<p>I like to use the walk in clinic at our pharmacy for when I need my kids checked for strep throat or an ear infection. I don’t think they need a doctor for that and it’s usually a lot faster than going to the pediatrician. However when they are having an asthma problem I take them to the specialist. It just depends on what’s wrong.</p>
<p>texas, </p>
<p>The pain wasn’t always terrible. I chalked it up to Tendonitis, at first. I often work on my feet all day, so I figured I was constantly aggravating it. I kept thinking that rest and anti-inflammatories would do the trick. When I actually had time to seriously rest it for almost a month and the pain started to intensify, I went in. </p>
<p>I did dramatically cut back on my daily exercise which has had a negative effect with my weight. Should I have gone in months ago? Yeah - but other factors like surgeries for two family members plus their extended recovery, plus having two jobs made it difficult.</p>
<p>Geez… if I went in every time I hurt somewhere I’d hurt before, it’d be better time management to just never leave. Problem is, some things just go away and some turn out to have become chronic, while you thought you were just aging. Tough call for the non-medically aware to make, hypochondriacs not included.</p>
<p>NP, MD, specialist, wouldn’t seem to matter as much as just finding someone with a wider experience as to what’s normal.</p>
<p>Samurai - Hope you find relief soon. I think some of the chronic ailments are not taken seriously enough to get immediate attention which results in, no biggie they will wait two more weeks. Once you go to the specialist, they will tell you what is wrong right away but then want the tests to confirm, determine treatment options, dosage of medicine etc. and will make you wonder why don’t they just give the pain medicine and make a guess at the dosage until results come back. So I am afraid it might take 2-4 weeks beyond your visit to the specialist to get a treatment plan. Hopefully, your specialist proves me wrong for your sake.</p>
<p>Samurai, if you go to an urgent care center, they can probably do an x-ray and splint it. At least that might make you more comfortable until you can see the specialist.</p>
<p>
If Medicaid reimbursements were lower, then maybe the doctors practiced in other locations in the afternoons to make enough money to stay in practice. I don’t really see what’s wrong with this (if this is indeed the reason). Would a possible alternative (refuse to see Medicaid patients or severely limit the number) be more palatable?</p>
<p>There is nothing wrong with it. It is a question of whether people accept treatment from NPs as easily when they have another choice who might be a doctor. I suspect it is not the case in Houston.</p>
<p>People not in Houston, however, may realize that we need to bring health care costs down, and you don’t need 4 years of med school and 3 years of residency to know how to deal with diaper rash. Why pay for a nuclear bomb when a fly swatter will do?</p>
<p>I suspect ACA has almost no role in Houston since Texas is not supporting exchanges or Medicaid expansion at this point.</p>
<p>So I don’t think anyone here cares.</p>
<p>We have plenty of doctors. I was shocked to hear that Texas Children’s hospital has 830 pediatricians on staff. And that is just one hospital in the middle of the city.</p>
<p>Texas trains a lot more doctors than other states (at least compared to California) based on the size of population. There are 1730 doctors graduating each year. They have one of the best in state admissions (90%), make it really cheap to attend medical school which means they graduate with much lower debts compared to other states in the nation.</p>
<p>texaspg, I think you might have a misunderstanding of ACA in Texas. As you say, Texas is not doing the Medicaid expansion, and Texas itself is not setting up exchanges.</p>
<p>However, the federal government is setting up exchanges for Texas. People who live in Texas and who do not have employer-supplied health insurance will be able to buy health care through the exchanges. Texans who earn from 133% of the poverty line to 400% of the poverty line will get subsidies to buy that insurance. Some Texans will chose to pay the penalty and not buy insurance, but some Texans will take advantage of the exchanges to newly get insurance. Therefore, we can conclude that more Texans will have health insurance, and more Texans will be using health care services such as preventative care and routine health care.</p>
<p>All 50 states will have health care exchanges, and all 50 states will have subsidies for people from 133% of poverty to 400% of poverty to buy insurance on the exchanges. Young healthy people who don’t anticipate getting sick or getting pregnant might not sign up for the exchanges, but people with pre-existing conditions certainly will unless they are fools. </p>
<p>Think about it: you have a child who recovered from leukemia, or you had a heart attack three years ago, or you have severe asthma, or you want to have a baby next year. Are you going to listen to the people who tell you not to get subsidized insurance? Of course not, because you’re not an idiot.</p>
<p>So in places where healthy people don’t sign up, insurance will be expensive, but in places where healthy people do sign up, it’ll be pretty cheap. And that’s the insurance we’re all going to be subsidizing with our tax dollars. </p>
<p>This is the health care death spiral: health insurance is prohibitively expensive when only sick people sign up.</p>
<p>We do have Texas provided pool for people who can’t get insurance already. I was trying to help someone on a work visa but found out only permanent residents can be part of it. The rates are reasonable but were not subsidized like ACA.</p>
<p>We will see when those exchanges show up here. From what I am hearing, it is not as easy as typing statements online saying it is a done deal when the State is resisting.</p>
<p>The Texas pool has a lifetime cap. Also, it is subsidized by the state of Texas, in two ways: first, all subscribers’ premiums are subsidized by the state, and second, people of limited income have further subsidies. Texas pool subscribers pay a premium that is double the premium deemed standard in Texas, minus the low-income subsidy if any.</p>
<p>It’s not obvious to me why Texas would want to continue that program, given that subscribers will now be able to buy insurance on the exchanges.</p>
<p>If State is subsidizing, then they will just leave it open and let the numbers dwindle thus limiting their exposure. </p>
<p>It is a win win for them since they can say we don’t really care about exchanges since we already have our own but also cut the costs if people leave.</p>
<p>This is just my opinion and I have no inside into any state pol machinery.</p>
<p>A lot of mental health treatments are done by psychologists, right? Like cognitive behavioral therapy?</p>
<p>My son was seeing a wonderful psychologist for his Aspergers. It was never obvious to me why a psychiatrist would have been better, and for sure a psychiatrist would have been a lot more expensive.</p>
<p>^ Sorry; I deleted. I am always editing my posts because I am worried that this is not the right venue. </p>
<p>“A lot of mental health treatments are done by psychologists, right? Like cognitive behavioral therapy?”</p>
<p>Not in my community. Not many PhD’s around here on insurance panels. </p>
<p>With regard to when a psychiatrist is better, where I live, it depends on the context. It might be better if your treatment is best thought of in the context of a “99213”. Essentially this means “medical decision making”. In some communities it does not seem unusual for PhD’s and LCSW’s to be giving medication recommendations to pcps. It baffles me, but if that is what the people want, and NOT the additional training I’ve had, who am I to disagree? </p>
<p>Would you mind sharing your thoughts about “Aspergers” not being in DSM V?</p>
<p>Whether my son’s condition is called Asperger’s or autism doesn’t change the fact that he has significant disabilities. So I don’t have strong feelings at the moment on the DSM change.</p>
<p>^ I see. I am assuming that means he is also eligible for services through regional center. I would love to see one of those “maps” , showing how closely regional center and and autistic spectrum disorders overlap in a given zip code. </p>
<p>On another forum there is a discussion of how kids in the UK were more likely to be diagnosed with autism than with ADHD.</p>
<p><a href=“http://sfari.org/news-and-opinion/blog/2013/comparing-prevalence[/url]”>http://sfari.org/news-and-opinion/blog/2013/comparing-prevalence</a></p>
<p>Under ACA, you will only be able to enroll in insurance during an open enrollment period, from October - November each year (except for 2013-2014, when there will be open enrollment through March. </p>
<p>Even with open enrollment, the insurance will NOT pay for expenses already incurred. </p>
<p>So let’s take the example of a healthy young man in my extended family. He is in his late 20’s, physically active and robust, no known health problems. Except for one: last year, he noticed a lump in his groin, went to the doctor – and it turned out that he had testicular cancer. He needed an immediate biopsy, surgery, and of course the appropriate ancillary and followup care. I don’t know the details in his case, but you can get an idea of what it might have cost from this thread:
[How</a> much will this cost?](<a href=“How much will this cost? - TC-Cancer.com - Testicular Cancer Information & Support Forum”>How much will this cost? - TC-Cancer.com - Testicular Cancer Information & Support Forum)</p>
<p>He had insurance – but the point is, he was “healthy” until the day of his cancer diagnosis; and he was diagnosed with a young person’s disease. In the future, an uninsured man who gets this diagnosis in February will be able to get insurance, but not until October 1 of the following year. I don’t think many would want to forego treatment for that long.</p>
<p>You wouldn’t leave your house uninsured with the idea that you could wait until after the house caught fire until buying insurance. </p>
<p>Anyone under age 30 will be eligible to opt for less-costly catastrophic coverage under Obama care, and that age group is also the ones who who are most likely to qualify for subsidies.</p>
<p>We have never had any services through the regional center, so I don’t know much about it. My son may be eligible for services for his Aspergers, but we have not tried to get them. In fact, we’ve never had any government services for my son of any kind, since we homeschooled him.</p>