<p>LasMa, it’s not simple. That 45-million number, which may or may not be accurate, is not one big lump of the same problem. It includes pre-existing conditions, perfectly healthy people who elect not to purchase insurance, and the poor…along with subsets of all of those groups. Then we have the whole health care vs. health insurance question. It’s not simple. </p>
<p>But you’re so critical of ACA, I assumed surely you have a better idea.</p>
<p>Well, that’s silly assumption. There are lots of other ideas. They’ve all been mentioned here many. many times. Supporters like to pretend it was this or nothing and amusingly most of them (not you) have no clue what this even is. ACA is unpopular for a reason. Well, lot’s of different reasons depending on personal circumstances. You expected me to solve this? I’m flattered.</p>
<p>Now, my son has just driven my car into the garage door so I have a new problem this evening. No injuries but the door is not happy. Geez people.</p>
<p>No, Flossy, supporters like to point out how a good idea was mangled by a certain side going full force with media words about how we were headed for socialism, if we provide single payer. Gads, we’re still hearing the same OMG comments by that side, misinfo, incomplete analyses, fear-mongering, etc. Yeah, maybe we’ll all rush out to live in VT. No, maybe our loved ones will die from Obamacare and then we’ll suffer our just desserts, lifelong guilt, anguish. The sky will fall and we’ll realize GP was right. The VA didn’t have issues before. People didn’t die before. Everything was fine. </p>
<p>The link from emily was laugh out loud funny. </p>
<p>Well, in fact it was this or nothing, practically speaking. But there have been other proposals. I’m just interested in your personal opinion about what would have been a better solution than ACA. </p>
<p>My last post was for Flossy, not LF.</p>
<p>Okay I’m back. Personally, I would have preferred incremental fixes to particular problems. And, I don’t know why it was this or nothing when no-one even knew what exactly this was at the time. They would have passed anything. They didn’t care, which is actually kind of interesting since the accusation against anyone who notices flaws is that they don’t care enough. Just my opinion.</p>
<p>Glad to hear no one was hurt, and I hope your garage door will be on the mend soon!</p>
<p>Particular problems? Like preexisting conditions? The problem is, you can’t fix JUST that. Then the sickest people would flock to get covered, while the healthy stayed away, and the insurance companies certainly weren’t going to stand for that. Like affordability problems? Who do you suggest should help the poor get insurance? </p>
<p>It wasn’t this or nothing back in the beginning. When first proposed, ACA included a public option, where people could – if they wanted to – sign up for Medicare. The insurance companies swiftly killed that too (wonder why?). Of course the other option is single payer, which was a non-starter. Again, because of the power of the insurance companies.</p>
<p>BTW, it’s disingenuous to say that ACA supporters don’t notice flaws. Every ACA supporter on this thread has talked about them, and they are myriad. But some of us want to fix them, rather than throw the whole thing out, and throw 8 million Americans back into the ranks of the uninsured.</p>
<p>That is where I am. I want the ACA fixed. First thing I would like to see is the option for anyone in the individual market to be able to sign up for Medicare…</p>
<p>Medicare recipients’ premiums don’t begin to cover the cost of their care. When you say “anyone can sign up for Medicare” do you mean “anyone can sign up for Medicare if they pay a much bigger premium than Medicare recipients pay”? If not, how is this proposal funded? If so, how is the premium determined?</p>
<p>How will medicare (medical) math work…someone please explain…</p>
<p><a href=“http://files.medi-cal.ca.gov/pubsdoco/rates/rates_information.asp?num=22&first=94799&last=99499”>http://files.medi-cal.ca.gov/pubsdoco/rates/rates_information.asp?num=22&first=94799&last=99499</a></p>
<p>Look at code 99213 - basic office visit. My doc billed my private insurance $150 for this code. My private insurance negotiated a $78 payment. Medical…would reimburse this doc $24. How can a doc spend 30 minutes with a patient and receive $24? THIS is what we are so proud of expanding…whooo haaa…huh?</p>
<p>We have a shortage of doctors now. How many of the best and brightest would go through medical school and residency in order to become a low-paid government worker if we had Medicaid for all? Would you want to be told that now you’re going to have to work for the government and BTW your salary was going to be drastically cut? This while you are in debt for $300,000 for medical school costs. </p>
<p>People also forget that Medicaid expansion means the Feds pay for 3 years, then they pay less. So now what? Some states, perhaps wisely, elected not to trust them and not to sign up for something they could not afford to sustain. It’s just going to grow and the money is going to shrink. That’s what always happens.</p>
<p>Tatin, what was proposed was Medicare for all, not Medicaid. And how does Medicare for all (assuming that’s what you meant) result in doctors become government workers?</p>
<p>I do agree with you that medical school is insanely overpriced. That should be addressed.</p>
<p>If there is only one payer, that payer sets the rates paid to doctors. If there is no competition among payers, the rates will be very low. When only Medicare/Medicaid pays your fees, you are in essence a government employee. The only way out would be to become a cash only doctor.</p>
<p>Reading the comments and threads on other pre-med and medical student sites as I do, there is already a lot of angst at the direction things are going. Lots of questions as to whether medical school will even pay off and when. After 30 years? There are also lots of anxiety-ridden questions as to whether other careers will be better, given a potential government take-over of medicine. </p>
<p>But someone needs to explain how increasing the number of patients who will reimburse a doc $24 for a 30 minute well person check can possibly work. Even if the doc worked for 18 hours instead of 8, volume will never, ever ever make the math work. So, more patients have coverage with a payment structure physicians can not afford to take. How will this work???</p>
<p>Maybe the consolation prize is the Medical patients can customize their insurance cards to make them prettier - just like Visa and MasterCard :^o </p>
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<p>Which is where those low-paid government doctors you decry would work, presumably. And since, I’m sure you’ll agree, most doctors wouldn’t choose a low-paying government job over a lucrative private practice, the doctors caring for the poor would be the leftovers, the doctors who weren’t quite good enough to cut it in private practice. That’s how the labor market works, right? Meaning, inevitably, a two-tiered health care delivery system, in which the poor get substandard care. </p>
<p>I just got a call from our health insurance agent….our plan is up for renewal soon and she told me that the premium is increasing 57% !!! I’m beyond pissed off. Doubt that we will qualify for any kind of subsidy and I know we can’t afford that increase…great…</p>
<p>So sorry. And LasMa, now we have substandard care for paying customers along with a huge price increase. Government benefits are not supposed to be just as good as working. Who would work? That’s already the problem with low wage employment but without it you are stuck. Sigh.</p>
<p>It’s still two tiered, maybe three if you count concierge care, btw.</p>
<p>Medical Group Management Association finished a survey of over 40,000 physicians across the US to assess their experience with Obamacare. One of the findings is that nearly 50% reported being unable to provide covered services because they were “out-of-network”</p>
<p>Here are some interesting quotes:</p>
<p>"Many patients purchased products with a very narrow network and didn’t understand the ramifications. They are very upset once they learn that they can’t go to the specialist or hospital of their choice. As primary care providers, we are now faced with the extra burden of trying to find them care within their new narrow network. Payer directories are woefully inaccurate and impossible to rely on.”</p>
<p>“Former patients were shocked to learn about their very narrow network of providers. It was terrible to have to inform them of their lack of coverage.”</p>
<p>“We are consistently denied “out of network” approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.”</p>
<p><a href=“Doctors Surveyed On First 120 Days With New Obamacare Patients”>http://www.forbes.com/sites/danmunro/2014/05/26/doctors-surveyed-on-first-120-days-with-new-obamacare-patients/</a></p>