Here are some perspectives from a physician/surgeons points of view: 1) when attempting to admit our patients to a hospital for surgery we are frequently asked to take them to another facility because the reimbursement the Hospital will receive via Medicare and via the Insurance the patient has will not reimburse enough to cover the Hospitals costs. What that means long-term; it will begin to happen more and more and eventually there may be no Hospital willing to admit the doctors patient. 2) Surgical procedures for which surgeons bill for example $2000.00 and were paid 1800.00 are now paid at 25% of $2000.00. or $500.00. Hardly worth the risk of performing and barely covering the cost of performing. So, eventually, they will have to stop accepting insurance and require patients to pay up-front and file the charges on their own for reimbursement of their costs. 3) More and more physicians and hospitals will find it necessary to stop accepting Medicaid and eventually Medicare Insurance because it will not be cost effective to do so. 4) The cost of private health insurance will continue to increase at an unprecedented pace due to the mandate that they cover those with costly pre-existing conditions such as cancer, heart disease, liver disease, kidney disease, diabetes, obesity and the like. And because of the mandate to pay 100% of preventative health tests. 5) premiums for small group health insurance, individual health insurance will skyrocket due to #4 above and because there will still be millions of uninsured emergency room visits because those individuals are not part of the "individual mandate" and won't pay penalties for not obtaining insurance. 6)Electronic health records are costing providers 1/4 of a million dollars to implement and are increasing the number of hours they spend per day, up to 12+ hours, exposing the health information of their patients, exposing the doctor to increased law suits and sanctions by HHS and the IRS and at present is not benefiting their patients overall treatment. At present, only the Government is benefiting by using the informationn to "increase audits of the physicians medicare reimbursements" and to penalize and prosecute physicians that submitted their charges in good faith and based on the information available to them by Medicare and HHS.
The law is not perfect but where were doctors when it was being debated, many fought it but none said if this becomes law we will have to deal with it. Your input as an industry with hospitals needed to go in then now its a bit late. Some issues I see we did not include sending patiants abroad for care when its expensive as an option you go to India to a top tourist hospital there most work can be done far less than in a US facility and have similar if not in some cases better outcomes. Another issue what happened to the Hippocratic Oath old or modern aren't you obligated as a MD to treat the patiant and ease suffering I didn't see money in there. My grandfather was a surgeon and in his day he expected for his degree and career absolute job security (MD's are usually pretty secure in their work) and a standard of living in the solid middle class for life. He made as a surgeon at a community hospital and later administrator what a skilled union worker say a master machinist would make and live that well. Seems to me your not starving, your not getting fired or laid off and will always have a job so I would ask did you enter medicine to help others or to make a lot of money (as opposed to living in a decent lifestyle and not have to worry about things)? Just asking but seems to me most of the debate is how much you make not what is good for the people of the nation. If your wondering my grandfather under state law HAD TO do so much free care at a charity hospital or county facility or prison or not have a license if I recall it was 160 hours a year. On the ACA electronic records, medical homes for patiants with teams working together, testing and such are required to cover those who are poor and working class at least you will get some money for treating a poor person if they are on Medicaid or in an exchange (in the second likely well) over nothing. And you know if you have to treat an indigent patiant with nothing your not going to get paid and you refuse its illegal in every state under Federal Law. Wouldn't even Medicaid be better than nothing. Medical records if electronic in the long run will be cheaper or at least ease getting medical records moved around. Every major nation with universal health care in any form uses them in France is the standard all your info is on one card! Why are you blaming the Feds states have a bigger role to play and most are either dragging their heels on the ACA or refusing outright to do the required parts of the law, you want reforms and the like that is the best place to do it. Take tending the poor an issue in this states could do many things set-up community state run hospitals for them, or have a state tax to pay for care boosting payments or simply order MD's and facilities to have a license they must do so much free work per year and not give you a choice (last an idea not my prefered option either but they could my grandfather above had that obligation). Are you for allowing a qualified LNP to practice on his or her own primary care you know for most cases they can treat medical issues quite well, and could just as easily refer to someone more trained in needed like an MD? That could free up the system of the need and allow MD's to practice on those that need their special skills.
Over the past few decades the health care industry in the US has vastly increased its charges to the nation while decreasing the proportion of the population cared for with private monies. You already suck up far more national income than every other nation on the planet and provide lower quality care to fewer people than any other developed nation. How long do you think you can get away with that before you are taken to account?
I'm confused. What's cheaper, pills so you don't need surgery, or surgery that could have been avoided? It's solving the problem, before it becomes a real problem.
There will be times when patients would prefer other doctor and especially the Federal Government not to have access to some of there records and diagnoses. This will lead to patients not sharing the truth with their doctors because they don't want what they say to be on record, this will not lead to better treatment plans. Plus, the time spent by doctors to document the patients visits electronically will result in less quality time spent with the patient overall and currently providers do not have access to the records of other providers and if they begin to it will result in many legal issues. Legal issues that physicians will be exposed to. And, there is no regulation that will protect one physicians from be exposed to the misuse by another physician or the State or Federal Government. Patients should have the right to deny their information from being transferred from one provider to another or to the Federal or State Government but under current Obama Care Law they have no such right. Good luck patients you are screwed. You medical information is totally unprotected. The only way to protect your medical information is to pay cash for your services. Something more patients are selecting to do because most private physicians and surgeons have began to give discounts to those patients that pay cash or charge their treatment and submit their services to their insurance on their own.
At no point would I believe that a a R.N., LPN or any other person who is not a licensed Physician should be allowed to diagnose and treat a patient that presents with a medical issue. If you want to do that, you might as well let people treat themselves. R.N.'s LPN's do not receive the training that would be required to diagnosis various medical conditions, order needed tests, "read the results of those tests,prescribe treatment based upon those test results and so on. Get it? I think you don't. And, they can only "treat" cases well after they have been correctly diagnoses by a qualified medical doctor after ordering and reviewing the appropriate tests and deciding on the appropriate treatment and then only under the direction of the doctor that has the ultimatel legal responsibility and who he believes his subordinate is able to provide the treatment he prescribes. Do you underastand that? Do you realize that that is and should be the law? Would you want to be seen, diagnnosed and treated by someone that hasn't had the appropriate education and training to save money? Or would you rather pay to see and be treated by a Professional? Lastly let me ask this? Why can't a pro-se defendants charged with a misdeamenor offense have anyone they chose help them to defend themselves? Why do they have to pay a lawyer? Isn't it the same thing? You respond
Did Obama care make the problem worse? I am not so sure. Many years ago, my son was born severely premature. The all wise insurance program then in existence, unchecked by any force governmental, logical, emotional, moral, or otherwise, declared my infant son a pregnancy complication. Oh, I'm sorry, he won't become human and part of your policy until you take him home and he becomes a member of your household. Until then, he occupies the same medical position as the after-birth. Now, I,m sorry, but there is nothing in all of so-called Obama care (you know how disingenuous this name is - both stupid and insulting and you know the proper title of the legislation) that even approaches the level of pure evil that that insurance company managed with that characterization of my infant son. He is healthy, wonderful, successful, but not through anything that evil insurance company did. We can probably do better than the current legislation. But, since all of the Republican party opted to opt out of helping with the legislation, even though much of it originated with Massachusetts and Mr. Romney and other Republican proposals, I suggest that the Republican party do some serious soul-searching and find it within themselves to find compromise and save the nation from the shame of our current health care system. We are at the bottom of civilized nations lurching rapidly toward uncivilized. And that is inspite of Mr.Obama's efforts.
How about Nurse Practitioners? I have lived in and visited numerous places where there were no doctors at all, apparently these places were not glamourous enough to attract them, but they had medical clinics nonetheless because the people decided that they would get sick and injured and require immediate care because they would likely be dead by the time they reached the services of a fully qualified licensed physician who was only a day or a week of travel away depending on the weather. They were usually staffed by a combination of RNs, LPNs, and one or two NPs. They were often far more experienced than the doctors they would send them to and I never heard of them ever making a wrong diagnosis or ordering the wrong treatment. Your blanket condemnation of nurses and blind faith in licensed physicians as reliable dispensers of health care diagnosis and treatment is really a bit neanderthal when the reality is that there are not nearly enough GPs and doctors seem to be abandoning the role of diagnostician unless it falls within their speciality. Who does that leave on the front line? Are you suggesting that there has to be an MD at every one of the CVS mini clinics? My health care plan has assigned me a NP as my gatekeeper. I am comfortable with that because I know she will have no problem helping me with minor issues and no hesitation in sending me up the line if any serious problems develop. Meanwhile I am not wasting a physicians time and everyones money.
I also had a premature delivery and my insurance covered his birth, post-care and follow-up care without issue. He was 3lbs 6 oz. but was perfect in my eyes. While he had some verbal, reading and eyesight issues he now owns his own videography company while taking college classes he feels will help him in his business. I also had a "postmature" delivery where my son used his own body fat to survive before delivery he weighed 4 lbs, 11oz. looked like ET played with toys in his warmer immediately. He also had full newborn coverage under our group health insurance. As to you question if Obama Care has or will make group health insurance and health insurance in general worse, I can say yes, yes, yes. I have a degreee in Health Administration since 1977 and my husband has been in medical practice since 1982 and we have seen the health care field worsen since the early 90's. Our income has decreased by 50% while my husband works longer hours, sees more patients, does more surgery. Hospitals are losing money. Reimbursements fail to pay our costs and provide a reasonable profit. Therefore, more hospitals and doctors will stop seeing patients that are covered by X,Y,Z insurance or Medicare and Medicaid because they can't afford to. This is truthful and a fact.
What about military spcial forces medics they do all kinds of procedures and often trest locals in areas and seem to do a fine job, they can even treat animals. A relative removed an appendix of a rural area in his deployment areas and had no issues. And their training takes two years! And I PREFER LNP's in fact doctor why can't they treat common conditions on their own save elitism like yours holding back the needed reforms.
