Why Republicans Refuse to Reconcile Themselves to Obamacare

[Montecresto]

Your criticisms of the "scheme" are legitimate, I do however wish that you would acknowledge the bi-partisan nature of the "scheme".

 

[jaeger19]

The first bill is 2,407 pages. The second bill 55 pages.

Yep.. My PDF version is 2407 exactly... (there are 6 versions of the bill)

Have you read it yet?

 

[fmw]

For the OP, the Republicans do not want a single payer government controlled health industry. Since Obamacare is step one in the road to that, they want to get rid of it. If Obamacare is not demolished then people will hate it beyond belief and the democrats believe they will then be able save the day by replacing it with a single payer system. Pretty straightforward, I think.

 

[jaeger19]

What sort of medical insurance does a single, childless, healthy twenty-five old need? They need a cheap policy with a large deductible which covers catastrophic care and calls for routine care to be paid out of pocket. Exactly what Obamacare has outlawed.

Outlawed huh? Too funny. First.. the ACA allows catastrophic plans... it does limit the deductible to a certain amount.. in 2010 it would have been 5950 or so individual and 11,000 for family. The only other change from a typical catastrophic plan would be that it requires paying for three routine visits.

(e) CATASTROPHIC PLAN.—
14 (1) IN GENERAL.—A health plan not providing
15 a bronze, silver, gold, or platinum level of coverage
16 shall be treated as meeting the requirements of sub17
section (d) with respect to any plan year if—
18 (A) the only individuals who are eligible to
19 enroll in the plan are individuals described in
20 paragraph (2); and
21 (B) the plan provides—
22 (i) except as provided in clause (ii),
23 the essential health benefits determined
24 under subsection (b), except that the plan
25 provides no benefits for any plan year until
117
HR 3590 EAS/PP
1 the individual has incurred cost-sharing ex2
penses in an amount equal to the annual
3 limitation in effect under subsection (c)(1)
4 for the plan year (except as provided for in
5 section 2713); and
6 (ii) coverage for at least three primary
7 care visits

Gee.. I didn't see anything in their saying they are outlawed


Secondly, what single childless healthy twenty five year olds need is... a moderate deductible plan. Too low is not necessary,, and too high? When they do get sick or hurt, since they don't make enough money for the deductible... they will wait until its an emergency and then it costs everyone more money and, or.. they are unable to pay off the deductible so that cost gets passed on to the rest of us that can pay our deductible.

In addition, they need routine visits paid for... they are cheap and are preventative medicine. Its one way that socialized medicine countries manage to lower their healthcare costs. They allow all sorts of visits to the local clinic... which prevents a lot of worse things.... and cost contain on the more expensive treatments.

 

[Visbek]

I don't recall seeing you provide any scoops on any of the bombshell surprises of the past 3 1/2 years

1) What "bombshell surprises?"
2) That's your idea of expertise? Seriously?

you don't even appear up-to-speed on the legislative history of the scheme

The House amended it with the Health Care and Education Reconciliation Act of 2010.

Oh right. Changes don't count if they're in a separate bill, for procedural reasons. :roll:

 

[Visbek]

For the OP, the Republicans do not want a single payer government controlled health industry. Since Obamacare is step one in the road to that, they want to get rid of it. If Obamacare is not demolished then people will hate it beyond belief and the democrats believe they will then be able save the day by replacing it with a single payer system. Pretty straightforward, I think.

Yes, that's as straight-forward as a pretzel.

Most people won't "hate" Obamacare, similar to how most residents of Massachusetts don't hate Romney's health care reform. Most people will continue to get insurance from their employers, and that's not changing. People who don't get insurance from their employers will no longer be turned down because of phantom "pre-existing conditions." No one is objecting to putting 26 year olds on their parents' insurance, or receiving checks from their insurance company for excess expenditures on overhead.

Single payer would be better. However, Obamacare isn't a Top Secret Step to establishing single payer.

 

[Montecresto]

For the OP, the Republicans do not want a single payer government controlled health industry. Since Obamacare is step one in the road to that, they want to get rid of it. If Obamacare is not demolished then people will hate it beyond belief and the democrats believe they will then be able save the day by replacing it with a single payer system. Pretty straightforward, I think.

They are consistent in this for a long time now too. In 1945 after securing a majority in congress the GOP attacked an attempt at a form of government healthcare along with the AMA. It was shelved and then with the advent of anti-communism thru the early fifties the issue faded away, despite Truman's attempt. The AMA even levied a one time 25 dollar surcharge on all their members and spent 1.5 million dollars fighting it, that was the largest sum of money spent to that date to defeat a measure. They even produced a pamphlet that likened it to communism quoting Vladimir Lenin saying that national healthcare is the primary Arch to a socialist society, though I believe nobody has ever confirmed that Lenin actually said that.

 

[paddymcdougall]

Outlawed huh? Too funny. First.. the ACA allows catastrophic plans... it does limit the deductible to a certain amount.. in 2010 it would have been 5950 or so individual and 11,000 for family. The only other change from a typical catastrophic plan would be that it requires paying for three routine visits.



Gee.. I didn't see anything in their saying they are outlawed


Secondly, what single childless healthy twenty five year olds need is... a moderate deductible plan. Too low is not necessary,, and too high? When they do get sick or hurt, since they don't make enough money for the deductible... they will wait until its an emergency and then it costs everyone more money and, or.. they are unable to pay off the deductible so that cost gets passed on to the rest of us that can pay our deductible.

In addition, they need routine visits paid for... they are cheap and are preventative medicine. Its one way that socialized medicine countries manage to lower their healthcare costs. They allow all sorts of visits to the local clinic... which prevents a lot of worse things.... and cost contain on the more expensive treatments.

Thanks, Jaeger.

And to repeat an earlier post - for those of you worrying about low-income people who can't pay for insurance - there will be subsidies for them.

So now those who were worried about that - you can worry about those same people not being able to afford gas for their car, food for their table and...wait, you don't care about that? You're only worried that they won't be able to afford insurance? Maybe you're just using them as an excuse because you hate the ACA......

 

[Greenbeard]

Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole.

Seven Factors Driving Up Your Health Care Costs | PBS NewsHour

I'm not sure what this is supposed to refute. Health spending growth and health price inflation are both at historic lows right now; overall growth in health care spending has slowed such that the CBO has had to revise downwards its estimates of federal health spending by hundreds of billions of dollars this decade.

I assume you can at least acknowledge these facts, as I don't know of anyone who denies them.

To repeat, the main bill is 2,401 pages and the second bill is 55.

And to repeat for you: the entirety of the Patient Protection and Affordable Care Act (all amendments incorporated) and the health care piece of the reconciliation bill can be viewed here: http://housedocs.house.gov/energycommerce/ppacacon.pdf That's just over 950 pages.

Even if you go the Library of Congress website for the ACA legislation and download the PDF of the enrolled bill (i.e. the final version passed by the House and Senate), it's 906 pages. And that one isn't even cleaned up, it leaves in sections that are stripped out by the amendments at the end.

 

[Montecresto]

Thanks, Jaeger.

And to repeat an earlier post - for those of you worrying about low-income people who can't pay for insurance - there will be subsidies for them.

So now those who were worried about that - you can worry about those same people not being able to afford gas for their car, food for their table and...wait, you don't care about that? You're only worried that they won't be able to afford insurance? Maybe you're just using them as an excuse because you hate the ACA......

The ACA has good aspects to it. Chief among them is that its good for my business (Medical billing) because its driving doctors to me. Doctors who once did their billing in house, but find it increasingly complex. Doctors who are refusing to go on EMR are being hit with a 1.5 % fine which will go up regularly and eventually licences won't be issued to Dr.'s starting new practices unless they are on an EMR. Older doctors have huge concerns for the privacy of their patients due to EMR's. Older doctors are retiring early because of the ACA. That's the good doctors, the ones with lots of experience, that you want to go have your surgery done by, not the guy who's been in practice for three years. Other doctors are throwing their hands up and going to work for the hospital as a salaried employee. I hear doctors say all the time, "I just want to practice medicine". Old docs often aren't computer savvy. But like I said, the best thing about the ACA is.............business is booming and I'm hiring.

 

[obvious Child]

This is ridiculous. The exchanges and the financing schemes are "the bulk of the law," the goodies are icing. Why are supporters of the scheme reduced to nonsense like this?

Sounds like you didn't like how this thread is going and hence why you're resorting to partisan vomit.

Look at the link I provided. The list of items that people love are the bulk of the bill. You can whine all you want, but people do like what's in Obamacare.

I see you're ignoring the alternative.

Tell me, if Obamacare is so bad, why aren't you championing the left of premiums from responsible people? After all, that's what the GOP proposal amounts to, advocating free loading. Tell me, how is that taking responsibility or even being remotely conservative?

 

[Montecresto]

Updated: Thursday, August 8 2013, 11:00 PM CDT Dr. Ben Carson, the renowned pediatric neurosurgeon who recently retired from Johns Hopkins, has been an outspoken critic of the Affordable Care Act from the beginning. What is the impact now, on doctors? Carson said, “It means a new horror every month, basically as we find out more and more things that are required of us.” Requirements, like more documentation…In order for doctors to get paid, and loopholes... That could leave doctors holding the bag. For example, if patients in state health insurance exchanges fail to pay their premiums. The patient gets a three month grace period. But insurers are only responsible for paying one month's worth of bills. Carson said, “Those are going to be the things that make medicine considerably less desirable. Unless it's addressed you're going to have a lot of people getting out of the profession.” In fact, recent numbers show.... that more than 9,000 doctors opted out of Medicare participation in 2012. That number tripling since 2009. Many factors contributing to a projected shortage of doctors and the emergence of concierge practices, where doctors take on a smaller number of patients who pay out of pocket thousands of dollars a year.

Read More at: http://www.weartv.com/news/features...or-speaks-out-affordable-care-act-34749.shtml

 

[Greenbeard]

In fact, recent numbers show.... that more than 9,000 doctors opted out of Medicare participation in 2012. That number tripling since 2009.

That's far from the whole story.

And yes, the number of doctors saying no to Medicare has proportionately risen quite a bit -- from 3,700 doctors in 2009 to 9,539 in 2012. (And in some cases, Obamacare has been a convenient scapegoat.)
But that's only part of the story.

What the Journal didn't report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.

And other providers aren't turning down Medicare, either. The number of nurse practitioners participating in the program has only gone up, Jan Towers of the American Academy of Nurse Practitioners told California Healthline.

9,000 docs may have opted out, but many more opted in. The net result being that there are 29,473 more doctors accepting Medicare this year than last year.

 

[Montecresto]

Oh you can be sure that number will continue to increase. In fact if it only triples once more it will neutralise any growth. And the CMS has an interest in ACA success. I wouldn't necessarily trust the government when it comes to the government defending themselves.

Endless searching. Repeated rejection. Trips to the emergency room when all else fails. The horror stories are familiar to seniors who can't find a new primary care doctor willing to accept their Medicare coverage.

But just how widespread is the problem? And why are doctors opting out of the program in the first place?

To find out, the PBS NewsHour health unit traveled to Austin, where the Texas Medical Association -- one of the few state medical societies tracking the problem -- recently found that the number of Texas physicians accepting Medicare patients dropped from 78 percent in 2000 to 58 percent in 2012..

http://www.pbs.org/newshour/rundown...ctors-shrinks-for-some-medicare-patients.html

 

[jaeger19]

A few points on physicians and providers and the ACA.

1. Physicians are not retiring because of the ACA.. that trend started a while ago and though a scapegoat.. its not the whole story. I know.. I am a private practice provider

Physicians and other providers are retiring or selling to hospitals and becoming employees for the following reasons.

1. There are a lot of physicians that are baby boomers... as the baby boomers reach retirement age.. so to do baby boomer physicians

2. Declining reimbursement. This started in 1998 with the Balance budget act. While reimbursement has declined.. costs have gone up. This is really problematic for the private practitioner. That's because what we sell is time.. and there are only so many hours in a day. My reimbursement for an hour of care is lower NOW than it was in 2005. That's not just medicare.. but the private insurances that follow medicare. That means for private practice providers there are two ways to make for this. One is to become more efficient.. for example with electronic medical records. As stated before.. EMR has been going on for quite a while as its more efficient to do documentation and billing while the patient is with you.. so that you can bill for more time.. rather than do 5 hours of care and two hours of documentation. Its also much more cost effective to have it done electronically rather than pay office staff hours to do it by paper. In fact.. my gripe is that insurance companies STILL want paper. Even Medicare at times.

So the other way that private practices can survive with declining reimbursement is by expansion... making up on volume what you don't get by margin. that means expansion of business, that can mean the use of ancillary staff such as PA's, more employees and more headaches. That's not because of the ACA..thats because of whats been going on in healthcare that's led to the ACA.

So a lot physicians practices have been consolidating or selling out to the bigger hospital chains.

3. Fewer newer doctors that want to buy into private practices... Quite frankly, there are fewer providers that want to be in private practice. The hours are long, the whole business side of it, you don't have coverage.. etc.. There are more physicians, particularly more female physicians.. that want the stability and flexibility to work as an employee with a good salary, time off, structured hours and fewer headaches.

 

[Montecresto]

I agree with what you said about the balance budget act. But the ACA certainly IS causing grief for the doctors, I too talk with them every day (I own a Medical Billing Co.) and have lost four clients who have thrown up their hands in disgust over the increased regulations, deadlines and 2% penalties for not getting on an EMR and have retired. they are frustrated because they just want to practice medicine. I've lost a few younger ones, that have thrown in the towel for similar reasons and gone to work for the hospital. ACA has also been good for my business because it has driven doctors to me needing help working through the changes. The ACA is not going to be a plus for doctors in any event.

Recent polling indicates as many as 83 percent of doctors across the country are unhappy with the Affordable Care Act and some doctors are even saying that it will result in them retiring early. In states like Mississippi with shortages of physicians, that could make a bad situation worse.

http://msbusiness.com/blog/2012/12/14/is-it-less-pay-and-more-hassle/

 

[jaeger19]

I agree with what you said about the balance budget act. But the ACA certainly IS causing grief for the doctors, I too talk with them every day (I own a Medical Billing Co.) and have lost four clients who have thrown up their hands in disgust over the increased regulations, deadlines and 2% penalties for not getting on an EMR and have retired. they are frustrated because they just want to practice medicine. I've lost a few younger ones, that have thrown in the towel for similar reasons and gone to work for the hospital. ACA has also been good for my business because it has driven doctors to me needing help working through the changes. The ACA is not going to be a plus for doctors in any event.

Recent polling indicates as many as 83 percent of doctors across the country are unhappy with the Affordable Care Act and some doctors are even saying that it will result in them retiring early. In states like Mississippi with shortages of physicians, that could make a bad situation worse.

Doctors concerned about Affordable Care Act may decide to simply retire - Mississippi Business Journal

I am not arguing with you that you hear physicians complain about the ACA and how they are going to retire because of it. I am quite sure that happens.. however, I am suggesting you take their comments with a LARGE grain of salt. First off.. the time when as a private provider one could "just treat patients" is FAR FAR gone. It began going away for a while.. and certainly was gone by 2000. The idea that these physicians were just cruising along with a big happy smile until the big bad ACA came on board and ruined it all is simply bunk. The medical field has gone through WAY to much change in the last two decades.. managed care, the balance budget act and physician fee schedules, the medicare modernization act.. Heck HIPPA in 1996, etc etc. As far as regulation? the ACA is a drop in a bucket when it comes to regulation of the medical field. The Docs you are talking about were on their way out.. long before the ACA. In fact.. its the problems with the healthcare system and insurance industry that have lead to the ACA.. it did not develop in a vacuum.

As far as the ACA not going to be a plus for providers? Lets see, no pre existing medical conditions.... hmm that means that there are going to be more folks that needed care, surgery that were unable to get it because it was pre existing but now their insurance covers it... that means more patients with money to pay for it.

Lets see.. a mandate to be on insurance.... gee that means more people that have a means to pay their bills... not to mention that its going to be subsidized so folks can get coverages that cover 80% to 90% of the allowable. That means more patients with money to pay for care.

What else? Oh yeah.. now that more folks will be purchasing their OWN insurance.. they will need to know more about it and more importantly, if the insurance company tries to jerk them around, they can hop insurance, which means insurance companies will be somewhat more beholden to the actual consumer than to their employer.

AND it could mean that more insurance companies means more a more competitive field for referrals... instead of a big hospital swooping in and become a "preferred provider" and undercutting private practices.

What are the downsides? Some EMR which quite frankly.. if you weren't doing already... you had bigger problems than the ACA... however, what fails to be brought up is the tax credits and tax writeoffs that are given to upgrade to EMR which balances out the cost. and possibly there will be an issue with payments based on outcomes...

Are there flaws.. serious flaws in the ACA?... yep... but most of those things have to do with establishing subsidies and with the arbitrary effects on business.. and less on providers. If anything, the ACA will be a net gain for providers because of the increase in patients with insurance, the decrease in pre existing conditions, and the increase number of insurance competition.

 

[Montecresto]

Ok, I guess you really are unaware of just how many doctors offices across the country ARE NOT ON EMR! I sign doctors on that are still paper chart and sell them EMR regularly. I'm working with a private doctor owned clinic of 91 physicians that own their own 11 story building, they do their billing in house paper charts and the doctors hand write there notes in their charts and they've been quite content. But now they're realizing that they have to go to EMR, again that nasty 2% penalty which will go higher amongst other reasons. These doctors voice very real concerns about patient privacy which is quite secure inside their paper chart locked in their files, not so much in cyberspace. About a dozen doctors in this group are quitting. A loss to the healthcare system!

As to the positive aspects of the ACA that you have pointed to, I don't dispute. It's a matter of whether or not they as handsomely offset the negatives as you are trying to prove. The doctors are aware of the positive aspects of the ACA but still, they have this to say.


By David Pittman, Washington Correspondent, MedPage Today
save|AA
WASHINGTON -- Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found.

Six in 10 physicians (62%) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. That perception is uniform across age, gender, and specialty, it said.

http://www.medpagetoday.com/PracticeManagement/PracticeManagement/38013

 

[jaeger19]

Ok, I guess you really are unaware of just how many doctors offices across the country ARE NOT ON EMR! I sign doctors on that are still paper chart and sell them EMR regularly. I'm working with a private doctor owned clinic of 91 physicians that own their own 11 story building, they do their billing in house paper charts and the doctors hand write there notes in their charts and they've been quite content. But now they're realizing that they have to go to EMR, again that nasty 2% penalty which will go higher amongst other reasons. These doctors voice very real concerns about patient privacy which is quite secure inside their paper chart locked in their files, not so much in cyberspace. About a dozen doctors in this group are quitting. A loss to the healthcare system!

As to the positive aspects of the ACA that you have pointed to, I don't dispute. It's a matter of whether or not they as handsomely offset the negatives as you are trying to prove. The doctors are aware of the positive aspects of the ACA but still, they have this to say.


By David Pittman, Washington Correspondent, MedPage Today
save|AA
WASHINGTON -- Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found.

Six in 10 physicians (62%) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. That perception is uniform across age, gender, and specialty, it said.

Survey: More Docs Plan to Retire Early

I would submit that you are unaware of how many doctors and providers ARE on EMR because those folks are not coming in to see you. However, I do hope for that those that come in for EMR help, you help them get on the Medicare incentive program for EMR. It can be up to 15,000 per individual for the first year, 12,000 for the second, 8,000 for the third year and so on for up to 5 years total. I believe if they accept Medicaid.. there is also an incentive program for that too.

As far as being pessimistic outlook on the future of medicine? Less Autonomy and falling income... things that have been happening for at least a decade, not because of the ACA. Like I stated.. the ACA might reverse that... a lot depends on whether we have a working congress that can modify the ACA as unintended consequences happen or whether they continue to act like little children.

 

[Montecresto]

Yes, we do help them with that and it's 18,000 for the first. And yes I'm well aware of the fact that lots of doctors are on EMR. And no I don't know if the congress will quit acting like children about this.

 

[wbcoleman]

Your criticisms of the "scheme" are legitimate, I do however wish that you would acknowledge the bi-partisan nature of the "scheme".

My recollection is that it passed with zero Republican votes in the Senate and 1 out of 435 in the House.

 

[wbcoleman]

Sounds like you didn't like how this thread is going and hence why you're resorting to partisan vomit.

Look at the link I provided. The list of items that people love are the bulk of the bill. You can whine all you want, but people do like what's in Obamacare.

I see you're ignoring the alternative.

Tell me, if Obamacare is so bad, why aren't you championing the left of premiums from responsible people? After all, that's what the GOP proposal amounts to, advocating free loading. Tell me, how is that taking responsibility or even being remotely conservative?

The exchanges and the mandates are the heart of the scheme, and they are not popular. The goodies are icing.

The elements of an alternative ought to include ending the favorable tax treatment of employer-provided insurance, deregulation of medical insurance markets, and vouchers to assist in paying medical expenses of the poor.

 

[Montecresto]

My recollection is that it passed with zero Republican votes in the Senate and 1 out of 435 in the House.

You mean your still denying the republican contributions to the "scheme"?

 

[obvious Child]

The exchanges and the mandates are the heart of the scheme, and they are not popular. The goodies are icing.

So you're saying that people are against a private insurance market where private insurance has compete? That is what the exchanges are. It's hilarious to see the GOP come out against their own principles because someone with a D behind their name proposed them. As for mandate, perhaps not, but it is the conservative thing to do. People taking responsibility for their own healthcare.

The elements of an alternative ought to include ending the favorable tax treatment of employer-provided insurance, deregulation of medical insurance markets, and vouchers to assist in paying medical expenses of the poor.

None of which fix the problem I stated. Try again.

 

[fmw]

They are consistent in this for a long time now too. In 1945 after securing a majority in congress the GOP attacked an attempt at a form of government healthcare along with the AMA. It was shelved and then with the advent of anti-communism thru the early fifties the issue faded away, despite Truman's attempt. The AMA even levied a one time 25 dollar surcharge on all their members and spent 1.5 million dollars fighting it, that was the largest sum of money spent to that date to defeat a measure. They even produced a pamphlet that likened it to communism quoting Vladimir Lenin saying that national healthcare is the primary Arch to a socialist society, though I believe nobody has ever confirmed that Lenin actually said that.

Many of use believe that whatever government does, it does incompetently for a variety of reasons. I, for one, want the government to do as little as possible - only what it absolutely necessary. So I oppose socialized medicine just like I oppose socialized everything.