, treating dishonest people (they just "forgot" to tell us they had not paid premiums) it is unsustainable.
Sorry for the long post, and some may disagree, but this is the new reality we face.


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[itchin]

He doesn't care. He's a left wing extremist. You can show a million real world examples. Facts don't matter to left wingers.

 

[lennie]

He will care when he or his loved ones (other than senators or congress folks cause they have a different system in this socialist environment) cannot get the healthcare they "deserve" or "have the right". You want to start another thread about pills being a right? Talk about inflaming the "people".
I had an idea years ago which is totally impractical. One IQ point One vote. Think on that one (way off topic).


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[TheDan]

And then have to send a notice/bill to the patient, hope to get that recovered, follow all the collections process specific to medical bills, etc.

Why doesn't the government do that? That's what an insurance company would do in that situation right? They want to act like an insurance provider, then they need to take the risk like an insurance provider. Of course that "risk" will just be added to the national debt.

 

[texas skeeter]

It is all about tax.

Everyone pays tax to fund it.

Correction, Only 50% of folks pay actual taxes in this Country!

 

[Sugar Land]

If you don't pay tax then you don't get shit.. IMO

 

[Younggun]

Thats funny, because we aren't ranked as high as you have stated. Go do your homework instead of spouting a wild generalization such as the one above.

I guess that's why people travel from the north and south to visit out hospitals.

 

[texas skeeter]

Yeah it's funny YG, I've known/met at least 2 dozen folks in my adult life from other Countries that come to the US specifically for something related healthwise/ to see a doctor!! LOL