Companies downsizing hours to avoid Obama Care

[Plow]

to bother with perm or not... I really don't feel like explaining every intricacy of the bill, can you people really not google "what's in obamacare" or something?


here, start with this: http://www.reddit.com/r/explainlikei...did_it/c530lfx


You know how republicans always go "tax rich less, they have more money, everybody has more money," with no actual methods or systems for it to "trickle down" and increase collective wealth?


Obamacare is kind of like that. It says "make americans healthier, share the load more, restrict the wtfworthy charges, and health care prices will go down."


The big difference, of course, being that Obamacare is actually in extremely in-depth system organizing thousands of cost saving measures. Not a hail mary.

[Plow]

hit this one too http://www.reddit.com/r/explainlikei...did_it/c537rqi

[kuronosan]

I think they just hate Kansas.

[Blubbartron]

I don't know about Perm, but I'm fully aware of the details of the Affordable Care Act. I work as a software developer for an EHR company FFS, lol. I pretty much have a job thanks to it. Well, that and Core Measures. But Core Measures makes me want to end humanity.

That said, I think I, at least, may have been misunderstood. Don't think that my criticisms of obamacare indicate that I think it was a step in the wrong direction - it wasn't. My issue is that it was a baby step in the right direction when it could have been a gigantic leap. But in either case (with or without the public option), obamacare is *INSURANCE* reform. If we truly want to make healthcare affordable we need to fix the other side of the pricing equation as well, which is retarded doctors doing the same $6000 procedure on one patient because the patient walked across the street to a sister hospital. The ridiculous costs of malpractice insurance don't help either.

[kuronosan]

The largest problem with Obamacare is really about what you said. It does nothing to fix how much the doctors charge. How much the doctors charge is really just a function of the reimbursements from insurance companies and vice versa.

It's pretty sad that you can get a broken arm re-set for like $200 in some lower city hospital or clinic but then get charged $5000 for the same thing in a different state. Then of course there's the worry that if you lower the cost of procedures then less people will want to be doctors because they won't get as much money.

Funny. I thought the point of being a doctor was to help people.

[MF Perm tha Fineass]

to bother with perm or not... I really don't feel like explaining every intricacy of the bill, can you people really not google "what's in obamacare" or something?


here, start with this: http://www.reddit.com/r/explainlikei...did_it/c530lfx


You know how republicans always go "tax rich less, they have more money, everybody has more money," with no actual methods or systems for it to "trickle down" and increase collective wealth?


Obamacare is kind of like that. It says "make americans healthier, share the load more, restrict the wtfworthy charges, and health care prices will go down."


The big difference, of course, being that Obamacare is actually in extremely in-depth system organizing thousands of cost saving measures. Not a hail mary.

You're making the case for an argument I never made. I'm a fan of Obamacare for all of those reasons. The cost saving measure save costs for the government and the buyer, on some levels, but it still does not help lower the actual cost of healthcare. It's been pointed out by a few others already so I don't need to go into more detail.

It's a step in the right direction, but our entire system is fucked up. Hopefully this is the first step in a long game to bring about single payer or government provided healthcare. The bottom line is for profit hospitals are crushing the system and forcing the insurance companies to pay out more and cover more people is going to bring about change in one way or another when they start losing money for their shareholders.

[Daemien]

The largest problem with Obamacare is really about what you said. It does nothing to fix how much the doctors charge. How much the doctors charge is really just a function of the reimbursements from insurance companies and vice versa.

It's pretty sad that you can get a broken arm re-set for like $200 in some lower city hospital or clinic but then get charged $5000 for the same thing in a different state. Then of course there's the worry that if you lower the cost of procedures then less people will want to be doctors because they won't get as much money.

Funny. I thought the point of being a doctor was to help people.

Don't you work as a lab tech or something? How can you be so ignorant of the billing/employment aspects of healthcare while being involved in it yourself?

[notorious bum]

Obamacare fails on so many fronts, bump whatever understanding you may think you have on it's intricacies. It's naive to believe it's going to do anything but provide an ineffective band-aid for such a niche group of Americans for likely a short period of time if no other attempts are made at more reform(goodluck waiting for a public option to materialize in washington). Again, this shitty legislation was co-opted by big pharma and the insurance industry. The only good to come out of it were things that should have been passed as their own amendments decades ago.

To expand on the reform fail, looking outside the box for a second, here's a good Frontline piece that covers a glaring problem in the healthcare debate that is often neglected or ignored

http://www.pbs.org/wgbh/pages/frontline/doctor-hotspot/

Can House Calls Save Health Care?

Some communities across the country are betting on it.

One is Camden, N.J., as featured in our recent film Doctor Hotspot. Correspondent Atul Gawande introduces us to Dr. Jeffrey Brenner who uses data to target and care for the city’s sickest and most expensive patients. The above clip tells the story of Derek, a patient who suffers from asthma and a seizure disorder. In the six months since a home care nurse started visiting him, his hospital visits have been reduced from 35 to just two.

Other cities and towns across the country are sending paramedics to perform routine health care check-ups instead of arriving on the scene only when 911 is dialed.

First reported by the Associated Press’ Steven K. Paulson and today by Kirk Johnson in The New York Times, these experiments are in response to squeezed budgets and forthcoming changes to Medicare under President Obama’s new health care plan. (Medicare won’t pay if someone is readmitted to a hospital within 30 days with a repeat of the same illness.)....

[kuronosan]

Don't you work as a lab tech or something? How can you be so ignorant of the billing/employment aspects of healthcare while being involved in it yourself?

How exactly am I ignorant of it? I know exactly what patients get charged versus approximate costs to the facility.

Hang on. Let me just quit and live on the streets because the system needs fixing.

[Plow]

Yeah, figured, no point trying to explain to people that are literally going to choose to ignore the facts even when presented with them.


I always forget that the reason people don't know shit about these things is that they don't want to.

[Drex]

The largest problem with Obamacare is really about what you said. It does nothing to fix how much the doctors charge. How much the doctors charge is really just a function of the reimbursements from insurance companies and vice versa.

It's pretty sad that you can get a broken arm re-set for like $200 in some lower city hospital or clinic but then get charged $5000 for the same thing in a different state.

What you should really be asking is why insurance companies, who are presumably trying to maximize their own profits, feel obligated to reimburse $5000 to a hospital for a $200 or less procedure. As you said, if they reimbursed less, doctors would charge less. So who is holding a gun (slide 14, especially green box above chart title) to the insurance company's head and forcing them to make such large reimbursements just to stay in business?

Related: if for-profit schools are so awful, how can they charge so much? You all like Huff Po, right?

I mean, I'm not on crazy pills, right? If doctors charge whatever they are reimbursed, then obviously the reimbursements are too big, right? And if the gov has more market-share than all private insurers combined, then it's pretty clear who determines how much is reimbursed for a given procedure, right?

[Blubbartron]

What you should really be asking is why insurance companies, who are presumably trying to maximize their own profits, feel obligated to reimburse $5000 to a hospital for a $200 or less procedure. As you said, if they reimbursed less, doctors would charge less. So who is holding a gun (slide 14, especially green box above chart title) to the insurance company's head and forcing them to make such large reimbursements just to stay in business?

Related: if for-profit schools are so awful, how can they charge so much? You all like Huff Po, right?

I mean, I'm not on crazy pills, right? If doctors charge whatever they are reimbursed, then obviously the reimbursements are too big, right? And if the gov has more market-share than all private insurers combined, then it's pretty clear who determines how much is reimbursed for a given procedure, right?

Those stats are pretty misleading because they're not normalized for population or type of care. Caring for the elderly and disabled (medicare/medicaid) is inherently more expensive than your middle-aged working person. That said, the person holding the gun to the head of insurance companies is doctors, and insurance companies have a gun to the head of doctors as well (it's a shitty mexican standoff). If insurance companies start to dramatically lower the reimbursement amount, primary care physicians will start blacklisting those insurance companies. Doctors are their own business and can refuse service to anyone. It's increasingly common for doctors to refuse taking patients who are on medicare. The problem here is that if you don't get treated by a PCP, your simple problem can rapidly become a major fucking problem requiring emergency hospitalization. Under EMTALA, hospitals *must* treat (stabilize) these patients, and the shortfall between insurance reimbursement and actual cost of treatment cannot be passed to the patient if they are unable to pay (the IRS changed tax law so that the shortfall can be written off).

As most people are aware, emergency treatment is a FUCKTON more expensive than proactive/early treatment. It's counter-intuitive, but insurance companies would lose money if they reimbursed less and their customers had to go to emergency departments more frequently because they couldn't find a decent PCP to manage their health. Not to mention if your insurance is only accepted at limited places, customers would be more likely to switch, thus losing them even more money.

[MF Perm tha Fineass]

What you should really be asking is why insurance companies, who are presumably trying to maximize their own profits, feel obligated to reimburse $5000 to a hospital for a $200 or less procedure. As you said, if they reimbursed less, doctors would charge less. So who is holding a gun (slide 14, especially green box above chart title) to the insurance company's head and forcing them to make such large reimbursements just to stay in business?

Related: if for-profit schools are so awful, how can they charge so much? You all like Huff Po, right?

I mean, I'm not on crazy pills, right? If doctors charge whatever they are reimbursed, then obviously the reimbursements are too big, right? And if the gov has more market-share than all private insurers combined, then it's pretty clear who determines how much is reimbursed for a given procedure, right?

You try going to a restaurant and paying the portion of the bill you think you should pay. Let me know if the restaurant comes down on its prices.

[Drex]

You try going to your vendors and paying the wholesale prices you think you should pay. Let me know if the vendors come down on their prices.

Hope you don't mind that I adjusted your analogy with a more relevant, real-world example. If it works for Walmart...

I mean, I guess the restaurant thing can work if:

1) I spend more money at the restaurant than every other customer combined,
2) I pay like far more than the cost of preparing the meal,
3) the restaurant has no other potential customers except the ones already shopping there, and
4) the other customers have to pay whatever I pay.

It's increasingly common for doctors to refuse taking patients who are on medicare

How can you link to an article that explicitly states the problem is Medicare and then conclude that the problem is doctors? I don't even know if I can take it seriously since it proudly advertises its conservative think tank source, but nothing in that article backs up anything you're saying in your post, so I can't figure out why it's here or why it's relevant.

I mean, if doctors are willing to give up their biggest and most important customer just to get the hell away from Medicare, I think it's pretty clear that the doctors are not being greedy.

More importantly...

Those stats are pretty misleading because they're not normalized for population or type of care. Caring for the elderly and disabled (medicare/medicaid) is inherently more expensive than your middle-aged working person.

Sure, but it seems to be inherently more expensive to the elderly in the US relative to the elderly in other developed nations as well, and that's a problem only because the resulting effectiveness is still not especially great anyway.

http://old.post-gazette.com/pg/image...lderly_412.gif

http://blogs-images.forbes.com/danmu...costsbyAge.png

[MF Perm tha Fineass]

Hope you don't mind that I adjusted your analogy with a more relevant, real-world example. If it works for Walmart...

I mean, I guess the restaurant thing can work if:

1) I spend more money at the restaurant than every other customer combined,
2) I pay like far more than the cost of preparing the meal,
3) the restaurant has no other potential customers except the ones already shopping there, and
4) the other customers have to pay whatever I pay.

No, you can't change the analogy to fit your argument. Your change makes zero sense. You can't buy health care wholesale. The providers set the price for a service. You can buy the same steak at two different restaurants. One restaurant is family style, has tacky decorations, and people bring their kids while the other has quiet ambiance, expensive paintings and furniture and the menu is prepared by a world renowned chef. The second restaurant is going to charge you $30 more for that steak and you're going to pay for it, you're not going to haggle the price down because the other restaurant charges less or you can buy that same steak and atmosphere in France for $25 cheaper.

Your analogy is dumb and your understanding of the healthcare industry is mind-boggling. In healthcare in this country the buyer ( or in the case of insurance, the payer ) has almost ZERO bargaining power. If the hospital bills the insurance company $5000, the insurance company is legally obligated to pay that bill or otherwise pass of some of the cost onto the patient. It's a bill for a service and it must be paid. An insurance company can't refuse to pay the bill or haggle it down, if they do the hospital will just bill the patient.

[archibaldcrane]

Insurance negotiates rates for services in-network in advance, don't they?

[archibaldcrane]

And then some docs say "fuck these low rates, i don't wanna be in your network" - which is also what some docs say to medicare.

But of course, the fewer insurance plans they accept, the fewer patients they will have.

[Blubbartron]

How can you link to an article that explicitly states the problem is Medicare and then conclude that the problem is doctors? I don't even know if I can take it seriously since it proudly advertises its conservative think tank source, but nothing in that article backs up anything you're saying in your post, so I can't figure out why it's here or why it's relevant.

I mean, if doctors are willing to give up their biggest and most important customer just to get the hell away from Medicare, I think it's pretty clear that the doctors are not being greedy.

The article is a source to the fact that doctors are turning away people with Medicare (a lot of people are unaware that doctors can do this, due to confusion over EMTALA and general ignorance). Their conclusion is moronic, which I thought went without saying. I draw my own conclusions from simple facts like that, because I don't need people to think for me.

Your conclusion of "doctors giving up their biggest and most important customer" ignores that fact that each individual doctor is running his own business, in almost all cases (some doctors are on salary from hospitals, and they're awesome - we need more like them). You also seem to be forgetting that there is a scarcity of available time for doctors (that's why you very rarely can make an appointment today/this week with your PCP). If a doctor turns away Medicare patients because Medicare doesn't pay them as much as they think they should be paid, they aren't losing money - they're making more by getting normally insured patients to fill up those "lesser" time slots. In other words, why the fuck would someone choose to lower their per hour income for certain hours of the day if they don't have to? That's exactly what they're doing by accepting Medicare patients, unless the area they live in has like 70% of the population on Medicare, in which case getting paid something is better than getting paid nothing because you aren't working (no patients).

[kuronosan]

The power of billing lies solely with the provider. It's not uncommon for them to nickel and dime patients to get more money out of insurance companies.

Physicians negotiate higher reimbursements to get more and insurance companies negotiate lower so that they lose less.

It's just that right now doctors are turning away insurance providers who must now provide more for less. So either the doctor charges less or the insurance company charges more. If company does this the other will find a way to profit (doctors charge more since reimbursement is guaranteed or insurance charges patient more since payment is guaranteed).

The only way to solve this issue is a public option.

[BaneTheBrawler]

http://blogs-images.forbes.com/danmu...costsbyAge.png

More proof that Baby Boomers are terrible. Except my parents.