Obamacare failing?

[Outdoorsygal]

One of the biggest complaints about Medicare is that they are not allowed to negotiate prices. Many feel that's a big part of why drugs costs are so out of control. Manufacturers can charge whatever they want and know that the government will just pay it. I certainly hope that changes at some point.

The Republicans blocked a bill introduced in 2007 and another was introduced in 2015
I understand part of Hillary's healthcare plan is to correct this.

[clatoden99]

Depends on your definition of "work" - if you are using that word in context of solving problems, then no. While staying as non-partisan as possible in answering this question, I genuinely think that the thing will collapse under its own weight. The bureaucratic hurdles are too high, the impact on the economy is too great, and the law will end up either getting repealed or drastically scaled back.

There is another school of thought out there which believes that Obamacare "working" will result in the death of the private insurance industry and a transition to a government single-payer system. It depends on one's perspective and word choice, I suppose.

[disneysteve]

There is another school of thought out there which believes that Obamacare "working" will result in the death of the private insurance industry and a transition to a government single-payer system. It depends on one's perspective and word choice, I suppose.

As I said above, if we move to a "single payer" system that looks like Medicare but for everyone, that will not kill the private industry at all. It will only add to their business. The only way a single payer system would eliminate the private industry is if it pays 100% of all costs from day one. As long as there are deductibles, co-pays, doughnut holes, co-insurance, etc. there will continue to be a market for the private companies to fill in the gaps.

[TexasHusker]

Isnt insurance kinda (or more like fundamentally) a socialist concept to begin with...?

No......

[Spiffster]

No......

How is it not? Its a form of shared risk and liability. Sure the insurance companies make a profit (perhaps the rational behind your terse response), but insurance itself is based on the premise of shared risk, very much a socialist concept. One exception being if your self insured, I suppose then you avoid the social aspect of insurance.

[creditcardfree]

As I said above, if we move to a "single payer" system that looks like Medicare but for everyone, that will not kill the private industry at all. It will only add to their business. The only way a single payer system would eliminate the private industry is if it pays 100% of all costs from day one. As long as there are deductibles, co-pays, doughnut holes, co-insurance, etc. there will continue to be a market for the private companies to fill in the gaps.

As a doctor what do you think the solution is? I'm just curious. And you may have put it out there before, but I'm not sure I came across it.

[DaveInPgh]

[TexasHusker]

How is it not? Its a form of shared risk and liability. Sure the insurance companies make a profit (perhaps the rational behind your terse response), but insurance itself is based on the premise of shared risk, very much a socialist concept. One exception being if your self insured, I suppose then you avoid the social aspect of insurance.

Socialism: a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

Insurance: a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.

I fail to see the connection.

[Spiffster]

Socialism: a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

Insurance: a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.

I fail to see the connection.

Thats because you are simply googling "Socialism" and "Insurance" then cutting and pasting the definition of the two... I think you know more about how insurance actually works than this, or at least I would hope so.

If not perhaps you should look up the two words in an encyclopedia, rather than an online dictionary, then you may see a few more connections.

[TexasHusker]

Thats because you are simply googling "Socialism" and "Insurance" then cutting and pasting the definition of the two... I think you know more about how insurance actually works than this, or at least I would hope so.

If not perhaps you should look up the two words in an encyclopedia, rather than an online dictionary.

I was a managed care executive for 23 years so I feel like I have a decent understanding.

[disneysteve]

As a doctor what do you think the solution is? I'm just curious. And you may have put it out there before, but I'm not sure I came across it.

How many pages would you like me to type?

Seriously, the idea that everything would be just dandy if we went to a single-payer system or if everyone had coverage is inanely simplistic. The healthcare system is outrageously more complex than that. There is no simple fix. No one change would solve the problems. There are problems at the government level. There are problems at the insurance company level. There are problems at the patient level. There are problems at the hospital level. There are problems at the pharmaceutical company level. And there are problems at the doctor level.

I think the thing that would most directly address as many of those issues as possible would be a single-payer system. Having one uniform set of rules that applied to everyone would make life so much easier for everybody involved - patients, doctors, facilities, pharmacies, etc. As it stands today, we literally have hundreds of different sets of rules and policies that we have to negotiate on a daily basis, and they are regularly changing which makes it even worse.

Everyone says the government would screw it all up, but look at Medicare, a government-run plan that covers 44 million people today. It's actually a remarkably efficient system all things considered. Of all of the insurance plans that we deal with, Medicare is probably the one we have the least trouble with. We don't have to jump through anywhere near the hoops that we need to with private insurers. It is far more doctor-friendly (and patient-friendly).

I could go on and on about specific issues and problems, and I'm happy to if people have specific questions, but overall, I'd say having a zillion different companies managing things is horrendously inefficient and endlessly frustrating to everyone involved.

[Singuy]

How many pages would you like me to type?

Seriously, the idea that everything would be just dandy if we went to a single-payer system or if everyone had coverage is inanely simplistic. The healthcare system is outrageously more complex than that. There is no simple fix. No one change would solve the problems. There are problems at the government level. There are problems at the insurance company level. There are problems at the patient level. There are problems at the hospital level. There are problems at the pharmaceutical company level. And there are problems at the doctor level.

I think the thing that would most directly address as many of those issues as possible would be a single-payer system. Having one uniform set of rules that applied to everyone would make life so much easier for everybody involved - patients, doctors, facilities, pharmacies, etc. As it stands today, we literally have hundreds of different sets of rules and policies that we have to negotiate on a daily basis, and they are regularly changing which makes it even worse.

Everyone says the government would screw it all up, but look at Medicare, a government-run plan that covers 44 million people today. It's actually a remarkably efficient system all things considered. Of all of the insurance plans that we deal with, Medicare is probably the one we have the least trouble with. We don't have to jump through anywhere near the hoops that we need to with private insurers. It is far more doctor-friendly (and patient-friendly).

I could go on and on about specific issues and problems, and I'm happy to if people have specific questions, but overall, I'd say having a zillion different companies managing things is horrendously inefficient and endlessly frustrating to everyone involved.

Medicare also has better reimbursements vs some of these blood sucking private insurances. The higher reimbursements come at a cost..which actually greatly benefits pt...such as zero reimbursements for subsequent hospital visits under 30 days...or having to meet a set of core measures...medication therapy management by pharmacists...mandatory electronic record keeping..etc etc. We essentially are forced to follow their rules to reap the benefits of the higher reimbursement and the business.

Steve is absolutely right, single payer is where it's at...but people who hates big government will literally have their heads explode at the thought of single payer systems..because in a way they do set a lot of rules for the providers to follow (usually to save cost in the long run, reduce errors, and increase safety standards).

[creditcardfree]

How many pages would you like me to type?

Seriously, the idea that everything would be just dandy if we went to a single-payer system or if everyone had coverage is inanely simplistic. The healthcare system is outrageously more complex than that. There is no simple fix. No one change would solve the problems. There are problems at the government level. There are problems at the insurance company level. There are problems at the patient level. There are problems at the hospital level. There are problems at the pharmaceutical company level. And there are problems at the doctor level.

I think the thing that would most directly address as many of those issues as possible would be a single-payer system. Having one uniform set of rules that applied to everyone would make life so much easier for everybody involved - patients, doctors, facilities, pharmacies, etc. As it stands today, we literally have hundreds of different sets of rules and policies that we have to negotiate on a daily basis, and they are regularly changing which makes it even worse.

Everyone says the government would screw it all up, but look at Medicare, a government-run plan that covers 44 million people today. It's actually a remarkably efficient system all things considered. Of all of the insurance plans that we deal with, Medicare is probably the one we have the least trouble with. We don't have to jump through anywhere near the hoops that we need to with private insurers. It is far more doctor-friendly (and patient-friendly).

I could go on and on about specific issues and problems, and I'm happy to if people have specific questions, but overall, I'd say having a zillion different companies managing things is horrendously inefficient and endlessly frustrating to everyone involved.

Thanks for sharing! I understand it is complex. And the 'same rules' for everyone is a good point. I look at the VA (also government run) and it's a mess. Those veterans don't have choice in their plan. They can't see whatever doctor they want. And their ability to get care isn't even always close to where they live, making the problem even worse.

I 'heard' many doctors don't take Medicare because they are not reimbursed for their true cost. Is there any truth in that statement? Our family has Tricare (government) and our options for providers is much more limited in some markets. Maybe it is Tricare that doesn't reimburse well.

[disneysteve]

I 'heard' many doctors don't take Medicare because they are not reimbursed for their true cost. Is there any truth in that statement?

Definitely.

Medicine is a very odd profession. It is one of the very few areas where the person providing services has virtually no control over what he charges for those services. There are times when reimbursement either doesn't cover actual cost or provides such a razor thin profit margin that it isn't worth the time to provide the service. And that's not just true of Medicare but many insurance companies.

Example: Is it worth our time and effort to administer flu shots in our office if we have to wait 60-90 days for reimbursement and then only make $2-3 profit on each shot? Or is it just easier to tell patients who want the vaccine to go to WalMart or CVS and get it there? Years ago, we used to give well over 500 flu shots each year. Now we probably give under 100 because of this.

[disneysteve]

having to meet a set of core measures

Perfect example, and this is a more recent development: quality metrics, it's called.

Here's the problem. Medicare has one set of metrics. Horizon Blue Cross Blue Shield has a slightly different set. Aetna has yet a another somewhat different set. If we had one set to focus on and track, that would be one thing, but when we have to track different things for different companies and the goals and targets are different for different companies, we end up spending hundreds of hours doing statistical analysis that has absolutely nothing to do with patient care.

Give us one set of rules to follow and let us get back to work.