Open Thread: How to Undo ObamaCare

The key problem is the

Submitted by MightyMouth on Tue, 11/15/2011 - 12:22pm.

The key problem is the overall concept—which begins from the premise that our system of health-care financing will only keep costs under control if the government becomes an even greater force in the health sector than it is now and proceeds to create a system that will cause premiums to rise rapidly in the individual market and create major dislocation in the employer market, driving people into vastly overregulated exchanges that would push premiums higher still, and then initiate a program of subsidies whose only real answer to the mounting costs of coverage will be to pay them with public dollars and so inflate them further.

That has got to be the longest sentence I have ever seen. I was out of breath by the end.
I agree with it, but for the Love of God give an old guy a break!

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Defund it. Unfund it. Kill it when you can.

Submitted by ConservaSerb on Tue, 11/15/2011 - 1:52pm.

No way Thomas should recuse himself. Before he does that, the spouse/significant other [Snottominor & Say-again] of each justice needs to be investigated for their political leanings. In fact, every judge should be given a lie detector about pillow talk.

Say-again has to recuse herself. A prosecutor who prosecuted a defendant can not sit as judge in the same case. She pushed BarryDon'tCare .. . so she can't judge it.

Now to the question of how to "undue" it: Boehner and the other "conservatives" need to find their balls and simply say they're not passing any money for it. Not now. Not ever. I'm still trying to figure out how much discretionary spending this . . . Manchurian Marxist Muslim . . . has authority to spend. It's starting to look like it's virtually unlimited.

After the victory over Soetoro and the takeover of the majority of the Senate and retention of the majority of the House, the VERY FIRST BILL that comes up on January 21, 2013 is repeal of the whole thing. But . . . there also needs to be legislation put in place to address Medicare and Medicaid and some of the ridiculous profits doctors are making off of MRI's and other fancy-shmancy wunderkind.

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The major problems with Obamacare.

Submitted by drsamherman on Tue, 11/15/2011 - 2:54pm.

Right off the bat, the background conditions for implementing Obamacare are faulty. First, you cannot suddenly dump over 30 million patients into an already overworked and underfunded health care system. There are virtually no economies of scale left to be achieved. Every last dollar has been wrung out of the health care system starting back in the 1990s. Secondly, there is already a monumental shortage of primary care physicians (family practice, internal medicine and pediatrics) that serve as the first layer of patient care. The shortage will not abate, but will grow worse as residency programs and other training opportunities have all but disappeared thanks to shrinking reimbursement.

As for the legislation itself, no physician has a problem with removing the pre-existing conditions clause that prevents a number of people from having health insurance. Nor do physicians, for the most part, have a problem with the idea of insurance exchanges or other mechanisms to break down interstate restrictions that often cause conflicts in care delivery. Most, if not all, physicians have a problem with increasing patient load and decreasing reimbursement. We also have a problem with imposing cookbook medicine through standards which may not apply to the patient base that we see. Psychiatry and neurology are not fields that lend themselves to evidence-based practice in many cases, as either there are few studies in some of the conditions we treat or our patients are coming to see us because the EBM guidelines failed them. Another problem most physicians have with the legislation is the nightmare load of administration that comes with all of the new requirements imposed in the name of "quality". It is hard to treat more patients when you have more time requirements in your office filling out forms.

The costs of the Obamacare plan are obvious and the financial hocus pocus don't work.

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If anyone were going to

Submitted by allouchsit on Tue, 11/15/2011 - 2:55pm.

If anyone were going to recuse themselves it would have already happened. All nine justices participated in the discussion of the petitions to hear the case, so all nine justices will ultimately decide the case. If Kagen were an honest person -- and she is not -- she would have already recused herself when the case came up for conference last Thursday. She did not.

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Stop Socialism now by starting with obamacare...

Submitted by vrwc13 on Tue, 11/15/2011 - 3:57pm.

...then start working through all things government deciding which ones need to go too. And don't stop reviewing until all have been looked at.

Seems defunding is a way to go.  No money, no agency.

I like Perry's idea of defunding all foreign aid and starting them all from scratch.  And cutting 3 Federal agencies, why stop at three?

v 

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NV reapportionment

Submitted by NevadanConservative on Tue, 11/15/2011 - 6:46pm.

Yes, I know the main lead of the thread was Obamafilth. Since this, however, is an Open Thread,  and the item of some note, I felt it justified and submit the following.

Yesterday, the Nevada Congressional district was reapportioned. Nevada now has four Congressional districts.

http://www.leg.state.nv.us/Division/Research/Districts/Reapp/2011/Proposals/Masters/CON-Masters-ST-C_Size-INC.pdf

has the reapportionment as it appears on the map.

District 1 is most of Las Vegas, and the home of most of the unions. Areawise, it is about 80 square miles, less than 1/10 of 1% of the state. Districts 2 and 4 are approximately old district 2 cut in half. District 3 largely the area of Clark County  south of District 1.

Since the midterms, this state's Congressional representation was 2-1 R/d. We were on our way out of a long, corrupt blue tunnel. NV-1, with its high union count is destined to be permanently Reid blue for the forseeable future. Depressing, as I live in it. 

Joe Heck threw out Dina "I never met a spending bill I couldn't sign" Titus out at the midterms. His new challenge will be to hold District 3.

Sorry, folks... barring something unforseen, the best this observer can tell you for a 2012 Nevada is 3-1 R/d in the House, and a neutered Senate thanks to that whiny, pale creep. 

NVCon

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What kind of health insurance do you now have?

Submitted by alvin on Tue, 11/15/2011 - 11:35pm.

I would be interested in what kind of health insurance the commenters here have?
Employer? Medicare? VA? Individual policy? And the cost.

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The realities of practicing medicine now.

Submitted by drsamherman on Wed, 11/16/2011 - 12:15am.

As many of you know, I sold my solo practice to become part of a large physician group practice between December and January of last year. It was an extremely difficult decision to make, but in the end I felt duty-bound to provide for my patients and my employees in the best possible way.

This is difficult, but here is how that decision was derived and what happened:

1) My practice was bleeding money since 2007 when Texas introduced its first serious reductions in Medicaid.

2) The "time to file to time to pay" (collection days) went from 32 to 180 with some of my largest private insurance payers.

3) I faced the choice of business bankruptcy or closing my practice, negatively impacting my patients.

4) I received an offer from a very large group physician practice to integrate my patients and become their employee.

5) I negotiated with the purchasing group practice to retain my employees and their seniority dates and retention of my patients.

6) They agreed, and in doing so assumed responsibility for billing, collections and all other financial obligations of my solo practice.

The fact is that I stopped seeing Medicaid patients in 2008. Per Texas regulations, I notified those patients via verbal and written communications that I could no longer accept Texas Medicaid as a primary payer starting in 2009. This meant losing over 25% of my patients, but financially I had no alternative. The reimbursement rate was such that it covered only 58% of what it cost (with zero margin) to take care of them, and this was unsustainable over the long run. The group practice not only agreed to accept my Medicaid patients, but also hired two other psychiatrists who I knew and appointed me section chief AND guaranteed me and my employees with seniority back to date of hire (or in my case date of opening my solo practice). I became their chief of neurology (easily billable) and psychiatry ( more difficult to bill) overnight. My employees and I both had better benefits and our financial situation was immediately repaired. Solo practice is now a relic, and psychiatry remains primarily a solo or partnership practice. Large psychiatric groups are rare due to the problems with billing and reimbursement. In one fell swoop, those problems were gone. Granted I lost a hell of a lot of autonomy, but I gained guaranteed vacation time (I am the senior-most physician at 35 years of practice giving me nine weeks of vacation) and we all received better benefits and a retirement program. That is how medicine has changed--from a solo, patient-centered practice to a factory mentality. Get used to it, because that is the future called cookbook medicine. I regret that I was financially forced to sell to a larger practice, but in return I am the permanent section chief.

The upside has been that I was able to hire two Iraq War veterans from the Air Force as physician assistants for my neurology and psychiatry practices respectively. These two are the tops when it comes to PAs, and they have made my life considerably easier. I deliberately sought to hire veterans because I knew their field experience in psychiatry was invaluable. They treated the worst cases of PTSD, depression, anxiety, etc. I trust both of them with my life and my patients. I practice with two other neurologists and another psychiatrist and we have coalesced as a group force to challenge any other neuro or psych practice out there.

The bottom line is that all of you will see consolidation in medicine not unlike the banking sector. You can blame Obamacare fore removing any sense of personalized therapy in favor of algorithm-derived medicine, not unlike an assembly line or a bakery.

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