Gordon, PA-C Posted June 2, 2015 Author Share Posted June 2, 2015 hope so. I'm in favor of universal health care. Universal health care is one thing -- mandated indentured servitude is something else. I've got no problem if the USA decides to institute a single payer system. Creating a system where doctors and PAs can voluntarily choose to join a universal healthcare network is totally fine. But I do have a problem if the people that create a single payer system make it law that doctors and PAs MUST work in the single payer system. That is outrageous and should never be allowed to happen. Link to comment Share on other sites More sharing options...
db_pavnp Posted June 2, 2015 Share Posted June 2, 2015 But I do have a problem if the people that create a single payer system make it law that doctors and PAs MUST work in the single payer system. Well, that isn't what is happening, so you have no problems? Link to comment Share on other sites More sharing options...
aquafresh11 Posted June 3, 2015 Share Posted June 3, 2015 I'd be interested in seeing how a clinic can be profitable or pay it's staff with a predominantly medicaid population. Medicaid pays about $15/visit on avg. Are you seeing >30 pts in an 8 hr shift? Medicaid has paid the same as Medicare for the last few years became of the affordable care act. I see 18 patients in an 8 hour day. The clinic I work in is very financially comfortable and expanding. It can work. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted June 3, 2015 Author Share Posted June 3, 2015 Medicaid has paid the same as Medicare for the last few years became of the affordable care act. I see 18 patients in an 8 hour day. The clinic I work in is very financially comfortable and expanding. It can work. I hope you are aware that the Medicaid pay bonus went away as of January this year. Unless you live in Montana, North Dakota, or Virginia you are about to see a MAJOR drop in reimbursments, up to 50% as Medicaid rates fall back to their pre-Obamacare levels. http://www.latimes.com/business/hiltzik/la-fi-mh-the-mortal-threat-to-medicaidand-how-to-fix-it-20150105-column.html It's no coincidence that Oregon is one of the states that is slashing Medicaid reimbursements at the same time that they are trying to force all doctors to participate in it. This is a classic bait and switch scam perpetrated by the federal government. Link to comment Share on other sites More sharing options...
turnedintoamartian Posted June 3, 2015 Share Posted June 3, 2015 It is a little hard to categorize this simply as bait and switch because this provision was specifically enacted for two years. Congress then failed to reauthorize it along party lines (surprising I know) and the burden shifted to the states. For the sake of being fair there are 16 states that will continue the increased payments, Oregon isn't one of them. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=137 Link to comment Share on other sites More sharing options...
CAAdmission Posted June 3, 2015 Share Posted June 3, 2015 I am not sure that more government intrusion into anything has ever promoted success. If I were in Oregon and the government were forcing me to do anything I would leave on principle. Our nation's founding fathers started shooting over far less intrusion than we endure today. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 I know folks who work in a clinic that is cash, medicad, or medicare only. they do very well. 3 guys. each works 2 12 hr shifts/week and makes well over 125k each for a 24 hr work week. 3 pa practice. doc never there, just signs charts. I worked in one of those for a while. I could spend 1 minute in the room with the frequent flier with the runny nose, 2 minutes documenting it, and move on. The Doc who owned the place made huge money by taking CMS money for seeing the "non-sick" in an "urgent care". Of course, we also did tympanograms on everyone for the extra $10, And just about everyone got the IM dexamethasone for the extra $25. If you coughed twice last week you got a CXR in the antiquated machine for the extra $65 charge. Of course, anyone who was actually sick was sent to the ED. oregon is not the first state to do this. this is a social justice issue. if you transition to a universal healthcare-like system, providers need to take that coverage. they need to make money of course, but the days of the spine surgeons making 5 million dollars/yr for working 3 days/week are coming to an end.....as well they should... Because those nations with so-called "universal healthcare systems" have great social justice, right? Why did the guy in charge of the healthcare system of Quebec come to Boston for his heart procedure? Because he, being the top animal in the farm, could afford the best care in the world, which was available here in the states. The problem with the spine surgeons making $5M/year 3days/week is because they found the niche in government regulations. It's just another example of regulations picking the economic winners and losers. Rev- I don't disagree with you. I think what will eventually happen is true universal health care like in the UK. we are the only developed nation not to have this. under that system we would all work for the govt at an established wage. I've looked at pay and benefit packages in the UK for PAs. a bit less money but MUCH better benefits like free child care when at work, tuition reimbursement for additional degrees, all practice related fees covered, etc. May end up there or in so. africa or canada in a few years. What if you don't want the free child care? Or the tuition reimbursement? That "bit less money" becomes important there. Of course, if there is only one employer (the guv'ment), then you don't have the ability to change to a different company to get better reimbursement. hope so. I'm in favor of universal health care. Universal health care sounds great in the media and in academia, because the leftists there won't tell you about the downside. The VA here is the best example of guv'ment run healthcare. It's generally terrible, with pockets of greatness. I had a suicidal vet in my ED recently with an acute on chronic PTSD reaction. I made at least 25 phone calls to three different VAs over four hours trying to get this guy help he needed. All I got for the first two and a half hours (from 0900-1130) were voice mails. I couldn't get hold of a real person other than the operator, who would just send me to another voice mail. Universal health care (ie: government run health care) will look just like your local VA, or DMV. Link to comment Share on other sites More sharing options...
andersenpa Posted June 4, 2015 Share Posted June 4, 2015 Why did the guy in charge of the healthcare system of Quebec come to Boston for his heart procedure? Because he, being the top animal in the farm, could afford the best care in the world, which was available here in the states. You can't cite individuals as a critique of a system that has to apply to a large group That's why it's called public health Link to comment Share on other sites More sharing options...
dmdpac Posted June 4, 2015 Share Posted June 4, 2015 Because he, being the top animal in the farm, could afford the best care in the world, which was available here in the states. So why did he come to the US? The US, which consistently has higher health care expenditures with worse outcomes than much of the developed world, does not have the best health care system out there. Link to comment Share on other sites More sharing options...
CAAdmission Posted June 4, 2015 Share Posted June 4, 2015 Net effect of socialized medicine: People with no healthcare will gain access to mediocre care. People with mediocre healthcare will not notice a change. People with decent healthcare will experience a downgrade to mediocre care due to cost containment. People with Cadillac healthcare are rich and will buy whatever access they want (like Canadian guy referenced above). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 Universal health care (ie: government run health care) will look just like your local VA, or DMV. yeah, just because it works in every other developed nation in the world, all of whom have better health outcomes than us for less money is no reason to try it here.... Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 So why did he come to the US? The US, which consistently has higher health care expenditures with worse outcomes than much of the developed world, does not have the best health care system out there. I didn't say we have the best health care system in the world. I said we have the best healthcare. Except, of course, for the areas where the federal government run the health care, like our VA. Then the healthcare is often terrible. The talking points about "higher health care expenditures with worse outcomes than much of the developed world" is as accurate as any other heavily biased statistic quoted by biased people. It is right along with sayings like "statistics lie, and liars use statistics", or Mark Twain's "There are lies, damn lies, and then there are statistics." People can mine data to make statistics say anything they want. The health care administration/public health fields typically draw people with liberal ideologies, and that bias shows in its research and statistics. You can't cite individuals as a critique of a system that has to apply to a large group That's why it's called public health But things that are "public" are also political, which usually leads back to the "some animals are more equal than others". Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 I didn't say we have the best health care system in the world. I said we have the best healthcare. no we don't. a country has the best health care when the entire population gets the care it needs. semantics I guess. the rich in this country have the best health care. the other 85+%, not so much.... Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 yeah, just because it works in every other developed nation in the world, all of whom have better health outcomes than us for less money is no reason to try it here.... There are LOTS of folks waiting in line right now in England who would disagree that "it works". I guess you have to define what it means for it to "work". Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 There are LOTS of folks waiting in line right now in England who would disagree that "it works". I guess you have to define what it means for it to "work". all of those folks are vaccinated, get care when they are pregnant, and can get free care in any er in the country and not receive a bill. those folks are waiting for elective procedures like hip replacements, not basic health care. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 no we don't. a country has the best health care when the entire population gets the care it needs. semantics I guess. the rich in this country have the best health care. the other 85+%, not so much.... Poor elderly latino in my ED with NSTEMI. This guy isn't just in the bottom 85 percentile, he is probably in the bottom 5th percentile economically. Doesn't speak English. This guy is the poster child for the "underserved" population. He was diagnosed with NSTEMI, treated, flown to tertiary care, sent to cath lab, 4 stents placed, post tx echo shows minimal wall motion abnormality, now he's back home working on the ranch (the ranch, of course, owned by one of those evil 1 percenters) and supporting the rest of his family who followed him from Mexico. So, tell me about how the "other 85+%" don't get the best health care? Link to comment Share on other sites More sharing options...
cinntsp Posted June 4, 2015 Share Posted June 4, 2015 Poor elderly latino in my ED with NSTEMI. This guy isn't just in the bottom 85 percentile, he is probably in the bottom 5th percentile economically. Doesn't speak English. This guy is the poster child for the "underserved" population. He was diagnosed with NSTEMI, treated, flown to tertiary care, sent to cath lab, 4 stents placed, post tx echo shows minimal wall motion abnormality, now he's back home working on the ranch (the ranch, of course, owned by one of those evil 1 percenters) and supporting the rest of his family who followed him from Mexico. So, tell me about how the "other 85+%" don't get the best health care? There is more to having the best healthcare than getting stents. There are a lot of years before and [hopefully] after that. It may have been completely avoided if he had regular access to care prior to that event. A yearly checkup with a few labs and a prescription or two will still be way cheaper over the years than the course of treatment you list. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 Poor elderly latino in my ED with NSTEMI. This guy isn't just in the bottom 85 percentile, he is probably in the bottom 5th percentile economically. Doesn't speak English. This guy is the poster child for the "underserved" population. He was diagnosed with NSTEMI, treated, flown to tertiary care, sent to cath lab, 4 stents placed, post tx echo shows minimal wall motion abnormality, now he's back home working on the ranch (the ranch, of course, owned by one of those evil 1 percenters) and supporting the rest of his family who followed him from Mexico. So, tell me about how the "other 85+%" don't get the best health care? 6 months from now he will lose his car and everything he owns when he can't pay the 150k bill and they send him to collections. that care in the UK would be free with paid time off for sick leave. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 all of those folks are vaccinated, get care when they are pregnant, and can get free care in any er in the country and not receive a bill. those folks are waiting for elective procedures like hip replacements, not basic health care. Every single child in America can be brought into the county public health office and, if indigent, receive free vaccines. Every one of them. No exceptions. And you know this. If you find a child in your ED who hasn't gotten vaccines, it's because the parents are fruitcakes, not because of lack of availability. Any indigent pregnant woman in the country can receive medicaid and receive prenatal care. You know this as well, because you have diagnosed that indigent woman with her pregnancy and told her how to get signed up for medicaid. In some areas she may have difficulty finding a primary care/OBGYN who will take medicaid, but she can walk into any ED for needed care. YOU may think a hip replacement is "elective", but for that 65 year old building contractor who is still supporting kids at home who needs to be able to climb ladders, it isn't so "elective". Nor is it so "elective" if it's your mother or father who is becoming more and more bedridden because they can't walk. So, who gets to decide what is "elective"? Bureaucrats in the government, right? Yeah, that always works well. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 6 months from now he will lose his car and everything he owns when he can't pay the 150k bill and they send him to collections. that care in the UK would be free with paid time off for sick leave. No he won't, because is an illegal, gets paid under the table, pays cash for everything, and nothing is in his name. He will never pay the bill, it will be written off as charity care. But now we are talking about the "system", and not about actual health care. In the UK, he may still be in the waiting room. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 you have to look at populations, not individuals. sorry if grandma can't get her hip done this week. look at outcomes. compare sweden to us. or even cuba.... Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 4, 2015 Share Posted June 4, 2015 You have to be able to zoom between populations AND individuals. What is the impact on policies on the entire populations, selected populations, and the on individuals. All of those are important. Same thing with medicine. A good doc will be able to zoom in to the molecular level, but yet still zoom out to the cellular, tissue, organ, system, and body level, and even further out to the personal, spiritual, and even family and social level while evaluating disease and treatment for their patient.By the way, would you take your grandma to Sweden for her heart cath? Would you take her to Cuba? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 By the way, would you take your grandma to Sweden for her heart cath? Would you take her to Cuba? yes. here she would probably get a hospital acquired mrsa infection from the foley they placed and left in for 3 days that she didn't need. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2015 Moderator Share Posted June 4, 2015 I imagine you have seen this. The WHO thinks we rank 37th in the world. look at who is above us: http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000 Link to comment Share on other sites More sharing options...
Maverick87 Posted June 4, 2015 Share Posted June 4, 2015 I imagine you have seen this. The WHO thinks we rank 37th in the world. look at who is above us: http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000 you have to look at populations, not individuals. sorry if grandma can't get her hip done this week. look at outcomes. compare sweden to us. or even cuba.... Based on the reference that you cited, US is #37 in quality and #1 in amount spent. Sweden is #23 in quality and #7 in amount spent. It's a significant difference, but it's not like Sweden is #1 quality with the least spent. At least, it's not enough to revamp an entire system over and attempt to replicate that system. Also, Cuba ranks lower than the US in quality. Of course, they don't spend a lot of money, but they are also third world. Link to comment Share on other sites More sharing options...
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