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Health Care Reform and the Law

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Once again, the polls are the only way that folks like us can discuss issues and have some quantitative measure. I agree with you that the polling has shown that the reasons for opposing Obamacare were somewhat varied. The polls that I remember showed dislike for universal payor system and the exchange that was passed. The American people seem to want insurance reform but just in the sense of forcing the current system to eliminate pre-existing conditions and not to drop patients when they get a serious illness. In a republic, such consistent and strong dislike of a bill should have lead to its' demise. The anger seen at the town hall meetings came from people who have not been politically active in the past based upon numerous interviews. These people felt like congress was not listening to them which was true since the bill passed anyway. That was part of the rejection of the democrat party in November.




Most legitimate news sources quote the same pollsters. There is no reason to seek out the opinion of a biased source as you request because it will not be fair. Despite the slurs that you make, Fox is a centrist station. The left is so far from the mainstream of American thought, that they seem to see centrist views as right wing.


Calico and Gern,


The American people do not like Obamacare for different reasons but dislike it nonetheless. Many of my liberal friends with whom I have lunch most days are just like the two of you. They like Obamacare so much and think they it is so good that they cannot comprehend that others do not share their views. The majority of Americans, based upon polling data that has issues, do not and have never supported Obamacare. That view cannot be proven to be supported by the recent elections but the elections certainly would be consistent with that view.


From my view as a physician with 25 years experience and from conversations with colleagues across the country (not scientific poll but it is 9 out of 10 physicians with whom that I talk), Obamacare will eventually decrease the quality of care, decrease the options available to the patient, will result in fewer physicians available to treat the patients, and will result in less able students applying to medical school. There will be committees deciding what criteria will qualify a patient for a given treatment. Now insurance companies decide whether they will pay for a given treatment (which can effectively mean that the treatment is not available) but the physician is still free to recommend the best therapy for the patient. Under Obamacare, physicians will not be able to even offer anything other than the prescribed by the government treatments. The doctor patient relationship has been severely eroded by the insurance companies where the physician increasingly works for the insurance company because that is who is paying for the treatment. Under Obamacare, the erosion will lead to a severance as physicians will work for the government controlled (though not employed - sort of a fascist system for the doctor) by the threat of criminal prosecution. To date, there is not a measured desire by the public to have this system. You both may feel that it would be better than what we have now - I do not.

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In reference to polls and physicians, have you looked at some of the newer "upstart" medical journals? While JAMA and NEJM haven't done any polls, some of the newer medical journals, I believe the one I read having polls is called NG Med, have and state that the majority of physicians in their survey believe as you do. ( sorry I can't name them as I just do a brief scan. NG Med is one I look at b/c it does have info I can use as) Further over 50%, sorry can't give the exact figure but is was a majority and surprised the heck out of me, said that if they knew now about the field prior to entering med school, i.e. Medicare reimbursement, malpractice insurance, state and fed regs, ad nauseum, they would NOT go into medicine. In fact the journal was started by a physician who got sick of practicing, and decided to do reviews of the latest technology and electronic information sources aimed at the medical field.



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I have seen those polls. Furthermore, a recent poll said that 74% of physicians would like to leave medicine now. The reason is consistent - government interference makes it difficult to provide the best care for their patients. The public has no idea how their care is already being adversely affected by government interference lose of time that in the past was devoted to patient care but is now devoted to filing out forms. In the mid 1980's, it would require ~20 minutes for me to discharge a patient and I would spend all but about the last 3 minutes of the time in the patient's room so that I could answer any other questions. Now, due to government imposed paperwork, the process takes about an hour and I spend only about 5 minutes in the patient's room. Part of that to be fair is due to lab and imaging reports being on computers whereas in the past, there were printed forms in the physical chart so that all information was literally in your hands. I think that the number is easily 50% figure is accurate. Even worse, almost every physician I know with college age or recent college age children encouraged them NOT to become physicians which is a reversal of the attitudes from 10 years ago or before.

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Ok Vol, I think I see the problem here.

I thought we were debating the "Affordable Care Act", but you are debating "Obamacare".


I don't watch FoxNews, so I'm at a bit of a disadvantage here on what Obamacare is. I have read summaries and sections of the ACA and find your "Obamacare" and the ACA have very little in common. EX: Nowhere in the ACA does it say physicians will not be able to even offer anything other than the prescribed by the government treatments.


Obamacare is a fabrication of the right wing, filled with fabrications and broadcast on FoxNews and right wing political blogs for those who don't wish to know the truth . Its a boogie man, propaganda.


If you would like me to continue debating you, we must agree on what we are debating. Otherwise its rather pointless. Eh?

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Vol_Scouter and I don't agree on a lot of medical issues, but I agree with him about the effect of the legislation on physicians.


Physicians are not normal people, let me say that again, physicians are not normal people. To be a sucessfull physician you need to be supremely self-confident, totally believe you have the answers the patient needs and the skill to provide them. At least that's who I want working on me and my family.


Then you subject these people to rule, guidelines, and enforcements? Not going to work. That which make Physicians capable work against them in following bureacracy


I don't know how many watch the TV series House, I try to miss as many as I can but I have seen a few. People marvel at the charactor, how evil and manipulative he is and I think he is dead spot on most physicians behavior. Brilliant in his job, but not the kind you are corral with rules

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Which truth would that be, Gern? The "truth" when Obama said if you like your plan, you can keep it and it won't change? All of us with HSA's know that is a lie, as our plans change in just a few weeks.


Or how about the "truth" that our premiums will decrease or stay the same? Our insurance costs are increasing significantly next year.


The really funny thing to come out of all of this is, I have several young, liberal college-educated business associates. They love Obama and believe he can do no wrong. They thought Obamacare was going to provide "free" health care to everyone. Imagine their shock when they learned Obamacare was going to require them to pay for insurance even if they didn't want it (they weren't purchasing insurance - part of the "we're young and healthy so we don't need it" crowd). Even though I have shown them that part of the plan in writing, they still don't believe it. They still think they are going to get health care for free. Liberals... They should have been watching Fox News so they could have learned something.

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I have to laff at OGE's comment:


To be a sucessfull physician you need to be supremely self-confident, totally believe you have the answers the patient needs and the skill to provide them. At least that's who I want working on me and my family.


I laff b/c many of the physicians I deal with are just like that. Heck one of my coworkers describes Docs as worse than fighter jocks. But if they don't know something, they admit it, and do the research to get the answers.


And those are the ones you want. Those are the ones that are also bristling at some of the rules and regs they need to follow, as well as the ones who complain the most and loudest at the paperwork they need to do. They want to take care of patients, not deal with the bureaucracy.

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Here you go, Gern. You must have just missed these on your favorite news source:


The Obamacare Problem Is Not the Individual Mandate



Virginia Panel Acknowledges Utility Of Individual Mandate, Urges State To Build Off Of Obamacare



It is really hard to have a productive conversation with you, if you don't keep up on current events.

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Brent, your Jedi skills are not strong. Huffpost is neither my favorite nor a news source. You see, I know the difference between news and opinion.


I will say that you have a lot in common with your liberal co-workers. None of you have any idea what's actually in the Affordable Care Act. I'd have the drinking water and air quality checked in your building if I were you.(This message has been edited by gernblansten)

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Under Obamacare, the erosion will lead to a severance as physicians will work for the government controlled (though not employed - sort of a fascist system for the doctor) by the threat of criminal prosecution.


Yah, sorry vol_scouter. Statements like that just don't track with reality. Da bill is a bit of a mess, but not even the most cynical, strained interpretation could come to that conclusion.


Much as I never agree with Gern, I think she's right that there's a difference between mythical "Obamacare" and the ACA, which was at its core a conservative Heritage Foundation Bob Dole/Chuck Grassley proposal. Even fits with da neo-con agenda pretty well, eh? A sort of corporate welfare for private insurers law.


I was unimpressed by the town hall meeting shenanigans. That was so clearly an organized lobbying effort that exploited the naive as not to be worth an ounce of thought. Like da seniors with the T-shirts sayin' "keep government hands off my Medicare!" :p


One would hope that somebody out there would do what they accuse Congress of not doing, and that's read the [bleep]ing bill.


For those who actually care about such things, here's at least one relatively balanced summary:




and one commentary that highlights da political untenability of the delayed taxes (which we've seen in this month's tax cut extension debate, eh? When it comes time to pay, Congress falls over itself to avoid taxing when it can instead extend da deficit).




That commentary misses some other accounting shenanigans which amount to delayed increases in plan expenses for long term care, etc.


So it's not an economically responsible bill, eh? No near-universal coverage plan can be (nor can status-quo be, for that matter) in an environment of an aging population and high-end medical care for the elderly. But it's also not a jail-the-doctors bill either, eh?


I think it's important to note that right now, because of compensation incentives, most docs are boutique docs, eh? They cater to a high-end, employed clientele and insurers that pay for lots of high-cost procedures that they can crank through, needed or not. Quite naturally, there is some angst at that gravy train bein' curtailed in any way, especially if it means more docs goin' back to (lower-paid, sniffly-noses, more economically efficient) general practice. They're a bit like da modern banker in that way, eh? :p



(This message has been edited by Beavah)

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Try this, Gern - unless you don't consider ABC News as "news."


'Obamacare' Costs More, But Covers More



I know enough about this plan to know it stinks. Evidently most Dems agreed, as they couldn't get far enough away from it during the election. I wonder why so many unions and companies are getting waivers from this supposedly fantastic plan?



That link is pretty general. It doesn't even mention the changes to the HSA plans starting Jan. 1.

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You know Brent, I actually went to that link and watched the entire segment, then read the article too.

Did you? It seemed to me to be pretty positive and factual on ACA, sorry "Obamacare".


Sure they did mention the .2 percent increase in costs, but also explained all the new benefits. I'm sure you just zeroed in on the increased costs and tuned out the rest of the information presented. Explains a lot.

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Glad to see you are getting up to speed on current events.


Go back and read page 2. Nearly all the economic predictions about this bill count on the 23% cut in Medicare to physicians. The "Doc fix" is going to be a major problem for this program, and for seniors.


"But there are problems with that projection since spending slow-down hinges on a planned 23 percent pay cut for physicians who treat Medicare patients going into effect. In June, Congress passed a law to update physician Medicare rates by 2.2 percent, but that temporary fix runs out on Dec. 1. Come January 1, 2011, physicians would also be slapped with an additional 3 percent cut in Medicare reimbursement.


If history is any indication, Congress will likely vote again to override the cut, likely making the projection that healthcare spending will slow in 2011 no longer applicable."


This piece was written back in September, before the elections. I wouldn't be so sure that the new congress will vote to override the cut. I expect we will see many more Dr's refusing to take Medicare patients if those cuts become real. Just another unintended consequence of this boondoggle.

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Don't you worry, I'm always up to speed. Try to keep up!


You seem to think I like the ACA (sorry, Obummercare). There are some provisions I like, some make sense, but mostly I don't like it and don't think its workable.

I'm only trying to catapult the propaganda (sorry, FoxNews facts) you and Vol fling about it.

Its a republican plan. Presented as a counter to Hillarycare (see, I can play) back in 1994 and passed in Massechusets by Romney in 2006. You both seem to ignore that fact. It will never achieve what it was sold to do, like most republican plans. Its a give away to the insurance lobby and a typical kick the can down the road neo-conservative borrow and spend plan. The only reason you folks hate it now is because the Democrats adopted it and passed it.


The plan I was in favor of was never even debated in the house or Senate. It was never proposed by the president. That plan would really get your dander up too.

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