Supreme Court upholds Affordable Care Act

MnTwins29

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Not happy with this

I was not happy to hear this - especially when the justices upheld the individual mandate as a tax and therefore not subject to the commerce clause. So, I guess now Congress will be free to tax certain types of behavior, not to mention this entire law is being paid for by Medicare "savings" through RAC, fines expected to be paid by providers not following regulations such as meaningful use, PQRS, and such. Not to mention that we already have a shortage of primary care physicians, and with the expected 30 million new patients seeking care that may not have done so before....ugh.
 

Pam Brooks

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Lance, I think we're going to have to agree to disagree! I'll state right up front that I'm a Boston-area liberal and save you the task of having to lambaste me later! LOL!! The good news is that I agree with you that our government cannot legislate healthy behavior, but I am a proponent of preventive care, and do see firsthand what happens when people go without healthcare. They wait until the last possible moment, and then it costs everyone much more than it would have if they'd asked for treatment earlier on. We all pay for it one way or another, when hospitals are forced to increase prices to pay for the uninsured. We also paid higher premiums to insurance companies who fully covered the preventable illnesses, while ignoring coverage for preventive care. Doesn't make sense. If you think about it, we already tax certain behaviors with the cigarette and ETOH taxes. I'm not saying we should penalize people with cancer, but if individuals can't take better care of themselves, where does it become my responsibility to ante up so that they can continue to neglect their health? That's probably a right-wing attitude, isn't it? :)
Sorry....that's a significant thorn in my side, and probably the biggest reason I support PPACA. Besides, what's wrong with not following meaningful use and PQRS? Who wants to be treated by a physician who can't follow quality measures? Not me. The act does address the shortage of primary care docs, with incentives for GME programs, which is currently sorely lacking and one of the biggest reasons docs choose the specialties (that and the reimbursement, which is also addressed in the Act.)


The Act is not without it's issues, and I am sure we'll all be impacted (both positively and negatively) but overall I think we're headed in the direction of reform, and I'd rather see some changes now, rather than later. I'm hoping that Brandi Tadlock will post her article "Obamacare 101" on this board. (I'll email her). She did a fabulous job of summarizing the 900+ page plan, in plain English....both the good and not-so-good. My complaint over the past few months is that so many people are ranting about this act without even fully understanding what it means, and taking their information solely from news reports....Fox, NBC, CBS. In my mind, PBS has done a much better job of presenting this issue in an unbiased manner, as has the BBC. It's not perfect, but it's not all bad, and frankly it's inevitable. As medical professionals, we can put a positive spin on this. The more people who are insured, the more they will seek healthcare and the more work we'll have! I'm not above stating my own personal agenda, here ;)

Mostly, I'm proud that the Supreme Court didn't play partisan politics.
 

dclark7

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I can see both sides of the issue. First of all many people forget that insurance companies are in business to make money (executive salaries aside, that's a whole different argument). And many people are confusing health insurance with health care. There are many people who do not have health insurance by choice (and pay their medical bills). I don't thnk that the mandate to carry insurance is going to change behavior. One of two things will happenor maybe both; people who don't like going to the doctor will still wait until things get really severe or everyone will be going to the doctor (if they can find one). If people wait we're still in the same boat, costly care for something that may or may not have been preventable. If more people seek medical care more money is spent on prevention and probably many unneccesary doctor visits. I remember when HMOs first started and most people had only a $3 copay. The office I was working in saw a huge increase in unneccesary visits because anthing that people perceive as "free" or low cost they want more of. Either way the result is the same higher, not lower costs.

Many people forget that insurance is risk coverage, the more that has to be paid out (the bigger risk you are) the higher your premiums. In healthcare as with other insurance if the company knows how much they will be required to pay (preventive care, medications) your premiums are going to be based on the known plus the unknown. There are no longer yearly or lifetime limits so the unkown just got bigger. Do I thnk people should have insurance? Yes. Do I think they should also carry some of the responsibility (copays/deductibles)? Yes. However, this is the USA, we want what we want, when we want it and we want someone else to pay for it. Americans need to understand that we all do pay for health care. Whether you pay the provider out of your pocket, if you pay insurance premiums or taxes to the government YOU ARE PAYING for healthcare. Most likely yours and your neighbor who can't or won't pay for him/her self. We also need to start having real discussions on how much care is too much. I'm not talking about "death panels" or "killing granny", I'm talking about when do we provide comfort measures and stop trying to do everything to keep people alive. I've seen way to many families asking medical professionals to do everything possible for patients that are clearly dying and all this does is prolong the inevitable. Just because we can do something doesn't mean we should.

I also don't think that the GME incentive is going to do too much to increase the number of doctors. I know some doctors who stopped seeing medicare patients when they realized their vets were getting paid more to treat their pets than they were to treat these patients. I also know a doctor who discouraged his chldren from going into the medical field because of increasing government regulations and I know three doctors who retired early because of everythnig that's going on (ICD-10, RAC, ZPIC, HiTech etc.)

All in all it's going to be quite interesting to see how all of this unfolds in the coming years.
 

MnTwins29

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No problem, Pam

It's all right to disagree - especially for this bill, because NO one is completely happy. Actually, you have the best compromise that can be currently done in nearby MA. The politics are what are so frustrating about this - the same GOP that howled about that program actually PROPOSED it in the 90's when Hillary Clinton started talking about health care reform.

I do believe that if there was one baseline means of covering everyone for items like annual visits, immunizations, screenings, etc. that would be best. Then an incremental increase if more diseases are treated, surgeries, etc. I know it sounds like I am trying to penalize people for being sick, but sorry, those who use the system more should contribute more.

Of course, our current model of employers picking up insurance costs is so inefficeint that it has to be revised - which this bill doesn't do.

Many points you make are valid. For the one I liked best, of course we want our docs to follow meaningful use and PQRS. So why in the world do you budget for revenue that depends on docs NOT following these programs?????

Heck, we could go on and on - just letting you know that I have no problem with disagreements and good, honest debates. I used to be very active in that arena - until every time I spoke out against this bill (or any other Obama program) I was called a racist. I got tired of trying to discuss issues with idiots, so I just stopped cold turkey. Now, a good discussion with you and others here, who actually understand a thing or two about this buisness, is something different!
 
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