10 million more patients

Yes 10 million more people covered under ACA but without adding one new MD/PA/NP. Our future will surely be changed forever.

Elaborate???

I smell opportunity not disaster.

Job security

Certainly, it remains to see what version of the ACA will actually unfold in 2014. And, yes, people will surely make faulty decisions with this resource. I hope that this will bring a substantial improvement in healthcare for many who never had the option. I was recently in Europe and Eastern Europe and people asked me why Americans oppose this new plan. They said to me why don't Americans want their fellow countrymen to have healthcare. It was very interesting to listen to their concerns and observations of us.

"Most people will be required to have health insurance starting in 2014 or pay a fine. That penalty for individuals starts at $95 or up to 1 percent of income and grow in later years. For families it would start at $2,085 or 2.5 percent of household income."

The fines are looking pretty good compared to health insurance cost. Not really seeing how the fine is going to steer people towards buying insurance from the exchanges, unless the exchanges are dirt cheap. Unlikely. Maybe as the fine grows, they're expecting people to funnel into the exchanges slowly? I know there's a clause about insurance costing no more than a certain percentage of income but I can't find it right now.

My dad operates a small business and already provides insurance to his employees - maybe 15-20 people. I could go to PA school (private tuition) basically debt-free on the money his business spends on health insurance in a year. Small business really suffer in the current system. Hoping this act will make it more attractive for employers to insure the people who work for them.

but the administration did hire 4000 new IRS agents to enforce ACA.

It is not required by food stamps that you buy healthy food. I was in line behind a women recently in the grocery store that was using a food stamp debit card. She had her cart full of soda, frozen pizza, and corndogs. Healthy options tend to be more expensive, but im sure the price difference could be easily made up from the ciggarettes she smoked. This lady also has government assistance in a monetary form... she uses some of it to buy marijuana. She does not have to take a drug test each month to prove she is not using it for illegal, unhealthy drugs. She also has medicaid, in which she uses for "chronic back pain", and various other illnesses that pop up. She is not held accountable for any of the misuse and irresponsible patient visits and regardless of what preventative medicine and issues I address, she just comes right back for any old thing. The reason I know this women very well is because I am a foster parent and I had to take care of some of her children when they were severly neglected. Some how, even with all this government assistance, she could not feed her children or bath them or take care of them in any way. So now it takes even more resources through the government to foster these children into my home. This one lady has easily wasted so much tax money that could have been avoided with rules and regulations and contributes nothing to society. If the government can not or will not regulate all the assistance programs and existing healthcare programs they already have, then how are they going to regulate this one. This is going to break the system, and medicaid will be like monopoly money, people will look at you crazy if you try to buy something at the store with it. Then there will be a panic that no one is taking medicare at all anymore. There will be a crisis and a "special committee" will be organized to address this unjust behavior of the medical world. The committee, headed by the surgeon general, will come out with some emergency intervention program that will be under the guise of being a short term program that will try to unify healthcare into a social type system for those desparate medicaid/care patients that can not get an appointment to save their life... literally! Then slowly one by one the government will outspend private insurance companies by printing money and "subsidizing" their unified social plan until that is all that is left. The small insurance companies will go quickly and quietly... no one may even notice. Then when the biggies start to crumble it will get peoples attention, but by that time it will be too late. Now suddenly people that had the good insurance plans will find themselves desparate because they will be without insurance. They will be forced into the "short term" emergency social medicine plan. This is when the plan transitions from being a crisis type emergency intervention plan, to a long-term social medicine plan.

Welcome to socialized medicine! I would start living healthier now and try to avoid needing any care at all.

We also spent our money making all of the technological and pharmaceutical advances that they didn't develop, but benefit from. of privatizing more and more of its care.

Not so fast...

http://content.healthaffairs.org/content/28/5/w969.abstract

Europe is actually no slouch in the medical research department, although they have been labeled (wrongly) as such for some time. I actually just got put on an international research collaborative looking at physician behavior (specifically "Audit and Feedback") and I am astounded at our European colleagues.

The simple fact is, the way that their health systems have advanced has not been through ideology, but through data and research....

If many folks would give up cigarettes and beer for their family of 4, they would have money for premiums.

Better yet.. increase the cost on tobacco and alcohol products. As an example, the typical 25 pack of cigs in Canada costs ~$10, and a 12 pack of coors is $20+. As compared with the US a pack of cigs is what? $3.00? and a pack of 12 coors is... a whopping $10??? give or take. Fact is, if you increase the price of booze by 200%, and tobacco by ~300%... whammy, theres alot of benjamins that are back into the system. Mandate it as a healthcare tax or whatever. If your going to make the decision to use that garbage, then pay for it. Everyone is always talking about the person who gets all the freebies associated with the partial socialized system because they dont work or dont make enough money, or are on welfare etc etc etc, but flying under the radar are those that are abusing alcohol and tobacco, paying the same premium and will inevitably use the medical services a heck of alot more than someone who doesnt smoke or drink. You increase those prices, you can pour so much more into the healthcare system and will alleviate some of the "socialized" costs (ie taxes). I think that is EXTREMELY reasonable. heck, if you choose to live a healthy lifestyle and shop at the local organics market, your going to pay a premium! Why not pay a premium if you choose to take on a very addictive, bad habit?

Problem is that wont work either, because changing that would be ludacris (opinion of smokers and drinkers) and piss off alot of people. There's no compromise, even though the idea of a healthier lifestyle could be so much more beneficial.

As an example, the typical 25 pack of cigs in Canada costs ~$10, and a 12 pack of coors is $20+. As compared with the US a pack of cigs is what? $3.00? and a pack of 12 coors is... a whopping $10???

Maybe 15 years ago--a pack of cigarettes in most places these days will cost you at least $7, and NYC/Chicago have been $10+ for some time now.

Not in Missouri. Maybe $3 was a stretch.. but it's still alot lower on average. Thats smoking tobacco. Chewing tobacco? 20$ for a can in Canada as compared to $2.00 for the "low grade" brands, and $4.00 for copenhagen. Bottom line is, even an increase of say 2-3.00 on tobacco, and a bigtime increase on booze would help the healthcare situtation financially and cause for a better lifestyle across the board.

and the comments that were posted to that study are also informative and enlightening as to the weaknesses of the study.

Agreed, it wasn't perfect, but the simple fact is, Europe conducts a boatload of medical research. We still spend more on R&D....but part of that is that the Commission (EU) hasn't really agreed on a research infrastructure. In the past, pre-EU, small countries were investing in research in various countries. As the EU has grown, funding is consolidated, but there are no agreed upon priorities or infrastructure to accomplish the same research objectives we do.....

Another facet, or way of looking at this is to determine how much we are spending on research that actually matters. Too much of our innovation and R&D budget is wasted on so called "designer" drugs and more medications that are no better than their pre-cursors. Too much is wasted on procedures that turn out to be harmful. I personally feel we waste a lot of our research effort on things that aren't needed. Thankfully, the NIH, AHRQ, HHS, HRSA, and others are starting to move their RFP's more towards delivery and value creation studies.

Personally, I never prescribe any medications that are not generic. The only exception would be when someone has failed everything else....and even then, I do it only under protest. I think most of the me2 drugs are ridiculous, and I don't trust the drug industry much farther than I can throw them.....

Especially with the shenanigans that the pharma industry conducts. We know that between 25-50% of studies on medications are never published.....those usually have positive findings that would reflect negatively on the drug in question. We also know that drug companies engage in marketing research.....they give out samples to practices, and ask them to use the medication, and tell them to fill out a form and that they are helping with research.....the problem is, they aren't studying the patients....they are studying the providers. They use ghost authors, one study (STEPS- looking at Gabapentin) was conducted by using this marketing or "Seeding" research......it listed several of the physicians as the authors of the study.....it was actually written by the marketing guy at the drug company.....This stuff happens all the time. Here's the abstract of an article that a friend, who actually investigates this stuff, wrote....

http://www.ncbi.nlm.nih.gov/pubmed/22095335

SO, do we spend more than Europe...yep. Do we get better research than Europe???? I don't know about that...

Yes 10 million more people covered under ACA but without adding one new MD/PA/NP. Our future will surely be changed forever.

OP, still not willing to explain the purpose of this discussion thread?