I feel pretty confident in saying that whatever the final GOP structure looks like, it will be substituting one Frankenstein monster for another. But given the significant opposition to the current proposal already expressed by a variety of political and economic interests, it appears there will be a lot of negotiating on the final plan. I don’t think it’s worth anyone’s time to drill down too far on the current details unless you’re a lobbyist or want to express an opinion to a member of Congress.
We need the CBO numbers too, they are essential!
Yeah, but if the CBO numbers don’t support the narrative, they’re fake news, so what’s the point?
It seems to me one of the really big issues with ultimately solving this is insurance industry reform though I don’t really have much hope that the current administration and congress is going to effectively tackle that. Huge amounts of money are going to the insurance industry and not effectively being directed into actual health care. Long term it seems like streamlining that and getting more money to actually go to health care and less to the insurance industry itself would help. Gradually decreasing jobs on the insurance side and increasing jobs on the health care delivery side.
Didn’t republicans lawmakers do that after ACA was passed?
Insurance related costs are not the only component of increased cost of health care in the US relative to other rich countries. Various other factors, each of which has its own political lobbying group, also contribute:
- Patients who think that more care is always better, fear "rationing", and are cost insensitive because their care is paid for by insurance which is paid for by a third party.
- Providers who are prone to ordering extra tests and procedures because it helps them with patients who think that more care is always better while increasing their own revenue.
- Drug companies pushing their new expensive drugs on television ads.
- Hospitals and other facilities that need the business.
Probably others as well.
Trying to tame the health care cost monster in the US means going against many well funded political lobby groups. But the health care cost monster makes it far more difficult to come up with any health care reform that can be considered “good” without being unreasonably expensive for someone who will complain loudly.
@iglooo Do you have 57 Gold plans to choose from?
“* Providers who are prone to ordering extra tests and procedures because it helps them with patients who think that more care is always better while increasing their own revenue.”
Don’t forget the role litigation plays in our country and its associated costs. I think many tests are ordered in part due to a CYA mentality.
@doschicos — do not disagree at all but will also add that our reimbursement system does not pay doctors to take the time to conduct a thorough physical and oral exams with patients. Picture an elderly patient with multiple ailments. If the doctor could spend say half an hour (or more) with each patient discussing the various symptoms, then some tests might be avoided.
The immediate referral to specialists, who then treat only their area of speciality, with no one really coordinating the patient’s whole care. I realize that PCPs were introduced as the gatekeepers who would oversee all care, but we have never reimbursed them for that function, and in its absence, more tests seeking a diagnosis.
" do not disagree at all but will also add that our reimbursement system does not pay doctors to take the time to conduct a thorough physical and oral exams with patients."
I agree completely, @CT1417, especially for PCPs. I can spend the same amount of time in the examining room with my PCP and a specialist and the reimbursement rate is easily 3-5 times higher for the specialist. That shouldn’t be IMO.
I hope this isn’t considered political, but it discusses health care AND mentions college:
https://www.mcsweeneys.net/articles/divorced-freelancer-seeks-man-with-corporate-health-insurance
It is actually absurd that the primary care specialties (internal medicine, family practice, pediatrics) are among the lowest paid specialties. A patient can come to a PCP with just about anything, and a good PCP needs to be able to determine what it could possibly be in order to effectively help the patient (whether such help is ultimately done by the PCP or a referred-to specialist). Guess the system and health care market really do not value PCPs.
It is also not surprising that PCPs seem to be more commonly graduates of foreign medical schools, rather than graduates of US medical schools with $300,000 of student loan debt.
PCPs tend to be more commonly NPs and PAs in my area. Good luck finding an MD these days. The ones still practicing aren’t taking new patients. This is not a knock on either NPs or PAs (I’ve had some good ones) but indicative how how few med students want to go into primary care because it doesn’t pay for their educational costs. Also, good luck in my area on having your PCP stay in any one practice longer than a few years, so you are bound to change PCPs routinely and this has nothing to do with ACA and more to do with faults in our healthcare model in general.
Total guess here but perhaps they are paid more simply because non-PCP specialist doctors would like to achieve a certain level of income for their work performed?
Two people each sell a bag of 10 apples. One guy sells 10 apples for $1 a piece… the other guy sells 5 for $2 a piece… both make the same money.
Do you think that’s what’s going on here with PCP vs. other specialists?
@college_query Thanks for making me smile. 
“But don’t expect sex. What you’re doing to my prospect of healthcare coverage is a total turnoff.”
I was expecting her to say, “But don’t expect sex, because I’ve already been screwed by you politicians.” 
Sadly, even corporate insurance is increasingly expensive and covers less every year. Today’s “Cadillac plans” for upper management are what I had, as a mere worker bee, twenty years ago… for a fraction of the price.
Yesterday, I decided that at 68, I cannot rely upon my internist to continue practicing indefinitely and started earnestly looking for an independent new internist. It was daunting. Of my neighbors, two of them are with the HMO, Kaiser. Of my friends, one is going to a concierge internist whom I’ve spoken with socially and is in “wind-down” mode and not accepting new patients and charges $1500/year per patient. The other friend I just called had recently switched to Kaiser because she was tired of hunting for docs after her doctors retired, also she liked that all of Kaiser is on the same system since they have ONE consolidated health record.
Kaiser has its pros and cons but I’m really not ready to switch to them at this point, so I will continue to search. One of the internists that was mentioned did her medical school in the Dominican Republic, so H was not impressed; not even sure if she’s accepting new patients. I will continue to ask around and find someone, I hope.
" charges $1500/year per patient." Is this typical of concierge charges? More reasonable than I would have guessed actually.
I believe the up-front fee varies, depending on the area. The concierge practice just started in our state about 2013, so probably the amount will increase over time, but I’m not sure.
Our clinic has 2 PCPs that do concierge. $150/month retainer fee.