tenblade2001
New member
W-O-W
Being a physician AND someone who has thoroughly vetted this topic (heck, at one time I thought a single-payer system was good at one point and I`ve actually read The Affordable Care Act), I believe I can contribute to the topic. Lets start from the beginning:
(1) The basic premise, and the justification put forth by supporters of The Affordable Care Act is that health care is a basic right. Q: Is that true? Even if one ignores the fact that this "right" is never mentioned in our Constitution nor The Bill of Rights, you have to acknowledge that EVERY right has an implied responsibility and failure to meet that responsibility means forfeiture of the right i.e. right to free speech but can`t yell fire in a theater . So if one has the right to healthcare, what is the implied responsibility? You have to take of yourself. But if you don`t, if there a penalty...NOPE. In fact, the physicians are penalized (thought satisfaction scores, "compliance" and "quality control" metrics). So, is there a "right" if there is no implied responsibility? The answer is no. To have one, you must have the other.
(2) "The cost of healthcare is skyrocketing due to (insert favorite villain...greedy doctors, big pharma, insurance companies).. eehh, a smidgen of truth, but mostly false. Healthcare cost are rising, but its mostly due to (a) increased cost of malpractice insurance. There is no penalty for a meritless lawsuit. So, it has become a game. The plaintiff`s attorney sues knowing that the hospital and malpractice insurance company will likely settle b/c it is cheaper than going to trial. If you question this, look at states like Tx and TN which have med-mal reform (vs. WV). Their operating cost are much lower. Secondly, meritless lawsuits have lead to "defensive" medicine. You order more test and more expensive test as a CYA (b) more "indigent" patients (... I use quotes b/c someone with a new iPhone than I have and $200 jeans is not indigent. They have other items they have deemed more valuable than health insurance) (c) more bureaucracy i.e. Joint Commission/JHCO. Hospitals and private practices have to hire "compliance officers" and spend a boat load of money to meet ever-changing "standards", moving goal post set in place by bureaucrats. When everyone meets the goal, the goal is changed. Why? b/c otherwise the bureaucrats would be out of a job. Another example...electronic medical records. A HUGE expense and little to no benefit to the patient. Nurses and physicians have to spend more time charting and less time taking care of patients. In addition, b/c the physician is overloaded they have to hire physician extenders i.e. physician assistants and nurse practitioners (d) increased cost of doing business i.e. having to hire multiple billing and collection people. When I perform a surgery, I have to get it precertified, then when I`m done submit a bill to the insurance company. Even if I have the precertification, they company will look and find any reason they can not to pay or pay less. In detailing terms, it would be a a customer coming in, you agree on a price for a two-stage correction and coating, but when they pick up the car, the pay you for a single stage...AND THERE`S NOTHING YOU CAN DO TO FIGHT IT...you just have to hand over the keys. This isn`t just the private companies, the worst offender is Medicare. (e) we have the capability to treat many conditions that used to be fatal but that treatment is expensive. Also, we have rising elderly population, who require more and more resources. In short, the cost of healthcare is rising, but its often due to the byproducts of government interference and frivolous lawsuits.
(3) The healthcare provided by single payer systems is just as good as the U.S. system- Again, there is a smidgen of truth. If you are young and relatively healthy...yes. Otherwise, not even close. All one has to do is look at the VA, the Canadian Health System or the British Health Service and you will see how bad a single payer system is. Look at the wait times for even "common surgeries" like hernia repairs or cardiac bypass....months. You know where most of the cardiac bypass patients come from in Mizzou Montana??? Canada. Healthcare IS rationed. In the UK, hospitals are given a certain amount of spinal fixation instruments.When they use it up, guess what? The surgery is either delayed or the patient is placed in traction; a treatment we haven`t used here in DECADES. If you have a skin cancer, your primary doctor can not directly refer you to a plastic surgeon or MOHs surgeon. They must refer to a dermatologist first (months to get appointment) who then refers to MOHs or plastic surgeon..several more months. In that amount of the time the skin cancer grows and turns what could have been a small operation into a major undertaking. OR time is rationed. There are only a set number of cases that will be done...period. Ask any surgeon that has spent a significant amount of time in a VA and they will all have a story about trying to get an emergency case done and encountering a significant delay vs. not getting to do it till the next day. So, why is a single payer system attractive? b/c the gov can control the cost of care AND NOT BE SUED. It is EXTREMELY hard to sue the VA and next to impossible to sue the UK system. The burden of proof is much higher AND in the UK, looser pays both attorney`s fees. Med-Mal or ambulance chasing is not the cottage industry that it is here.
(4) There are over 25 million uninsured Americans and they need coverage- Again, there is a smidgen of truth. Yes, there is an estimated 25 million people without coverage BUT that number includes (a) illegal aliens and (b) younger Americans that CHOOSE not to buy insurance.
Are there any benefits to The Affordable Care Act? Yes. The pre-existing conditions is a much needed reform but pretty much everything else sucks and it`s only going to get worse. I agree with many of the post; the system is broke. What will it take to fix it? (a) reduced bureaucracy (b) less but meaningful, data driven reform and policies/quality measures (c) med-mal reform (THIS IS HUGE...if you look at states with med-mal reform, like TX vs. physician hostile states like WV, there is no comparison in the quality of care and its delivered for much less) (d) increased competition...allow insurance companies to sell across state lines (e) health savings accounts: if people are paying for their healthcare there will be better stewards of their health AND they will insist on the best value.
Obamacare is a Trojan Horse. It`s purpose is to push and already broke system to the point of no return. At which point, the government will step in and take it over.
Being a physician AND someone who has thoroughly vetted this topic (heck, at one time I thought a single-payer system was good at one point and I`ve actually read The Affordable Care Act), I believe I can contribute to the topic. Lets start from the beginning:
(1) The basic premise, and the justification put forth by supporters of The Affordable Care Act is that health care is a basic right. Q: Is that true? Even if one ignores the fact that this "right" is never mentioned in our Constitution nor The Bill of Rights, you have to acknowledge that EVERY right has an implied responsibility and failure to meet that responsibility means forfeiture of the right i.e. right to free speech but can`t yell fire in a theater . So if one has the right to healthcare, what is the implied responsibility? You have to take of yourself. But if you don`t, if there a penalty...NOPE. In fact, the physicians are penalized (thought satisfaction scores, "compliance" and "quality control" metrics). So, is there a "right" if there is no implied responsibility? The answer is no. To have one, you must have the other.
(2) "The cost of healthcare is skyrocketing due to (insert favorite villain...greedy doctors, big pharma, insurance companies).. eehh, a smidgen of truth, but mostly false. Healthcare cost are rising, but its mostly due to (a) increased cost of malpractice insurance. There is no penalty for a meritless lawsuit. So, it has become a game. The plaintiff`s attorney sues knowing that the hospital and malpractice insurance company will likely settle b/c it is cheaper than going to trial. If you question this, look at states like Tx and TN which have med-mal reform (vs. WV). Their operating cost are much lower. Secondly, meritless lawsuits have lead to "defensive" medicine. You order more test and more expensive test as a CYA (b) more "indigent" patients (... I use quotes b/c someone with a new iPhone than I have and $200 jeans is not indigent. They have other items they have deemed more valuable than health insurance) (c) more bureaucracy i.e. Joint Commission/JHCO. Hospitals and private practices have to hire "compliance officers" and spend a boat load of money to meet ever-changing "standards", moving goal post set in place by bureaucrats. When everyone meets the goal, the goal is changed. Why? b/c otherwise the bureaucrats would be out of a job. Another example...electronic medical records. A HUGE expense and little to no benefit to the patient. Nurses and physicians have to spend more time charting and less time taking care of patients. In addition, b/c the physician is overloaded they have to hire physician extenders i.e. physician assistants and nurse practitioners (d) increased cost of doing business i.e. having to hire multiple billing and collection people. When I perform a surgery, I have to get it precertified, then when I`m done submit a bill to the insurance company. Even if I have the precertification, they company will look and find any reason they can not to pay or pay less. In detailing terms, it would be a a customer coming in, you agree on a price for a two-stage correction and coating, but when they pick up the car, the pay you for a single stage...AND THERE`S NOTHING YOU CAN DO TO FIGHT IT...you just have to hand over the keys. This isn`t just the private companies, the worst offender is Medicare. (e) we have the capability to treat many conditions that used to be fatal but that treatment is expensive. Also, we have rising elderly population, who require more and more resources. In short, the cost of healthcare is rising, but its often due to the byproducts of government interference and frivolous lawsuits.
(3) The healthcare provided by single payer systems is just as good as the U.S. system- Again, there is a smidgen of truth. If you are young and relatively healthy...yes. Otherwise, not even close. All one has to do is look at the VA, the Canadian Health System or the British Health Service and you will see how bad a single payer system is. Look at the wait times for even "common surgeries" like hernia repairs or cardiac bypass....months. You know where most of the cardiac bypass patients come from in Mizzou Montana??? Canada. Healthcare IS rationed. In the UK, hospitals are given a certain amount of spinal fixation instruments.When they use it up, guess what? The surgery is either delayed or the patient is placed in traction; a treatment we haven`t used here in DECADES. If you have a skin cancer, your primary doctor can not directly refer you to a plastic surgeon or MOHs surgeon. They must refer to a dermatologist first (months to get appointment) who then refers to MOHs or plastic surgeon..several more months. In that amount of the time the skin cancer grows and turns what could have been a small operation into a major undertaking. OR time is rationed. There are only a set number of cases that will be done...period. Ask any surgeon that has spent a significant amount of time in a VA and they will all have a story about trying to get an emergency case done and encountering a significant delay vs. not getting to do it till the next day. So, why is a single payer system attractive? b/c the gov can control the cost of care AND NOT BE SUED. It is EXTREMELY hard to sue the VA and next to impossible to sue the UK system. The burden of proof is much higher AND in the UK, looser pays both attorney`s fees. Med-Mal or ambulance chasing is not the cottage industry that it is here.
(4) There are over 25 million uninsured Americans and they need coverage- Again, there is a smidgen of truth. Yes, there is an estimated 25 million people without coverage BUT that number includes (a) illegal aliens and (b) younger Americans that CHOOSE not to buy insurance.
Are there any benefits to The Affordable Care Act? Yes. The pre-existing conditions is a much needed reform but pretty much everything else sucks and it`s only going to get worse. I agree with many of the post; the system is broke. What will it take to fix it? (a) reduced bureaucracy (b) less but meaningful, data driven reform and policies/quality measures (c) med-mal reform (THIS IS HUGE...if you look at states with med-mal reform, like TX vs. physician hostile states like WV, there is no comparison in the quality of care and its delivered for much less) (d) increased competition...allow insurance companies to sell across state lines (e) health savings accounts: if people are paying for their healthcare there will be better stewards of their health AND they will insist on the best value.
Obamacare is a Trojan Horse. It`s purpose is to push and already broke system to the point of no return. At which point, the government will step in and take it over.
1) you can not keep your plan or your doctor if you like them... Saying you can but have to pay more is lawyer-ese ie bending the truth. It`s not your plan , if you`re paying 2-3X what you did before (2) having the ACA plans do not guarantee you will be seen. MANY doctors are not accepting the plans (3) it is not saving more but costing SIGNIFICANTLY more... See the latest CBO projections. 
