D.C. Circuit guts ObamaCare

[Crackerbox]

I agree with you on the need for legal reform. Too many hoops are in place to successfully sue bad doctors.

Bad doctors? Do you think that overworked physicians seeing too many patients in an hour, not giving patients even 15 minutes of their time to do a workup and to prescribe medication might just might be a contributing factor?

Do you think these same overburdened physicians seeing millions more while falling 45,000 physicians behind in primary care and 46,000 behind among surgeons will then make more errors or less?

Wow, this is the freakin' Twilight Zone. Do you know that both physicians and RNs get sued? The RN is supposed to be looking at the chart and double checking physician mistakes and is a real pain in the butt for them and why they're leaving.

You do realize that many malpractice suits are settled out of court because of the very high number of spurious cases? That the juries often will side with the patient because they feel sorry for them? That the money largely goes to pay legal bills like extremely high attorney fees? That this then causes massive inflation as the cost is passed down to other patients by higher bills.

Oh yeah, it's just the poor sap physician who gave up their life to take on what they thought was a noble profession with a high level of respect from the populace. Oh what a sham!

 

[JollyRoger]

I do know that a patient (or the estate or relatives of a dead patient) has not prevailed against an insurer or a doctor in the Texas Supreme Court in over a decade - most decision not on the merits, but settling tort "reform" procedural disputes in favor of the doctors and patients. Doctors and insurers already enjoy many special laws that make them litigation proof. They don't need any more.

 

[Crackerbox]

Which is going to make medical care rise as millions of new Americans get health care and hence more malpractice claims on these physicians and RNs who are already overworked.

Nice. And then you'll pay more for healthcare due to spurious and accurate claims. But is it the physicians and RNs fault, or the idiot politicians who created this monstrosity? Yeah, tax the perceived rich by penalizing them when you created the problem legislatively. Makes perfect sense to me.

Obamacare solves nothing. He lied about the costs. You're going to pay at least $3500 more not save money. There's not enough staff to cover them. You'll have less time with your physician because he/she can't be in two or more places at once. You'll have to have more lawsuits by sheer logic alone. The only ones who will make more money are insurance companies.

Never forget that insurance is a scam when young. It's paying money in and hoping to get payouts later when older and less healthy. It's a gamble by paying up front and supposing you won't be dropped for some reason. The only way to make that work is if the birth rate is high enough to offset the costs of those who need the healthcare who are older or have preexisting conditions. Oh wait, the birth rate is dropping, so logically there won't be enough young healthy people to gamble away their money to support a nonsensical system.

112 million healthy young adults paying for 97 million who are older and have many health problems. Oh wait, we ruined the Middle Class in America by shipping jobs to the Pacific Rim, those waiters and bartenders will be paying for people who made more money for them, or they are reliant upon Medicaid themselves!

 

[JollyRoger]

Being the victim of medical malpractice to save a few dollars doesn't seem all that great. The system as is makes it too difficult to make bad doctors accountable for their malpractice.

 

[RobAnybody]

NUTS! Are you serious? Do you have any idea how expensive medical school is? The average physician gets a BS, gets four years of medical school, then a minimum of three years of residency. This alone sets them back $500,000.

*snipped more crazy rambling!*

OMG! NUTS! I had not considered these poor doctors! They should totally be allowed to charge $18 per Q-Tip. The government should not be allowed to negotiate costs with them! Nor should private insurance companies! These poor deprived vagrant MDs should absolutely be able to charge $18,000 to treat a sprained ankle! No one should ever question their prices - give them anything they want!

NUTS! Btw, Obamacare mandates that Mental Health issues be covered at the same copay as regular doctor's visits. I mention this for no reason whatsoever.

 

[kramerfan86]

Oh villainizing the doctors, that's a reasonable tract to take.

 

[Timsup2nothin]

Doctors have convinced approximately half the population that they need a prescription drug...and the continuing support of the prescription writing physician...to be healthy.

Who is it that has made all our poor downtrodden physicians so woefully overworked?

 

[kramerfan86]

When you have a population that is steadily getting more obese and diabetic are you exactly stunned the Rx rate has climbed? Do you think obesity and diabetes is a grand medical plot?

 

[jackelgull]

Diabetes is not so bad, you just have to learn to live with it. I have diabetes and I don't feel anything is missing from my life.


And one problem is that costs for medical schools is way too high in America. Taking a financial loan out is pretty much a guarantee that you'll never be debt free for the rest of your life.

 

[kramerfan86]

Diabetes is not so bad, you just have to learn to live with it. I have diabetes and I don't feel anything is missing from my life.


And one problem is that costs for medical schools is way too high in America. Taking a financial loan out is pretty much a guarantee that you'll never be debt free for the rest of your life.

Diabetes isnt too bad if you adapt appropriately which is why diet and exercise are the front line first recommendation, but when people fail to take that recommendation it can get pretty horrid, which is why the next line treatment is the drugs.

 

[RobAnybody]

Oh villainizing the doctors, that's a reasonable tract to take.

But, again, why are insurance costs high? Because doctors charge so much.

Insurance companies negotiate with doctors (& hospitals, where doctors work) to keep their costs down. Why? The less insurance companies have to pay doctors to treat patients, the less they can charge their customers. And thus, they can undercut their competition - i.e. other insurance companies.

Negotiating with doctors/hospitals to pay them less directly translates into lower premiums. Same thing with Medicare/Medicaid. The less government pays for Medicare/Medicaid members, the lower the costs.

It's mind-boggling how people don't get this. People want lower medical costs but then whine about the methods to get lower medical costs.

 

[FriendlyFire]

When you have a population that is steadily getting more obese and diabetic are you exactly stunned the Rx rate has climbed? Do you think obesity and diabetes is a grand medical plot?

Pain medicine, specifically opiates which lead directly to an explosion of hard drug use in America. Saddly the actual doctors themselves were lied to by the medical company and there guidelines saying that pain killers are NOT addictive in anyway. By the time Doctors realize this and stop selling prescription pain killers, In places like CA, the drug company's even lobbied to weaken regulations. This lead to a drug epidemic which is tearing apart America.

This is why we cant have nice things

 

[kramerfan86]

But, again, why are insurance costs high? Because doctors charge so much.

Insurance companies negotiate with doctors (& hospitals, where doctors work) to keep their costs down. Why? The less insurance companies have to pay doctors to treat patients, the less they can charge their customers. And thus, they can undercut their competition - i.e. other insurance companies.

Negotiating with doctors/hospitals to pay them less directly translates into lower premiums. Same thing with Medicare/Medicaid. The less government pays for Medicare/Medicaid members, the lower the costs.

It's mind-boggling how people don't get this. People want lower medical costs but then whine about the methods to get lower medical costs.

Except with the government its not a negotiation, sort of a key point.

 

[Timsup2nothin]

When you have a population that is steadily getting more obese and diabetic are you exactly stunned the Rx rate has climbed? Do you think obesity and diabetes is a grand medical plot?

No, but obesity and diabetes are a natural outcome of a culture of "good health can be purchased from a physician, so why worry?" and that culture has been produced and reenforced by doctors for decades.

 

[RobAnybody]

Except with the government its not a negotiation, sort of a key point.

No, you're completely wrong. The government simply has a lot of clout. They tell doctors & hospitals they will only pay X%*. Same as private companies do.

The whole point is this is how the negotiations go: "If you want our 48 million members to come to your hospital/practice, you WILL accept our prices.". Private insurers do the same thing, every day. They just don't have as many members to threaten with.

The more members you have, the lower you can "force" prices. It's a... um, free market thing.

EDIT: * this is a vast over-simplification - pretty much every procedure is negotiated, it's not a flat percent on everything; broken ankles, maternity - C-Section vs. vaginal; no charging $10 for an aspirin; does a cast cost $1000 or $100 - those are the things insurance companies, AND the government, try to negotiate lower while the hospital/doctor tries to negotiate higher

 

[Crackerbox]

Nope the pharmaceutical companies convinced the patients by advertising cures on tv, then managed care realized it's cheaper to have the doctor enter into a HMO contract and told them to prescribe more pills so they could see more patients. A pill is a cheap form of medicine versus changing a patient's lifestyle. The pharmaceutical company additionally sends pharm reps out to give the doctor the sell job on choosing to prescribe this drug over another, and the overworked physician takes their word as Gospel because they don't have the time to read all of the scientific studies on which drug would ACTUALLY would work better based upon the gender, the age, the multiple conditions of various types of patients, the issues with drug interactions, and the like.

The doctor is NOT out to get the patient, but extremely frustrated by the freakin' HMO system. And overcharging? You've got that all wrong. Most of that happens not in the doctor's office, but while under medical center care. And again, the overcharging most often is the result of trying to break even because nonprofits have to take on more indigent patients, plus a lot of patients give false information in Emergency Rooms and never end up getting billed or pay it.

So you're a physician with all of these unpaid bills. You work at a medical center or at your office, it makes no difference. Ask your doctor sometime how much they try to write off after trying in vain to collect on a bad debt.

You're blaming the wrong person entirely. Do you have any idea how long it takes to do a proper workup based upon medical school for something like a physical? A thorough workup say from Bates Physical Examination which is the standard textbook for this? 45 minutes per patient is probably the minimal amount of time. And the doc gets less than 15 minutes. Much of that is getting a patient history which is often a series of flat out subjective nonsense because American patients are embarrassed to tell the truth about their sexual habits, how much they really drink, how much they really overindulge when they eat, how much they smoke, etc.

It's a crap shoot to get an accurate assessment in less than 15 minutes. You're counting upon the RN to get a decent patient history and counting upon honest answers. Then say there are scads of things that can cause a particular presentation of an illness. It could be any number of bacteria for an infection. You don't have time to culture it. You guess which antibiotic based upon presentation and the prevailing bacteria that's going around based upon dated statistics from the CDC.

A week later the patient comes in and they're worse because you guessed it was this bacteria and so used this antibiotic when it was another bacteria and so you need to give them a new prescription. As some can kill off healthy bacteria, the patient now has other symptoms.

Don't you get it? Medicine is highly complex. The doc has the insurance company giving them a protocol for treatment to stay in complaince with the HMO. A private insurance company tells the doc that this patient doesn't have good enough insurance so they'll have to have less physicial therapy. The pharm rep is telling the doc to use this medication instead. The patient is insisting the doc prescribe this drug because it's advertised on tv and the commercial was compelling.

It's absolute lunacy before Obamacare, and you want this nutty halfbaked garbage to become the standard?

 

[JollyRoger]

I don't always amputate the wrong leg, but when I do, tort reform bails me out.

 

[sophie]

No, you're completely wrong. The government simply has a lot of clout. They tell doctors & hospitals they will only pay X%*. Same as private companies do.

The whole point is this is how the negotiations go: "If you want our 48 million members to come to your vaginalhospital/practice, you WILL accept our prices.". Private insurers do the same thing, every day. They just don't have as many members to threaten with.

The more members you have, the lower you can "force" prices. It's a... um, free market thing.

EDIT: * this is a vast over-simplification - pretty much every procedure is negotiated, it's not a flat percent on everything; broken ankles, maternity - C-Section vs. vaginal; no charging $10 for an aspirin; does a cast cost $1000 or $100 - those are the things insurance companies, AND the government, try to negotiate lower while the hospital/doctor tries to negotiate higher

Link to video.

 

[RobAnybody]

Nope the pharmaceutical companies convinced the patients by advertising cures on tv, then managed care realized it's cheaper to have the doctor enter into a HMO contract and told them to prescribe more pills so they could see more patients....

That whole post is a phenomenal goal post move.

But, while we're (now, somehow) on the subject of pharmaceutical companies, people often complain about how the government is not, due to regulations, allowed to negotiate better drug costs, & keep drug costs down.

You know how they'd do that, if people got their wish?

By leveraging their 48 million members. By telling the drug companies "hey, you want our 48 million members to be able to go to your pharmacy? Yes, you, CVS, I'm talking to you. By charging less." Exactly the same approach people whine about when dealing with doctors & hospitals.

Oh, why, oh, why does the government pay less for medical costs to doctors!?! They are such oppressive tyrants! But... oh, why, oh, why doesn't the government negotiate lower drug costs?!? Is there a prescription for my cognitive dissonance?

 

[hobbsyoyo]

EDIT: * this is a vast over-simplification - pretty much every procedure is negotiated, it's not a flat percent on everything; broken ankles, maternity - C-Section vs. vaginal; no charging $10 for an aspirin; does a cast cost $1000 or $100 - those are the things insurance companies, AND the government, try to negotiate lower while the hospital/doctor tries to negotiate higher

You realize that trying to explain the finer points of our health system to this crowd is just wasted effort?

You're a champ for trying but no amount of reason can expplain OBAMACARE to a certain segment of society.