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Opinion on affordable care act


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This has been discussed here before. In the interest of full disclosure, I worked on the ACO part of the bill, and worked with the Senate Finance committee on some of the other parts as well.

 

It's okay. I give talks on health reform all over the country, some of the others here have heard them. I always say "it's a good start". Certainly not a panacea, certainly doesn't address everything and like with every piece of legislation there are bad things in with the good (that's the reason they call it making sausage).

 

If you really want a good conversation though, you have to be much more specific. The ACA was a large bill, and there are many provisions. If you have questions about a specific provision, that might be a better start than a really nebulous, general question.

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As someone who grew up without health insurance I am all for it.

 

My (albeit possibly biased) personal experience is those who adamantly oppose it are those who have lived an at least somewhat privileged life and have never been without health insurance or God forbid been sick without good health insurance before.

 

There are many kinks to work out but I am all for it on principle alone.

 

This is just my opinion, no offense meant to anyone.

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As someone who grew up without health insurance I am all for it.

 

My (albeit possibly biased) personal experience is those who adamantly oppose it are those who have lived an at least somewhat privileged life and have never been without health insurance or God forbid been sick without good health insurance before.

 

There are many kinks to work out but I am all for it on principle alone.

 

This is just my opinion, no offense meant to anyone.

I agree. we need some type of universal coverage for every american. there are too many gaps in the current system for example retired vets under 65 with less than 20 yrs of military service...no medicare, no tricare, etc

recently had a guy like this with a big mi and zero coverage. worked full time at low wage job without benefits, no savings, etc

er visit + transfer to tertiary care ctr for cath likely wiped out all his savings and put him into debt from which he will never rebound.

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I agree. we need some type of universal coverage for every american. there are too many gaps in the current system for example retired vets under 65 with less than 20 yrs of military service...no medicare, no tricare, etc

recently had a guy like this with a big mi and zero coverage. worked full time at low wage job without benefits, no savings, etc

er visit + transfer to tertiary care ctr for cath likely wiped out all his savings and put him into debt from which he will never rebound.

 

I agree with you, stories like that are sadly unfortunate. I just think the ACA has too many holes. I've read my articles how the lower class will be hit the hardest by the 9.5% of their income for their premium. That's just not realistically affordable for the working lower class. I'm hopeful some provisions will be made to this legislation in the near future.

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I always love to see such a strong opinion supported by so much data. I'm convinced. DOWN WITH THE GOVERNMENT!!!!

 

Law should not be allowed to control medicine. Medicine is an art, a practice that cannot be legislated. Here is a written opinion by a respectable doctor that is reflected by many in the medical field.

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it that they expect to depend on, when they lie on an operating table under my hands?"

"Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it-and still less safe, if he is the sort who doesn't."

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Not a provider yet! But government should have zero involvement with OUR healthcare. Affordable Care Act will cripple our country even further

 

Just a suggestion. If this is an example of your critical thinking skills and analytic ability, do the PA profession a favor and look for a different profession.... :-)

 

So, in your world, it serves the needs of the population to let anyone do anything in pursuit of delivering health care. No licensing (government), QA (government), cost control (government), public health (government), accreditation (government), etc., etc. With what do you propose that we replace the current system? I'm convinced from your statement that the laissez-faire approach, where everyone just acts in their own best interest, will serve the health care needs of the population well. Not!

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From a provider standpoint, the ACA is better by a long shot that what we have been doing up till now. I find it entertaining that if your take some of the key elements of the ACA (e.g., no exclusions, coverage of children, Medicare prescription drug coverage, preventive care, etc.), and ask folk's opinion about it individually and not in the context of the pejorative "Obamacare," people are overwhelmingly supportive. What they are not supportive of is mandated coverage. I find it amusing that mandated coverage was a conservative corner stone to health care reform until Congress and President Obama adopted it, and now they are against it.

 

I have news for everyone. ACA is going to save a lot of money, and I can give you one concrete example. We already deliver health care to everyone, using the most expensive and inefficient system possible, our EDs. You make it across the threshold of our ED, and you get a million dollar work up for anything with no thought to cost. Guess who pays for this? Why do we have the money to spend on this incredibly bad way to deliver health care, but can't fund our community clinics and family practices to make sure that grandma effectively treats her HTN and DM. We are spending plenty on our HCS and have little positive to show for it. Look at ANY other industrialized nation and compare the US to their HC outcomes. We suck.

 

Why do we share the common misconception that the "government" can't run health care efficiently, but that a profit driven CEO, who gets bonuses for reducing costs by denying care, can? What is wrong with this picture? It would behoove folks who want to look at international experience watch Fareed Zakaria's special on health care in other countries. One example. Taiwan has a nationalized health care system that delivers health care to virtually the entire population with a 2% overhead. Compare that to the overhead of our system, about 30%. Because of their universal EHR, Taiwan has real time public health data on everything going on in the country within 24 hours of it occurring. It takes years to generate the same data in the US. There are many other examples from the experience of other health care systems around the world. How you delivery health care, and how your pay for health care, are two distinct and separate problems within HC reform.

 

The ACA has a lot of warts, and doesn't go near far enough in my opinion. HC is changing and we all have to change with it. The status quo prior to the ACA was destined for disaster. At least we have a hope now of covering everyone who needs HC, and controlling costs. We still have a long way to go.

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I have news for everyone. ACA is going to save a lot of money, and I can give you one concrete example. We already deliver health care to everyone, using the most expensive and inefficient system possible, our EDs. You make it across the threshold of our ED, and you get a million dollar work up for anything with no thought to cost. Guess who pays for this? Why do we have the money to spend on this incredibly bad way to deliver health care, but can't fund our community clinics and family practices to make sure that grandma effectively treats here HTN and DM. We are spending plenty on our HCS and have little positive to show for it. Look at ANY other industrialized nation and compare the US to the HC outcomes. We suck.

 

The ACA has a lot of warts, and doesn't go near far enough in my opinion. HC is changing and we all have to change with it. The status quo prior to the ACA was destined for disaster. At least we have a hope now of covering everyone who needs HC, and controlling costs. We still have a long way to go.

 

I agree. "Go to the ER" shouldn't be the default national health care option.

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I always enjoyed seeing patients in the ER who's chief complaint was one of the following (Most patients are mediCal or Medi/Medi):

 

Fever since last night

Flu like symptoms

Abscess

Rash x 2 weeks

Cough x 10 days

Suture / staple removal (ACI states to go to PCP)

Refill prescription

Eval for hospice referral

Ear ache

Sore throat

Eye irritation / Blurred vision

Chronic extremity pain

 

I remember a friend of mine went to the ER for SOB (there was a bug going around). Guy was in between coverages from changing employers and ended getting the full work up. CXR, CBC, BMP, CK, Trop, Albuterol HHN Tx. Bill was $7k... Now they're broke. It's these types of circumstances that make me believe in the ACA because the guy did everything right, he was just on in the probationary period waiting for his benefits to kick in.

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Law should not be allowed to control medicine. Medicine is an art, a practice that cannot be legislated. Here is a written opinion by a respectable doctor that is reflected by many in the medical field.

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it that they expect to depend on, when they lie on an operating table under my hands?"

"Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it-and still less safe, if he is the sort who doesn't."

 

I agree. Law should never control medicine. Why should laws determine who can practice medicine, who can dispence drugs, or who can make new drugs. Regulation is always bad. We should be like artist. If I want to skip school and practice in the square that should be my right!

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I always enjoyed seeing patients in the ER who's chief complaint was one of the following (Most patients are mediCal or Medi/Medi):

 

Fever since last night

Flu like symptoms

Abscess

Rash x 2 weeks

Cough x 10 days

Suture / staple removal (ACI states to go to PCP)

Refill prescription

Eval for hospice referral

Ear ache

Sore throat

Eye irritation / Blurred vision

Chronic extremity pain

 

HA! These folks call 911 and EXPECT an ambulance ride for these symptoms, because they think they'll be seen quicker among other things.

 

I remember a friend of mine went to the ER for SOB (there was a bug going around). Guy was in between coverages from changing employers and ended getting the full work up. CXR, CBC, BMP, CK, Trop, Albuterol HHN Tx. Bill was $7k... Now they're broke. It's these types of circumstances that make me believe in the ACA because the guy did everything right, he was just on in the probationary period waiting for his benefits to kick in.

 

Sorry to hear your friend had issues and is now between a rock and a hard place. That makes a good case for getting health insurance out of the work/pay arena. ;)

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Also to note is that increasing co-pays is important (high copay for ER, low for PCP) to "encourage" people to go where is most appropriate I think co-pays should increase, to place a higher value in some people's minds of how valuable the services and drugs they receive are. I work hard for my insurance which requires me to pay relatively high co-pays and never get brand names. Other people get angry if their Cymbalta, Doryx, and 10 bottles of lantus pens are anything but free/1.15/etc.

 

In short... hopefully it will bring some accountability to each citizen for their own health, making providers jobs more rewarding, as patients will come in wanting help to improve their health (and as a result lower their expenses).

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Just a suggestion. If this is an example of your critical thinking skills and analytic ability, do the PA profession a favor and look for a different profession.... :-)

 

So, in your world, it serves the needs of the population to let anyone do anything in pursuit of delivering health care. No licensing (government), QA (government), cost control (government), public health (government), accreditation (government), etc., etc. With what do you propose that we replace the current system? I'm convinced from your statement that the laissez-faire approach, where everyone just acts in their own best interest, will serve the health care needs of the population well. Not!

 

Sorry I was rash with my earlier response. I will be more lucid; govt should have a limit in our healthcare system. I don't see how it is right for them to justify they can fine citizens if they do not purchase a health insurance plan. We have every right to choose if we want to purchase healthcare or not. That is just my own opinion. What do I propose to replace the current system? Well I do believe in government assistance for lower income families and individuals. Therefore, implement a voucher system, the govt will give you X amount of dollars to purchase your own private insurance option. But hey every piece of legislation has its pros and cons, nothing can be perfect. The ACA is in the right direction, but like I said earlier some revisions need to be applied.

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You really want me to get into data? Im not going to go that far, but all I have to say is the government can't even successful run a post office and you feel safe with them handling our healthcare

 

And we can see failure already. The government doesn't run the Post Office. In fact, it runs considerably well considering the difficult situation it is in. It is not allowed to raise rates without Congressional approval, yet does not have access to ANY federal money. So, it cannot be run in a successful government model, yet, cannot raise rates or revenue to run more efficiently in a private sector model.

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well in principle that is a good idea (we should be able to choose not to have insurance) but since in our nation we will treat anyone who comes to the door, and hospitals and the gov't end up footing the bill at times; we can either choose to mandate coverage to help fight said expenses, or turn actively dying people away from the door at the ER. Not a nation I would want to live in.

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Law should not be allowed to control medicine. Medicine is an art, a practice that cannot be legislated. Here is a written opinion by a respectable doctor that is reflected by many in the medical field.

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it that they expect to depend on, when they lie on an operating table under my hands?"

"Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it-and still less safe, if he is the sort who doesn't."

 

Anecdotal sour grapes.....Laws and regulations will always impact medicine and its delivery. "enslave me".....wow. Hyperbole being, well hyperbolic......LOL.

 

BTW, many of us have also read Ayn Rand. Although I find her boring, tedious, and really kind of nuts to be honest. I was always more of a Sartre fan myself.

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We have the equivalent to the ACA here in MA. We call it "Romneycare" as it was Romney's plan for health care reform. 97% of the populace in MA has a legally set level of health insurance. This is a wonderful thing as it no longer means you have to worry about your patients refusing emergency care due to no insurance. I'll never forget one of my first days as an EMT-B in Illinois where a woman refused EMS care despite having a miscarriage and actively hemorrhaging very severely. She had no insurance (owning to a Wal-Mart type employer) and couldn't afford it.

 

Romney care has been excellent to us in MA. The cost is modest but the benefit is healthier people.

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Health insurance != free medical care. Insurance is SHARED RISK. That means that healthy young people pay more money so that sick old smokers can be covered. Is that fair, moral, or ethical? To compel people who make good health choices to subsidize the poor health choices of others? Oh, to be sure, most of the risk is age-based, but let's not ignore the impact that obesity, smoking, uncontrolled HTN, and the like have on healthcare costs.

 

By all means, people should have some recourse to pay for their health care, but if all the ACA money was divvied up equally, MOST Americans would be better off taking their share and paying out of pocket, if for no other reason than the overhead is going to be enormous.

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Health insurance != free medical care. Insurance is SHARED RISK. That means that healthy young people pay more money so that sick old smokers can be covered. Is that fair, moral, or ethical? To compel people who make good health choices to subsidize the poor health choices of others? Oh, to be sure, most of the risk is age-based, but let's not ignore the impact that obesity, smoking, uncontrolled HTN, and the like have on healthcare costs.

 

By all means, people should have some recourse to pay for their health care, but if all the ACA money was divvied up equally, MOST Americans would be better off taking their share and paying out of pocket, if for no other reason than the overhead is going to be enormous.

 

We're all in this together. This, of course, being life and the pursuit of happiness. Thus we are all in the insurance game together.

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I agree. we need some type of universal coverage for every american. there are too many gaps in the current system for example retired vets under 65 with less than 20 yrs of military service...no medicare, no tricare, etc

recently had a guy like this with a big mi and zero coverage. worked full time at low wage job without benefits, no savings, etc

er visit + transfer to tertiary care ctr for cath likely wiped out all his savings and put him into debt from which he will never rebound.

 

i'm currently working on 12 grand for 4 er visits re: kidney stones over 2 weeks. i'm a freaking pa working without savings, debt and with no benefits.

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