Trumpcare?

[disneysteve]

This is more than concierge medicine. It is a membership model whereby fee-for-service is eliminated. That accomplishes two things:

1. The provider is not incentivized to do more/see more/order more.

2. The patient is unfettered to receive the primary care that they need.

It isn't an insurance plan, but more of a primary care plan.

I'm in primary care. We are not incentivized to do more or order more. We only get paid for services we directly provide, which is basic family practice stuff. If I order testing or labs or imaging, I don't get paid for that.

I'm not sure what #2 means. I can see that with a smaller patient panel, it becomes easier to get an appointment, but we already see anyone within 24-48 hours and typically same day if they're sick. It would permit me to spend more time with each patient, though.

So it's a "primary care plan". I'm not really sure where the value is in that. It would be nice to spend more time with patients, especially those with chronic illnesses like diabetes, but other than that, I don't know what else the patient would get that they don't get already.

And I still don't know how it meshes with the rest of the medical system. You still need a primary care physician under your insurance company. If I find anything wrong that requires further testing or evaluation, you would then need to see your primary to get referred out for that stuff since I couldn't do it myself. It seems like that would really complicate things. I'd love to talk with a doc who does this and find out how stuff like that is handled.

[disneysteve]

We offer something similar to all of our employees for $10.62 per pay period (us paying half). We have 31 employees, and only 3 are on the plan.

You mentioned this before but said it just allowed them to go to a walk-in clinic for a low copay. That's very different than an established relationship with a family doctor.

[TexasHusker]

I'm in primary care. We are not incentivized to do more or order more. We only get paid for services we directly provide, which is basic family practice stuff. If I order testing or labs or imaging, I don't get paid for that.

I'm not sure what #2 means. I can see that with a smaller patient panel, it becomes easier to get an appointment, but we already see anyone within 24-48 hours and typically same day if they're sick. It would permit me to spend more time with each patient, though.

So it's a "primary care plan". I'm not really sure where the value is in that. It would be nice to spend more time with patients, especially those with chronic illnesses like diabetes, but other than that, I don't know what else the patient would get that they don't get already.

And I still don't know how it meshes with the rest of the medical system. You still need a primary care physician under your insurance company. If I find anything wrong that requires further testing or evaluation, you would then need to see your primary to get referred out for that stuff since I couldn't do it myself. It seems like that would really complicate things. I'd love to talk with a doc who does this and find out how stuff like that is handled.

One problem with poor folk is that they get zero primary care. They can't even afford a $25 copay. And I'm talking people making $10 an hour plus that again in tips. Us middle and uppers tend to think the issue is big deductibles. Heck hourly people can't even afford a prescription. Most poor folk have no established doctor, so certainly a clinic provides them more than nothing.

Most providers are incentivized to bill more/see more/do more. Even primary care. My wife went to an internal medicinr practice to consult about her elevated liver enzymes. Four weeks later we get a bill for over $800. Multiple lab tests performed at their lab, many of which the necessity was highly questionable, a $200 charge for a sonogram that "might" be necessary in the future, etc.

I guarantee you that the partner physicians in this practice are ripping people off. I took care of the matter which is another thread, but I assure you that most providers are incentivized to do more/see more/order more.

Primary care memberships are no more comprehensive to your heaith than the Walmart car care center is to your vehicle. But it might well be a part of the picture for many consumers.

[hamchan]

How in the world do you come up with "dude" with the name Peggy?

And you need to slow your roll. My take is far from cold. No where did I suggest that anyone wanting to live should off their self. I also never used the word deserve or suggested someone pass a cost/benefit analysis to get to live.

I stated that people suffering should have the right to discuss the option with their physician.

The person you were responding to was talking about his dad whose cost of care is around 250k annually, and you said "this is why assisted suicide needs to be legal." He never said his dad was suffering. That was a bold and unwarranted assumption on your part.

And like Steve said, no one is forced to get care they don't want.

[hamchan]

You are dealing with a chronic illness and I have great empathy for you. Perhaps there should be established a chronically ill program by the gubmit that addresses these types of situations. In these chronic situations, insurance has essentially become welfare, which wrecks the entire model.

One way or another people without expensive chronic illnesses are going to have to subsidize the care of people who do. If there's a government program then they'll pay for it through higher taxes. If the government requires private insurance to cover them, then they'll pay for it with higher premiums.

[TexasHusker]

One way or another people without expensive chronic illnesses are going to have to subsidize the care of people who do. If there's a government program then they'll pay for it through higher taxes. If the government requires private insurance to cover them, then they'll pay for it with higher premiums.

Taxpayers will have to pay, for sure. But again, when you have a terminal and/or chronic condition, we've really moved into a welfare situation rather than insurance.

My idea is to have national government programs for these situations. Managed care specifically for the chronically ill. Perhaps with federally run facilities such as the VA. Centralized, focused care. Cost containment.

[TexasHusker]

The person you were responding to was talking about his dad whose cost of care is around 250k annually, and you said "this is why assisted suicide needs to be legal." He never said his dad was suffering. That was a bold and unwarranted assumption on your part.

And like Steve said, no one is forced to get care they don't want.

I would consider spending $250K a year to be suffering. Not sure I'd be ready for someone to knock me in the head, but suffering regardless.

[PeggyHefferon]

The person you were responding to was talking about his dad whose cost of care is around 250k annually, and you said "this is why assisted suicide needs to be legal." He never said his dad was suffering. That was a bold and unwarranted assumption on your part.

And like Steve said, no one is forced to get care they don't want.

Well dude, it was a back and forth exchange that you have taken a bit out of context, and I 100% stand by my statement which was NOT directed at his father or their specific situation.

Also, the comment that "no one is forced to get care they don't want" is completely false. There are thousands (millions perhaps) of people that are declared mentally incompetent to make decisions about their healthcare. There are also many illnesses that result in a slow cruel death, unlike the personal scenario you referenced where medical care results in "a rich, full life with very little suffering."

Also, Steve's response referenced patients that got comfort and died a short time later. Again, nothing like the slow cruel death that some illnesses result in.

I am not the one making unwarranted assumptions here

[LivingAlmostLarge]

I think it depends. But the real issue is poor people will go without care until they desperately need it and then to the ER. And who pays the bills? The same taxpayers who have insurance and pay premiums. Same goes with young people.

And young people might be more healthy but they are just as likely I think to have an accident maybe a car, biking, etc that can cause quite a large medical bill. My MIL fell and needed surgery for a pin in her wrist, now a cast, etc. Is that a $10k thing? I don't think so.

Could that easily have happened to a 25 year old? Yes. Actually it has since I was 30 when I pulled my MCL snowboarding and my friend was 28 when he fell hiking and broke his leg. I don't think that it's hard to imagine doing something that could easily cause a lot more than having just bought health insurance.

But I am going to be many young people and poor will skip health insurance over paying and instead get emergency care and then declare BK when they see the bills.

And this is why hospitals are not keen on having uninsured patients they have to treat. It's been cut down through the ACA which has allowed them to get paid.

[TexasHusker]

And this is why hospitals are not keen on having uninsured patients they have to treat. It's been cut down through the ACA which has allowed them to get paid.

This problem was largely solved before ACA: Many (most?) MSAs/major cities have an indigent care program. I know where I live, there is a tax that covers all indigent care.

Many of those were considered "uninsured" by Obama when in fact they were quasi-insured by the taxpayer.

There exists here several indigent care multi-specialty clinics as well as a hospital, for the care of indigent patients.

Interesting how our indigent care tax didn't go away with Obamacare.

[LivingAlmostLarge]

Um that's not true. Lots of hospitals have to write off the care for people who don't have insurance. And many who don't have insurance get patched up for a short period of time until the next and then they need more care. My best friend works in a hospital and both our moms have been in hospitals/welfare case worker for 30+ years. This is not a new or foreign phenomenon. And it has gone done because of expanded medicaid and requiring insurance the write offs hospitals have taken.

[hamchan]

I would consider spending $250K a year to be suffering. Not sure I'd be ready for someone to knock me in the head, but suffering regardless.

That's only the case if you can't get decent insurance. Most people in that situation prefer to just get whatever treatments they need and continue to live their life. I sincerely hope you never find yourself, or someone close to you, in that position.

[hamchan]

Well dude, it was a back and forth exchange that you have taken a bit out of context, and I 100% stand by my statement which was NOT directed at his father or their specific situation.

Also, the comment that "no one is forced to get care they don't want" is completely false. There are thousands (millions perhaps) of people that are declared mentally incompetent to make decisions about their healthcare. There are also many illnesses that result in a slow cruel death, unlike the personal scenario you referenced where medical care results in "a rich, full life with very little suffering."

Also, Steve's response referenced patients that got comfort and died a short time later. Again, nothing like the slow cruel death that some illnesses result in.

I am not the one making unwarranted assumptions here

Yeah, I read the entire exchange. While I can agree that assisted suicide should be a legally available option, I think you might be grossly overestimating how many people with expensive medical conditions would be interested in taking that route. And when someone who has firsthand experience with a 250k to 1 mil annual cost of care tells you that what you said was pretty offensive, you should maybe listen to them.

[TexasHusker]

That's only the case if you can't get decent insurance. Most people in that situation prefer to just get whatever treatments they need and continue to live their life. I sincerely hope you never find yourself, or someone close to you, in that position.

I'm actually living it now with my dad.

[TexasHusker]

Yeah, I read the entire exchange. While I can agree that assisted suicide should be a legally available option, I think you might be grossly overestimating how many people with expensive medical conditions would be interested in taking that route. And when someone who has firsthand experience with a 250k to 1 mil annual cost of care tells you that what you said was pretty offensive, you should maybe listen to them.

Meh. I think we are getting into overkill range here. I vote that the thread be closed.