Opinion on affordable care act

[rcdavis]

The single, scariest, most fundamentally changing item in the ACA is the creation of the IPAB.. (independent payment advisory board).

 

Unelected members of a board which will review what medicare and insurance will and will not pay for, which procedures will, and will not , be allowed, under which circumstances... Appointed by a president to a board which is Above congressional and judicial review, which cannot be abolished, nor de-funded ... Ever.. Except for a very small window in time (a brief period of the first 6 months of 2017, and only then with a 3/5ths supermajority congressional vote). The board chooses its own successors and future members. There is no limit to "terms"

 

Think Shirley Jackson or Elizabeth warren in charge forever.

the IPAB will make the EPA look like a minor player in our society.

 

The health care policy in America will become what an "unelected, unaccountable governmental body" , which is above the law ( the democrats in the last congress somehow unconstitutionally have jiggered the system so that the hands of future congresses are tied), says it is.

 

OBAMA care right now is the law of the land. I suspect that folks will find it not as pleasant as others on this board seem to feel it will be. But, at least, should I be right, it is amendable by future congresses and courts.

 

Not so the IPAB.

 

THAT is where we should be scared... We have created a "god " with this board. One which we may not like.

 

It you enjoyed the rules of pol-pot, Stalin, hitler, and their ilk, you will love the IPAB.

[burnpac]

The single, scariest, most fundamentally changing item in the ACA is the creation of the IPAB.. (independent payment advisory board).

 

Unelected members of a board which will review what medicare and insurance will and will not pay for, which procedures will, and will not , be allowed, under which circumstances... Appointed by a president to a board which is Above congressional and judicial review, which cannot be abolished, nor de-funded ... Ever.. Except for a very small window in time (a brief period of the first 6 months of 2017, and only then with a 3/5ths supermajority congressional vote). The board chooses its own successors and future members. There is no limit to "terms"

 

Think Shirley Jackson or Elizabeth warren in charge forever.

the IPAB will make the EPA look like a minor player in our society.

 

The health care policy in America will become what an "unelected, unaccountable governmental body" , which is above the law ( the democrats in the last congress somehow unconstitutionally have jiggered the system so that the hands of future congresses are tied), says it is.

 

OBAMA care right now is the law of the land. I suspect that folks will find it not as pleasant as others on this board seem to feel it will be. But, at least, should I be right, it is amendable by future congresses and courts.

 

Not so the IPAB.

 

THAT is where we should be scared... We have created a "god " with this board. One which we may not like.

 

It you enjoyed the rules of pol-pot, Stalin, hitler, and their ilk, you will love the IPAB.

 

Funny, this sounds like the present system of 1500 plus health care delivery administrations making these same decisions not in the interest of the health of the patient, but in the interest the almighty dollar and profit. Why the folks who are decrying the IPAB have no problems with the present system doing the same thing, is beyond me. I will take one, centralized, consistent, evidence-based, patient centered, public health oriented system over the present system any day. Sounds like a dramatic improvement to me.

 

p.s., can we hold the Hitler / Stalin references when discussing this stuff? It is really offensive and frankly untrue.

[Guest JMPA]

What the ACA is going to do is further distance the quality of healthcare for poor and middle class people. The middle class and poor will now be grouped together, having to wait longer for diagnosis and treatment resulting in increased deaths from treatable or preventable diseases. The rich will always have whatever tests they need immediately available and all treatments available without worry of being denied by insurance or unable to afford it. It also wastes tremendous amounts of money by taking it from the providers and paying it to "oversee - ers". Lawyers and politicians are known as leeches of society for a reason.

[Guest Paula]

See what I did there? :)

 

Contrarian? Is this you? Welcome back. If not you, then, UpRegulated welcome to the forum.

[MedicinePower]

The pre-existing illness clause will have two interrelated negative affects on insurance coverage for your healthy 20 year old. The pre-existing illness clause will drive up premiums (substantially in many cases) but also allows people to purchase insurance at any time. The result will be that your 20 year old will just pay the fine and wait until he or she is ill to buy insurance. So, we will still have millions of uninsured people showing up at ER's without insurance, and the hospitals will continue to foot the bill.

 

Here in MA it is so complicated to pay the fine (it's part of our state taxes) that people who would want to pay the fine opt to buying the cheapest legal policy. It's resulted in 97% coverage which I think is pretty awesome.

[MedicinePower]

Not necessarily. Ask the Canadians or the British or those in Massachusetts that have to wait 45+ days to see a PCP.

 

I'm in MA. I have same-day access to my PCP. All of the group internal medicine practices in the area are advertising for new patients. The walk-in clinics are only about a 1 hour wait. There is no 45+ day wait in MA to see a PCP.

[gducky5]

I'm in MA. I have same-day access to my PCP. All of the group internal medicine practices in the area are advertising for new patients. The walk-in clinics are only about a 1 hour wait. There is no 45+ day wait in MA to see a PCP.

 

THIS. Thank you.

[rcdavis]

Funny, this sounds like the present system of 1500 plus health care delivery administrations making these same decisions not in the interest of the health of the patient, but in the interest the almighty dollar and profit. Why the folks who are decrying the IPAB have no problems with the present system doing the same thing, is beyond me. I will take one, centralized, consistent, evidence-based, patient centered, public health oriented system over the present system any day. Sounds like a dramatic improvement to me.

 

p.s., can we hold the Hitler / Stalin references when discussing this stuff? It is really offensive and frankly untrue.

 

I would not care about the IPAB were if its existence and decisions were reviewable... At least these evil insurance companies you bemoan are answerable to a court and legislative system.

 

If you truely look at the IPAB construct, I fail to see any difference between it and a totalitarian state.

 

No offense meant. Don't be so thin skinned.

 

If IPAB doesn't scare you, we will just have to agree to disagree.

 

I have never liked kool aid all that much.

[rcdavis]

Funny, this sounds like the present system of 1500 plus health care delivery administrations making these same decisions not in the interest of the health of the patient, but in the interest the almighty dollar and profit. Why the folks who are decrying the IPAB have no problems with the present system doing the same thing, is beyond me. I will take one, centralized, consistent, evidence-based, patient centered, public health oriented system over the present system any day. Sounds like a dramatic improvement to me.

 

p.s., can we hold the Hitler / Stalin references when discussing this stuff? It is really offensive and frankly untrue.

 

I would not care about the IPAB were if its existence and decisions were reviewable... At least these evil insurance companies you bemoan are answerable to a court and legislative system.

 

If you truely look at the IPAB construct, I fail to see any difference between it and a totalitarian state.

 

No offense meant. Don't be so thin skinned.

 

If IPAB doesn't scare you, we will just have to agree to disagree.

 

I have never liked kool aid all that much.

[68W2PA]

If IPAB doesn't scare you, we will just have to agree to disagree.

 

I'm not sure it is the boogey man you make it out to be. I also think you might be misrepresenting some of it.

 

Politifact took a look at the talking points you echoed and presented this piece:

http://www.politifact.com/florida/statements/2012/aug/23/paul-ryan/paul-ryan-said-15-unelected-unaccountable-bureaucr/

 

 

Here is more reading if you want it.

 

http://www.dpc.senate.gov/docs/fs-112-2-193.pdf

 

http://opinion.latimes.com/opinionla/2012/03/obamacare-ipab-the-ryan-plan-and-medicare-rationing.html

 

Here is the Kaiser Family Foundation's brief stating the healthcare reform law forbids the board from making recommendations that would "(1) ration healthcare; (2) raise revenues or increase Medicare beneficiary premiums or cost sharing; or (3) otherwise restrict benefits or modify eligibility criteria."the healthcare reform law forbids the board from making recommendations that would "(1) ration healthcare; (2) raise revenues or increase Medicare beneficiary premiums or cost sharing; or (3) otherwise restrict benefits or modify eligibility criteria."

[physasst]

What the ACA is going to do is further distance the quality of healthcare for poor and middle class people. The middle class and poor will now be grouped together, having to wait longer for diagnosis and treatment resulting in increased deaths from treatable or preventable diseases. The rich will always have whatever tests they need immediately available and all treatments available without worry of being denied by insurance or unable to afford it. It also wastes tremendous amounts of money by taking it from the providers and paying it to "oversee - ers". Lawyers and politicians are known as leeches of society for a reason.

 

Ummm...

 

http://www.ncbi.nlm.nih.gov/pubmed/16670412

[bradtPA]

Ummm...

 

http://www.ncbi.nlm.nih.gov/pubmed/16670412

 

 

Then what about this?

 

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321

[physasst]

Then what about this?

 

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321

 

We covered that. I think their findings were important as a pilot evaluation, but this was only a 2 year evaluation of ONE MSA (Portland). There were a number of positive findings, and in fact, in the most prevalent of the four conditions (Depression) they noted an improvement, this could suggest a power problem. Finally, there were some significant limitations in generalizability that the authors even acknowledged. By way of comparison, the JAMA article was representative, and powered well, but had some other limitations (self reporting) etc., but was likely more generalizable.

[rev ronin]

With all due respect... What happens when the healthy 20 y/o develops leukemia or is in a major MVA or is dx'd with bipolar and needs a $1000 script every month?

 

I could make the same argument about car insurance. There are plenty of people who have never been in a wreck that was their fault but still shell out $150/mo for car insurance. Would it be in their best interest to stop paying car insurance, since most of the coverage goes to the "bad drivers" anyways?

 

On average, the healthy young people will be better off. On average, the car insurance companies make more money on the safe drivers, even though they charge more to the bad drivers. Insurance is betting that something worse than average will happen to YOU. Holding on to your money is betting that you will have a LOWER loss profile than average. So much of the health insurance debate treats lack of insurance as a barrier to treatment. It is not and never has been--lack of money and/or willingness to allocate money to payment is the barrier.

 

I've been on no insurance, catastrophic-only insurance, traditional insurance, and high-deductible+HSA insurance. Of those, I liked the HDHP the best... except when my wife really didn't get the memo about us not being on HDHP anymore and paid $200 for a prescription after I'd started PA school, since she was so used to doing precisely that while on the HDHP.

 

Regardless, the healthcare debate is intellectually impoverished by treating 'insurance' as a proxy for money, when money should really be the object being discussed.

[ventana]

I agree. Law should never control medicine. Why should laws determine who can practice medicine, who can dispense 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!

 

 

in theory this is a great idea, in reality with corrupt (yes they exist) drug companies and vendors that will do anything to sell and Physicians and NP and PAs all thinking that the free lunch and marketing material doesn't affect their prescribing habits leave the patient holding a $400 bottle of medicines that could have been $4 for generic, and this is only if they are lucky enough to have insurance.

 

 

We don't have a system right now, but with the ACA we will have a broken system. At least that can be worked on and fixed.

 

 

There is no good reason to not have universal health insurance, we rank almost dead last of every first world country in health care markers except for $ spent per capita where we are 50% above #2, we are the only first world country with out a universal health insurance system. Notice I am not saying socialized medicine, but instead just getting the profit motive out of the insurance companies. Let the government handle the insurance - and for all you people that thinks government is not in the business of insurance, the last report I read was that government ALREADY is paying for greater then 60% of the care delivered in this country when you combine all the programs, medicare, medicaid, CHIP, VA, and all the smaller programs. The "The Keep Govt out of healthcare" is an argument that simply makes no sense right now.

 

 

Personally I don't see any of way to make sure every american has the RIGHT (yes right) for basic health care other then to have a national health care insurance.

 

No where however am I talking socialized medicine as we all know that would likely fail......

 

 

 

sad when a retired worker can't afford the $4 script for lasix - my patient yesterday

 

even worse when society lets it most at risk people fall through the cracks in the interest of insurance companies making money...

[Guest JMPA]

in theory this is a great idea, in reality with corrupt (yes they exist) drug companies and vendors that will do anything to sell and Physicians and NP and PAs all thinking that the free lunch and marketing material doesn't affect their prescribing habits leave the patient holding a $400 bottle of medicines that could have been $4 for generic, and this is only if they are lucky enough to have insurance.

 

 

We don't have a system right now, but with the ACA we will have a broken system. At least that can be worked on and fixed.

 

 

There is no good reason to not have universal health insurance, we rank almost dead last of every first world country in health care markers except for $ spent per capita where we are 50% above #2, we are the only first world country with out a universal health insurance system. Notice I am not saying socialized medicine, but instead just getting the profit motive out of the insurance companies. Let the government handle the insurance - and for all you people that thinks government is not in the business of insurance, the last report I read was that government ALREADY is paying for greater then 60% of the care delivered in this country when you combine all the programs, medicare, medicaid, CHIP, VA, and all the smaller programs. The "The Keep Govt out of healthcare" is an argument that simply makes no sense right now.

 

Personally I don't see any of way to make sure every american has the RIGHT (yes right) for basic health care other then to have a national health care insurance.

 

No where however am I talking socialized medicine as we all know that would likely fail......

 

 

 

sad when a retired worker can't afford the $4 script for lasix - my patient yesterday

 

even worse when society lets it most at risk people fall through the cracks in the interest of insurance companies making money...

you are talking in circles, national healthcare insurance ruled by IPAB is socialized medicine

[burnpac]

I would not care about the IPAB were if its existence and decisions were reviewable... At least these evil insurance companies you bemoan are answerable to a court and legislative system.

 

If you truely look at the IPAB construct, I fail to see any difference between it and a totalitarian state.

 

No offense meant. Don't be so thin skinned.

 

If IPAB doesn't scare you, we will just have to agree to disagree.

 

I have never liked kool aid all that much.

 

I have looked at the IPAB construct, and it is not what you and the right portray it to be. Calling it totalitarian doesn't make it so. I'm not thin skinned in the least, but sick and tired of the political right rolling out more swastikas than a Nuremberg rally every time they don't like something. At the very least it is dishonest, and at best inflammatory and insulting to the people who have actually been subjected to the regimes of the Hitlers and Stalins of this world. If you actually think that there is a comparison between the US government and Hitler Germany and Stalinist Russia, it might be helpful to study more history. I accept that you didn't mean to be offensive, but to many who have first hand experience with totalitarianism, the comparison that you made would be perceived as offensive. In three short years, an outgoing president and an incoming president will quietly and respectfully have coffee at the White House and we will change leaders without tanks in the streets, and with a celebration of freedom and democracy unrivaled in most nations. Just having this discussion here is an example of freedoms that many in the world don't enjoy.

 

I'm ok with disagreeing on this issue, but believe that as PAs and professionals we can use different language when we agree to disagree, and do it based on facts, and not fantasy. For someone who doesn't like Koolaid, you seem to be drinking a lot of a certain flavor. :-)

[68W2PA]

For those that think all socialized medicine is bad...

 

The best and most efficient insurance and health care I have received in this country was through the military which is 100% socialized medicine.

 

Heck... my medic training, my nursing school, and my PA training have all been either financed by the big bad socialized government or were directly administered via the big bad socialized government.

[Guest JMPA]

For those that think all socialized medicine is bad...

 

The best and most efficient insurance and health care I have received in this country was through the military which is 100% socialized medicine.

 

Heck... my medic training, my nursing school, and my PA training have all been either financed by the big bad socialized government or were directly administered via the big bad socialized government.

 

evidently you do not understand what socialized medicine is. every time the liberals are cornered they pretend they do no know what they are doing and point fingers and accuse others. I'm done here, there is nothing more to get out of this thread but unintelligent responses bordering hostility. Facts do not change no matter how one may try to twist them. ACA/obamacare is socialized medicine and it is detrimental to our healthcare system. In a few years there will be a lot of I told you so's

[physasst]

evidently you do not understand what socialized medicine is. every time the liberals are cornered they pretend they do no know what they are doing and point fingers and accuse others. I'm done here, there is nothing more to get out of this thread but unintelligent responses bordering hostility. Facts do not change no matter how one may try to twist them. ACA/obamacare is socialized medicine and it is detrimental to our healthcare system. In a few years there will be a lot of I told you so's

 

HAHAHA....ACA=socialized medicine. Wow. Thanks for the laugh, I needed that. I'd love to see a single payor system (ala France or Germany). The ACA is bad....only because it did not go far enough.

 

Calling the IPAB totalitarian is simply repeating the Faux News line. Anyway, I have patients to see, but thanks for the good laugh, I needed that.

[ventana]

you are talking in circles, national healthcare insurance ruled by IPAB is socialized medicine

 

 

that statement makes ZERO sense

 

The government will not own my practice, only the insurance company

 

I can run my practice the way I see fit

 

[h=2]Definition of SOCIALISM[/h]1

: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

2

a : a system of society or group living in which there is no private property

b : a system or condition of society in which the means of production are owned and controlled by the state

3

: a stage of society in Marxist theory transitional betweencapitalism and communism and distinguished by unequal distribution of goods and pay according to work done

See socialism defined for English-language learners »

See socialism defined for kids »

 

 

Before you throw around fear and rhetoric please make sure you understand the arguments.

 

 

I would tend to agree with the above poster that ACA didn't go far enough...... we are an embarrassment of the first world and many of the second world countries with our totally non-existent system. What should have happened (at least what i would have like to have seen happen)

 

Every year the eligibility age for Medicare decreases by 5 years, HUGE efforts to combat fraud (ie vendors that fake power wheel chair claims), Big reimbursement raise for primary care paid for by cuts to specialists and hospitals (seen what hospital exec make these days!!), massive push in legislature for advancing the PA and NP to become the primary care providers able to fully own and operate their own practices......

 

 

 

Now that is what I would have liked to have seen..... instead we got a broken system, that is still better then the non-existent system.

 

 

As for a "panel or board" overseeing things... needs to be reportable to congress, but I think this is a good thing. Drug companies, vendors, manufactures, and the whole business of health care is HUGE and puts HUGE pressures on the patients and providers. With out some way to push back the little guys get swept up..... why do people still insist in writing name brand HTN meds first line? Those free lunches and ad's really do work. We ALL should have a national formula (granted it would be huge) but it would help so much...... look at any other 1rst world country and study their systems then come back and talk about it..... and look at the embarrasing rankings the USA holds in the health of our people.....

[Guest JMPA]

that statement makes ZERO sense

 

The government will not own my practice, only the insurance company

 

I can run my practice the way I see fit

 

Definition of SOCIALISM

 

1

: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

2

a : a system of society or group living in which there is no private property

b : a system or condition of society in which the means of production are owned and controlled by the state

3

: a stage of society in Marxist theory transitional betweencapitalism and communism and distinguished by unequal distribution of goods and pay according to work done

See socialism defined for English-language learners »

See socialism defined for kids »

 

 

Before you throw around fear and rhetoric please make sure you understand the arguments.

 

 

I would tend to agree with the above poster that ACA didn't go far enough...... we are an embarrassment of the first world and many of the second world countries with our totally non-existent system. What should have happened (at least what i would have like to have seen happen)

 

Every year the eligibility age for Medicare decreases by 5 years, HUGE efforts to combat fraud (ie vendors that fake power wheel chair claims), Big reimbursement raise for primary care paid for by cuts to specialists and hospitals (seen what hospital exec make these days!!), massive push in legislature for advancing the PA and NP to become the primary care providers able to fully own and operate their own practices......

 

 

 

Now that is what I would have liked to have seen..... instead we got a broken system, that is still better then the non-existent system.

 

 

As for a "panel or board" overseeing things... needs to be reportable to congress, but I think this is a good thing. Drug companies, vendors, manufactures, and the whole business of health care is HUGE and puts HUGE pressures on the patients and providers. With out some way to push back the little guys get swept up..... why do people still insist in writing name brand HTN meds first line? Those free lunches and ad's really do work. We ALL should have a national formula (granted it would be huge) but it would help so much...... look at any other 1rst world country and study their systems then come back and talk about it..... and look at the embarrasing rankings the USA holds in the health of our people.....

 

typical liberal thinking if you yell loud enough and long enough that you will be right. if you want a socialized medical system then go to china, do not try to ruin MY nations healthcare with your cockeyed disassociated values.

PS you cannot run your practice as you see fit if you are not reimbursed for services that were not deemed approved by the socialist committee, if you did then your funds would dry up. I strongly suggest you consider some psychiatric medications because you are in need of mental adjustment

[True Anomaly]

typical liberal thinking if you yell loud enough and long enough that you will be right. if you want a socialized medical system then go to china, do not try to ruin MY nations healthcare with your cockeyed disassociated values.

PS you cannot run your practice as you see fit if you are not reimbursed for services that were not deemed approved by the socialist committee, if you did then your funds would dry up. I strongly suggest you consider some psychiatric medications because you are in need of mental adjustment

 

I thought you were done here? But I see you fell for your own precaution you pointed out in your most immediate post:

 

I'm done here, there is nothing more to get out of this thread but unintelligent responses bordering hostility.

 

Are you going to continue to throw around more unintelligent responses bordering on hostility?

[cbrsmurf]

I know it's an opinion thread, but does anyone's opinion really matter at this point? The ACA is going to be implemented whether you, the president or less than 2/3 of the Congress likes it or not.

[UpRegulated]

I'm in MA. I have same-day access to my PCP. All of the group internal medicine practices in the area are advertising for new patients. The walk-in clinics are only about a 1 hour wait. There is no 45+ day wait in MA to see a PCP.

One area's/person's experience/anectode vs. The Massachusetts Medical Society: http://www.masslive.com/business-news/index.ssf/2012/08/franklin_county_tops_physician_wait_time.html