Obamacare - My experience so far

07/16/2014 10:17:41 PM · #77

Originally posted by LydiaToo:

Why should the people who pay for their own, and other people's, healthcare have to govern themselves according to cost... when deciding whether to go to the doctor (and I think they SHOULD!), when the people for whom they pay healthcare, don't. If you CAN work... then ... you SHOULD work...

First, I'm not even sure your initial premise applies since the tax credits and aid only get people so far, and they're just as liable as you for the deductible and other expenses. That's the main reason over 90% of uninsured Americans eligible for Obamacare haven't signed up: it's still expensive, not free. Second, only 24.9% of the uninsured are people who make less than $25,000, and the vast majority of those either DO work or cannot due to age or disability, so we're probably talking about a very tiny fraction of people. You should be happy that thanks to this law, the much, much larger chunk of freeloaders who can afford insurance are finally being made to pay their fair share instead of sticking taxpayers with the ER bill because they chose to do without insurance.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/16/2014 10:47:32 PM · #78

Originally posted by DrAchoo:

If a Trillium patient makes five appointments and shows up for two and a traditional insurance patient makes two appointments and shows up for two, the two have utilized the same number of health care dollars, but the Trillium patient has utilized more than twice as much of my time.

Maybe you can use the time "freed-up" by the no-show to spend ten minutes with the previous client instead of the customary five and do some education or preventive care, or just have a human interaction ...

Also remember that many of the people who "just now" got subsidized health care haven't had established primary care in place, so they are more or less forced to use ERs/urgent care more often if their condition can't wait two to six week for an appointment, and they are not used to interacting with the (non-)system.

07/16/2014 11:35:59 PM · #79

Originally posted by GeneralE:

Originally posted by DrAchoo:
If a Trillium patient makes five appointments and shows up for two and a traditional insurance patient makes two appointments and shows up for two, the two have utilized the same number of health care dollars, but the Trillium patient has utilized more than twice as much of my time.

Maybe you can use the time "freed-up" by the no-show to spend ten minutes with the previous client instead of the customary five and do some education or preventive care, or just have a human interaction ...

Also remember that many of the people who "just now" got subsidized health care haven't had established primary care in place, so they are more or less forced to use ERs/urgent care more often if their condition can't wait two to six week for an appointment, and they are not used to interacting with the (non-)system.

I'd hate to change my interaction with one patient based on the actions of another. Seems like a poor way to run a clinic. I have time, anyway, to interact with patients since I am a specialist. Just know no-showing is a problem.

The Oregon Health a Study was back in 2008 so the current problems that we are massively experiencing in Oregon (not enough PCPs for all the new healthcare lives) aren't applicable to the study. The bottom line is that for whatever reason the party line that we insure people because they utilize less expensive services and save us money didn't bear out.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/16/2014 11:39:26 PM · #80

Originally posted by DrAchoo:

I have time, anyway, to interact with patients since I am a specialist.

Which invites the possibility that your personal experience is "special" ...

scalvert

Canon EOS-5D Mark III

07/17/2014 12:06:53 AM · #81

Originally posted by DrAchoo:

The Oregon Health a Study was back in 2008 so the current problems that we are massively experiencing in Oregon (not enough PCPs for all the new healthcare lives) aren't applicable to the study. The bottom line is that for whatever reason the party line that we insure people because they utilize less expensive services and save us money didn't bear out.

Funny that that 8 year old Oregon study seems to be the sole basis for a whole lot of conservative press claiming Obamacare will increase ER visits. Meanwhile, a majority of ER doctors say visits have NOT increased since Obamacare went live (27% report no change and 23% say the number has declined). That's pretty remarkable considering the overall patient pool has increased by millions. Most doctors polled expect ER visits to go up due to a shortage of primary care physicians, not "free" healthcare. This view is borne out by the fact that Massachusetts saw an initial surge in ER visits after implementing their health reform, which then declined in later years, with most of the decline (12.2%) in the lowest income quartile while the wealthier areas stayed the same. Likewise, the Oregon study only covered 18 months after 2008, but ER visits have declined since then. ER spending in Oregon declined 18% from 2011 to 2013 despite more people (and more low-income people) with health coverage. Looks like it's actually your theory that didn't bear out.

Sigma 12-24mm f/4.5-5.6 EX Aspherical DG HSM for Nikon

07/17/2014 12:19:54 AM · #82

Ya. I heard about the study initially a few months ago on that conservative mouthpiece NPR. It was published in that bleeding-red republican magazine Science. It was conducted by the radical right-wing organization Harvard School of Public Health.

It is often quoted because there are few instances where one can ethically come up with a well matched control cohort.

Message edited by author 2014-07-17 00:23:25.

bohemka

Nikon D700

07/17/2014 12:26:06 AM · #83

Originally posted by LydiaToo:

If you CAN work... then ... you SHOULD work. There's plenty to be done. There's trash on the road to my house right now... There are people who need to be taken to doctor's appointments... people who need meals. WHY are we paying people to do that... (with benefits like insurance benefits) when there are able-bodied people who can do it... and they're ALREADY getting healthcare for free because their income is too low (they're NOT WORKING!).

This is amazing.

Cory

Canon EOS-1D Mark IV

Canon EF 85mm f/1.2L II USM

07/17/2014 02:11:58 AM · #84

Originally posted by DrAchoo:

I have a high index of suspicion that a good part of this is the lack of perception of the "value" of my time because it is costing them nothing.

Generally I agree with you, but I want to pick a bone here...

Why should I respect my doctor's time? They clearly don't respect mine, AT ALL. It is common practice to show up for an appointment, wait 30 minutes, get in, wait another 30 minutes, see the doctor for 5 minutes, and leave.

At the end of the day I feel like I just got fucked out of an hour of my time, and want to send the doctor a bill at my regular rate for the hour of time I could have been working instead of twiddling my thumbs in their office.

Or, is there some bloody good reason you folks schedule things like this? If I did this to a client, I'd be asked to not return.

MelonMusketeer

Nikon D7000

Nikon MF 50mm f/1.4

07/17/2014 02:18:30 AM · #85

Cory, I'm happy to hear about your good med report. Maybe you just need a good fresh dose of clean salty air?

raish

Olympus C-2500L

Nikon AF Nikkor 50mm f/1.4D

07/17/2014 02:21:42 AM · #86

sick people who can't afford doctors should suffer and die - unemployed people should bury them

there was once an argument for the welfare state, which ran along the lines of a centrally administered infrastructure which educated people to maintain and develop that infrastructure with its transport links and postal and telephone communications services, its centrally administered security, defence, police and emergency services, and sewage, water and electricity to the population in general. From this basis it was possible to create and develop industrial production. The health and physical effectiveness of human operators of this infrastructure was important enough to justify centrally administered health care - from the cradle to the grave.

If industrial production is outsourced them all bets are off.

Cory

Canon EOS-1D Mark IV

Canon EF 85mm f/1.2L II USM

07/17/2014 03:16:51 AM · #87

Originally posted by MelonMusketeer:

Cory, I'm happy to hear about your good med report. Maybe you just need a good fresh dose of clean salty air?

Trying to find a new apartment in Miami in fact... Probably nothing wrong with me that a bit of good salty air can't fix, and what that won't take care of, a giant-ass melon gun can surely distract me from. :)

Mike

Tamron SP 24-70mm f/2.8 Di VC USD Canon Mount

07/17/2014 08:03:00 AM · #88

Originally posted by Cory:

Originally posted by DrAchoo:
I have a high index of suspicion that a good part of this is the lack of perception of the "value" of my time because it is costing them nothing.

Generally I agree with you, but I want to pick a bone here...

Why should I respect my doctor's time? They clearly don't respect mine, AT ALL. It is common practice to show up for an appointment, wait 30 minutes, get in, wait another 30 minutes, see the doctor for 5 minutes, and leave.

At the end of the day I feel like I just got fucked out of an hour of my time, and want to send the doctor a bill at my regular rate for the hour of time I could have been working instead of twiddling my thumbs in their office.

Or, is there some bloody good reason you folks schedule things like this? If I did this to a client, I'd be asked to not return.

you beat me to it...

and orthopedic specialists are the worst offenders. i used to waste half of my day waiting for a guy to tell me he didnt know what was wrong and I need to get an MRI.

RayEthier

Canon EF-S 18-55mm f/3.5-5.6 USM

07/17/2014 08:48:13 AM · #89

Originally posted by bohemka:

Originally posted by LydiaToo:
If you CAN work... then ... you SHOULD work. There's plenty to be done. There's trash on the road to my house right now... There are people who need to be taken to doctor's appointments... people who need meals. WHY are we paying people to do that... (with benefits like insurance benefits) when there are able-bodied people who can do it... and they're ALREADY getting healthcare for free because their income is too low (they're NOT WORKING!).

This is amazing.

NOT the word I had in mind since for me the word "Amazing" has a positive connotation. :O(

Ray

scalvert

Canon EOS-5D Mark III

Canon EF 28-135mm f/3.5-5.6 IS USM

07/17/2014 09:25:08 AM · #90

Originally posted by raish:

sick people who can't afford doctors should suffer and die - unemployed people should bury them

Hmm... where have I seen that basic argument? Recently, in this thread, and in the name of fairness...?

Kelli

Canon EOS-D60

07/17/2014 10:38:42 AM · #91

Originally posted by scalvert:

Originally posted by raish:
sick people who can't afford doctors should suffer and die - unemployed people should bury them

Hmm... where have I seen that basic argument? Recently, in this thread, and in the name of fairness...?

These threads depress me so much. To feel like you should be euathanized because you're no longer of value to society, no matter how many productive years you put in hurts. And when pushed, every last person who made a comment to that effect claims that it's not what they meant. But it's said, time and again. And the worst part is, sometimes, you actually start to believe it.

07/17/2014 11:01:21 AM · #92

I hear you guys. Doctors set a low bar with running on time. Not all practices are like that and I rarely run more than 10 minutes behind. It's part of the logistics of trying to plan for the unplannable. You don't necessarily know how long a patient is going to take so you estimate. It's hard to say "we're done. I have no more time for you" when it clearly, at times, needs to be said. Some doctors also plainly overschedule. That's on them. Sometimes it's because they want to make lots of money. Sometimes it's because they are the only game in town and kindly (but foolishly) want to help as many people as they can.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/17/2014 01:03:20 PM · #93

Originally posted by Cory:

At the end of the day I feel like I just got fucked out of an hour of my time, and want to send the doctor a bill at my regular rate for the hour of time I could have been working instead of twiddling my thumbs in their office.

This is not a new issue ... I think sometime in the 1980s some guy in England did just that, eventually suing the doctor for non-payment of the bill and winning the claim ... around the same time columnist Jon Carroll of the San Francisco Chronicle ran a series of articles on the subject, the last of which listed readers' suggestions for adressing the problem, my favorite of which was to "take off all your clothes and hang a sign around your neck reading 'I'm Next'" with the result being immediate installation in an exam room (or possibly a jail cell?) ... :-)

Mike

Tamron SP 24-70mm f/2.8 Di VC USD Canon Mount

07/17/2014 01:33:42 PM · #94

think about it, you are injured or sick, all you want to do is get better yet wyou are continuing to wait for an appointment, wait to see the doctor, wait to schedule a test, wait to get the results, wait to schedule treatment.... wait wait wait

jeez its no wonder people are pissed off through the whole process and dont value the care at any cost...

RayEthier

Canon EF-S 18-55mm f/3.5-5.6 USM

07/17/2014 02:54:46 PM · #95

Originally posted by DrAchoo:

I well remember the day that I asked my wife's physician whether I should bill him personally, or bill the practice for the 2+ hours I had been sitting in his waiting room.

Seems that his secretaries "Overbooked" because some failed to show up. I made him a deal and told him that if I failed to show up I would pay for missing that appointment... and then sent him a bill for my 2+ hours of wait time.

Guess what... he paid me. :O)... and she still visits him.

Ray

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/17/2014 02:58:04 PM · #96

Originally posted by RayEthier:

... I made him a deal and told him that if I failed to show up I would pay for missing that appointment...

Requiring 24-hour notice to cancel an appointment (without being billed) seems standard procedure at most practices (medical and dental) I've seen ... in fact, billing for "missed" appointments seems like an ideal "profit center" for enterprising practitioners who somehow manage to consistently overbook "unreliable" clients ...

Message edited by author 2014-07-17 15:00:11.

bohemka

Nikon D700

Sigma 12-24mm f/4.5-5.6 EX Aspherical DG HSM for Nikon

07/17/2014 03:17:46 PM · #97

Originally posted by RayEthier:

Originally posted by bohemka:

Originally posted by LydiaToo:
If you CAN work... then ... you SHOULD work. There's plenty to be done. There's trash on the road to my house right now... There are people who need to be taken to doctor's appointments... people who need meals. WHY are we paying people to do that... (with benefits like insurance benefits) when there are able-bodied people who can do it... and they're ALREADY getting healthcare for free because their income is too low (they're NOT WORKING!).

This is amazing.

NOT the word I had in mind since for me the word "Amazing" has a positive connotation. :O(

Ray

You're far too negative, Ray. She's upset that people are getting health care but not contributing, so her answer is to fire people who are contributing and replace them with people who aren't, which would quite obviously double the number of people receiving unfair "free" healthcare for every instance it was put in practice.

The bonus Kafkaesque twist is that in order to be qualified to hold your current position, you'd have to be fired from it. I do think that's amazing.

BrennanOB

Canon EOS-1D Mark II

Tamron SP AF 28-75mm f/2.8 XR Di for Canon

07/17/2014 03:24:15 PM · #98

Originally posted by GeneralE:

Of course the main reason our medical delivery system is in a shambles is the amount of effort expended by people who are supposed to be healers, seeking profit centers, or frankly trying to get paid by what they are owed by the myriad of medical coverages that the patients come in with. As a nation we pay more for less medical care than any other medical system in the first world. A big part of that is because we spend so much of our medical dollars on administration, chasing down dollars, and by keeping the basic structure of the medical insurance model, those inefficiencies are baked into the ACA.