Democrats' Health Care bill has been passed - SCOTUS ruling update

[Jump_Ace]

I read the article such that because of his political beliefs he would rather not help democrats. Of course its freedom of speech and he is entitled to it. But apparently politics are more important than health to some people. The world is changing and now its time to adapt whether you like it or not its now the law *BZZZT* thanks for playing

Jerome

 

[Danoff]

I read the article such that because of his political beliefs he would rather not help democrats. Of course its freedom of speech and he is entitled to it. But apparently politics are more important than health to some people. The world is changing and now its time to adapt whether you like it or not its now the law *BZZZT* thanks for playing

Ah... good old rule number 7 on the unofficial guide to posting in the opinions forum.

(Check it out here: https://www.gtplanet.net/forum/showthread.php?t=50628 you followed it to the letter)

 

[Biggles]

So I assume you support 100% slavery for doctors, then, not just part-time slavery like the rest of us get? Because a doctor is in the medical profession, that gives every potential patient a right to have his time, knowledge, and skill for free?

Hmm ...

I thought part of the point of "Obamacare" was to oblige people to have insurance so that the medical profession could always depend on getting paid?

 

[Danoff]

Hmm ...

I thought part of the point of "Obamacare" was to oblige people to have insurance so that the medical profession could always depend on getting paid?

He was responding to this.

Good, they should have quit. If they were in it for the money, then they shouldn't have been doctors in the first place.

 

[cpp214]

Let's see:

Being in the medical profession has what to do with the government deciding who you must treat and how much you'll get paid for it? Survey says... EVERYTHING.

Since when does the government decide the rates at which private insurers can/will reimburse doctors? Yes, the government decides how much Medicare/Medicaid will reimburse a doctor for a particular service, but if they are deciding private insurance company reimbursement rates, then I've really missed something here.

So I assume you support 100% slavery for doctors, then, not just part-time slavery like the rest of us get? Because a doctor is in the medical profession, that gives every potential patient a right to have his time, knowledge, and skill for free?

Ummm...no.

Since when does "In it for the money" = "They're not willing to work for free" or "I think all doctors should work without being paid?" I never said anything of the sort, and I never said they should have to treat people for free.

The point is that I have little sympathy for doctors who think they "deserve" to make a certain salary--and that's really what we're talking about in this case isn't it? Danoff used the anecdote of doctors he knows who are quitting the profession--I assume--because they aren't making "enough" money. It's not that they are not getting paid at all for their services. It's that they are getting paid less for they're services than they thought they would or should.

The fact of the matter is they get paid what the government and insurance companies consider fair market value. If they can't "get by" on that, then they should choose another profession, and re-evaluate their spending habits and lifestyle. They have advanced degrees for crying out loud, you'd think they could at least come up with a decent business plan for themselves or hire someone who can.

There are undoubtedly many people in this country and around the world who will continue to aspire to be physicians in America for the "right" reasons, and won't mind providing their services for a little less compensation.

 

[Danoff]

The fact of the matter is they get paid what the government and insurance companies consider fair market value. If they can't "get by" on that, then they should choose another profession, and re-evaluate their spending habits and lifestyle.

HA!

The doctor I know that quit over what the government considers "fair market value", simply went into retirement. He decided that continuing to practice was simply not worth the risk for the compensation. "Compensation" includes feeling good about what he was doing, not just money.

When you're a doctor, every customer is a liability. Your next patient could be one that will decide to sue you for millions (this is regardless of whether you do something wrong). To hedge your bets as a doctor, you pay something on the order of $50,000/year in medical malpractice insurance, and if all of your customers paid with medicare, your business would go under.

So the question becomes how much you're willing to risk getting sued over. If medicare reduces their rates, you take bigger losses on those patients (who you have to see). At some point it isn't worthwhile to stay in business - even if you have paying customers. Maybe even if you're making 6 figures.

My doctor friend loved being a doctor. It was who he was, and he was damned good at it. It was one of the hardest things he did to decide to retire young. But he made the choice because the government squeezed him out of business.

Don't sit there and act like we've lost nothing when we force good people out of business and let cut-rate folks take their place.

 

[Biggles]

That's a really sad story Danoff. He should have come up to Canada to work. My father-in-law was a doctor: owned a nice house in the ritziest area of Toronto, sent his kids to private schools, spent 4 weeks in the Bahamas & 4 weeks in Nantucket on vacation every year, belonged to the best clubs, drove an E-type jag ...

Damn, that whole "socialist" thing seemed to work out really well for him.

 

[Keef]

That's a really sad story Danoff. He should have come up to Canada to work. My father-in-law was a doctor: owned a nice house in the ritziest area of Toronto, sent his kids to private schools, spent 4 weeks in the Bahamas & 4 weeks in Nantucket on vacation every year, belonged to the best clubs, drove an E-type jag ...

Damn, that whole "socialist" thing seemed to work out really well for him.

You've both just cited one example. There are many examples of both cases and everything in between because there are surely tens of thousands of doctors in this country and Canada. The fact of the matter is that even in a free market scenario some doctors will thrive and some will go bust, just like any other business. The current problem is that the ones who thrive don't do it naturally and the ones who fail don't either. In both situations the government has a hand, basically deciding who gets what. That's just plain wrong.

 

[Biggles]

You've both just cited one example.

Exactement, mon ami.

 

[cpp214]

If doctors don't like Medicare/Medicaid reimbursement rates, they have no one to blame but themselves.

You know how those rates are determined? An American Medical Association committee makes recommendations to CMS (Centers for Medicare/Medicaid Services). CMS usually accepts just about all of the recommendations.

And guess what? 23 of the 29 AMA committee members are specialists--hence why specialists get reimbursed at higher rates for procedures that are often much easier and less time-consuming than procedures performed by general practitioners.

Here's a link to a description of the RVS update committee and the role they have in determining reimbursement rates:

The AMA established a process in the course of its activities to develop relative values for new or revised CPT codes. This process was established in the course of the AMA's normal activities and as a basis for exercising its First Amendment right to petition the Federal Government as part of its research and data collection activities, for monitoring economic trends and in connection and related to the CPT development process. In addition, CMS is mandated to make appropriate adjustments to the new RBRVS in response to the Omnibus Budget Reconciliation Act of 1989 to account for changes in medical practice coding and new data and procedures. The purpose of the RUC process is to provide recommendations to CMS for use in annual updates to the new Medicare RVS.

Here's a description of what RBRVS (Resource Based Relative Value Scale) stands for and how it works.

If doctor's aren't happy with reimbursement rates, they need to take a more active role in influencing the rate determinations of this committee

 

[Danoff]

If doctor's aren't happy with reimbursement rates, they need to take a more active role in influencing the rate determinations of this committee

Isn't that just always how government works...

I think you've just provided a perfect explanation for why government sucks. And exactly how American does that sound to you? If you don't like how much you get paid, go kiss some committee member's ass!? Sounds like everything America is supposed to stand against.

 

[McLaren]

They have this silly notion that they should be paid for their services. I don't blame them. If you're expecting doctors to serve people solely out of the goodness of their heart, you're expecting our healthcare system to collapse.

+1.

Expecting someone to go through 6-8 years of medical school and then just let some insurance agencies undercut their costs of operations and be happy with it is ludicrous.

 

[cpp214]

Isn't that just always how government works...

I think you've just provided a perfect explanation for why government sucks. And exactly how American does that sound to you? If you don't like how much you get paid, go kiss some committee member's ass!? Sounds like everything America is supposed to stand against.

A group of doctors tells the government...how much it should pay doctors.
And the government generally goes along with whatever the group of doctors recommends.

That sounds like a pretty sweet deal to me. I mean what do the doctors expect, that they should be able to charge whatever they want and people should have to pay it? It amazes me how some people can claim that doctors are somehow victims in the American healthcare system.

They have this silly notion that they should be paid for their services. I don't blame them. If you're expecting doctors to serve people solely out of the goodness of their heart, you're expecting our healthcare system to collapse.

Again, with the implication that doctors are going to be, or are currently being forced to perform services and not get paid for it. Is there any evidence this is happening, aside from emergency rooms having to treat people who may not be able to pay? Are doctors in private practice being forced to treat people without reimbursement? Have I completely missed something here? Because if this is happening, I'd actually have to sympathize with the doctors. But somehow, I don't think this is actually happening.

Doctors = victims/good guys
Government/patients = bad guys

Mind boggling

 

[nk4e]

Doctors = victims/good guys
Government/patients = bad guys

I wonder how the patients are the bad guys? Though "we" may complain on prices but there are those who just don't listen to the doctor on somethings that by chance. They come back to the doctor or switch. There are some patients that pay the amount and actually listen to the doctor.

 

[Biggles]

Mind boggling

Welcome to the fascinating, Through-the-Looking-Glass world of the GTPlanet Current Events forums ...

 

[Danoff]

A group of doctors tells the government...how much it should pay doctors.
And the government generally goes along with whatever the group of doctors recommends.

That sounds like a pretty sweet deal to me.

Yea you'd think so. But having a committee determine your income - even if the committee is made up of "doctors" (who are actually more like politicians), is about as anti-american as it gets.

Not only is that not a market, merit, or in any way fair determination of prices, but it amounts to unelected individuals making law. That's not a representative republic - that's rule by the appointed.

I mean what do the doctors expect, that they should be able to charge whatever they want [snip]

Full stop. Yes. This is fundamentally what every american expects of his business - that he should be able to set his own prices. And no, he certainly doesn't expect that others will necessarily pay it, but he has an expectation to be able to determine what others are willing to pay for his services by setting his own prices. That's capitalism - the very foundation of this country.

Again, with the implication that doctors are going to be, or are currently being forced to perform services and not get paid for it. Is there any evidence this is happening, aside from emergency rooms having to treat people who may not be able to pay?

Yes and no.

Doctors don't have to accept medicare as payment. And many doctors refuse to see medicare patients or limit the number of medicare (charity) patients they see. Some doctors don't have that luxury. There are specialties which lend themselves to primarily medicare patients. Those doctors teeter on the edge of going out of business based on what percentage of their patients use medicare and how much reimbursement they get from medicare.

A specialty that brings in about 20% medicare patients can just eliminate that portion of their patient pool. But a specialty that brings in about 80% medicare patients is relying on not losing too much money on medicare and making up the difference with the last 20% of their patients.

Pediatrics, for example, doesn't generally involve medicare. Pulminary specialists, on the otherhand, deal largely with 90 year-old people who are very near death. Medicare is rampant there.

 

[Biggles]

Hmm ...

amazing what you can find on the internet:

http://mdsalaries.blogspot.com/2006/01/pulmonologist-salaries.html

Actually, there's a lot of interesting (& often contradictory) information on that website about physician salaries, & comparisons between US doctors, Canadian doctors & other nationalities.

Danoff, if you approached the world with genuine curiosity & open-mindedness instead of ideological blinkers, you would find it a more interesting & nuanced place, where everything does not comfortably fit your pre-conceived notions.

 

[Danoff]

Yup, that's about what my friend (the pulmonary physician) was making when he decided he had to retire. Sorry, did you think that would come as a surprise to me?

Do you know what cardiologists make?

Malpractice insurance, even if you've never been sued, can be into 6 figures. $200,000/year might sound like a lot to you. It isn't.

 

[Biggles]

Did I say I thought it was a lot?

The website is an interesting source of information & comparisons - although I have no idea if they are all accurate - which suggests that the reality is a lot more varied & complex than you might think.

 

[Keef]

I'd just like to jump in here and thank everyone for arguing, whether you're right or wrong. At least you argue. My parents typically just say "I don't wanna hear it", and then go bitch about the cable bill or something. Enjoy those social security benefits you won't receive, dad, despite paying for it your entire life.

 

[Radracing]

Take it however you want it!

 

[DK]

Well, the way the Republicans have been whinging over the past few months is bound to draw some attention from people who are thinking of quitting their current job to become a comedian.

 

[Duke]

I mean what do the doctors expect, that they should be able to charge whatever they want and people should have to pay it?

Only if they want what the doctor has!

Say I wanted your house or car. I mean, what do you expect, that you should be able to charge whatever you want and I should have to pay it?

Mind boggling indeed.

 

[cpp214]

Only if they want what the doctor has!

Say I wanted your house or car. I mean, what do you expect, that you should be able to charge whatever you want and I should have to pay it?

Mind boggling indeed.

Buying a house is not absolutely essential to me. I can stay with friends or family if need be, or just rent an apartment.
Buying a car is not absolutely essential to me. I can hitch a ride with a co-worker, or walk, or catch a bus, etc.

But if I'm an insulin dependent diabetic, healthcare is pretty essential to me. Or if I have cancer, healthcare is pretty essential to me.
So that analogy doesn't hold much water.

According to your logic, by being able to charge people whatever they want, doctors would have people at their mercy. If they could charge whatever they wanted, our healthcare system, economy and national health as a whole would be even worse than they are.

In a perfect world, I would have no problem with doctors setting their own fees because--ideally--free market economics would take over, and the doctors who charged the most reasonable, affordable price would succeed, and the doctors who charged ridiculous prices would either go out of business or bring their prices down to compete with the other doctors.

But that's not happening in the real world. We haven't yet made it to Libertarian-Utopian-Nirvana-Land yet. In reality, healthcare in the U.S. and all over the world for that matter, is dominated by insurance--both private and government-run. Insurance companies are pretty good at turning profits. They generally won't pay for something unless they have to, and even then, they decide the price they will pay. Insurance companies, love them or hate them, (And I hate them) are the great equalizer. They prevent doctors from charging people outrageous prices for essential healthcare services. Without insurance companies or government regulations, unscrupulous doctors --in collusion with each other--could form a sort of monopoly, and charge whatever they wanted. I guess that would make some people happy.

 

[Famine]

And who's ensuring that the vital food, water and thermally acceptable environments - which actually are essential for everyone - reaches everybody, free of the cost of producing them and training people to provide?

 

[cpp214]

And who's ensuring that the vital food, water and thermally acceptable environments - which actually are essential for everyone - reaches everybody, free of the cost of producing them and training people to provide?

No one can ensure that people have access to these essentials free of cost.
Most governments do their best to ensure "affordable" access to food, water and shelter, but obviously they fall short in most cases. I don't know of any government that promises free access to these essentials.

But if you want me to address this even further, there is a competitive market for all of the items you mentioned--except water. For food, there are a variety of markets and restaurants to buy from. For housing, there are a variety of choices you can make, depending on your income and pretty much all of them will do the job--put a roof over your head. And as for access to water, if you live in the developed world, it's pretty accessible and affordable in spite of the lack of a competitive water market (governments pretty much have that market cornered).

But I think the important thing to remember is this: I'm not arguing that healthcare should be free. What I'm saying is that the most essential healthcare services should be affordable and accessible for anyone. And I'm also arguing that there should be some means of ensuring that the prices for these services are affordable. As I explained above, there is a market for these other essential services that helps to somewhat regulate the price. For essential healthcare, there would be no such price regulation if not for government-run or private insurance. Without those in place, doctors would pretty much be able to charge whatever they wanted for essential services.

I think people have a right to basic, essential healthcare services.
If they can't afford to pay, I don't mind paying for it out of my taxes.

I think, based on the nature of your question above, you probably disagree with that view. And that's fine. Some people look at healthcare as a right, some people view it as a privilege.

 

[Dotini]

And who's ensuring that the vital food, water and thermally acceptable environments - which actually are essential for everyone - reaches everybody, free of the cost of producing them and training people to provide?

In a word, nobody. But there is a little known US doctrine that says any nation on Earth which has any kind of important resource, be it water, oil or other minerals, must make them available at market prices or suffer the up-close and personal attentions of the Empire.

 

[Famine]

No one can ensure that people have access to these essentials free of cost.

And yet essentials they are. Few people will die by this time tomorrow without "free" healthcare. You wouldn't even make this time tomorrow if not in a human-temperature-acceptable environment.

But if you want me to address this even further, there is a competitive market for all of the items you mentioned--except water. For food, there are a variety of markets and restaurants to buy from. For housing, there are a variety of choices you can make, depending on your income and pretty much all of them will do the job--put a roof over your head. And as for access to water, if you live in the developed world, it's pretty accessible and affordable in spite of the lack of a competitive water market (governments pretty much have that market cornered).

So why is healthcare - which is less essential than food/water/shelter - not allowed to be subject to the same competitive market mechanisms?

Why do we not see unscrupulous builders - in collusion with each other - forming a sort of monopoly and charging whatever they want? Or unscrupulous farmers - in collusion with each other - forming a sort of monopoly and charging whatever they want?

But I think the important thing to remember is this: I'm not arguing that healthcare should be free. What I'm saying is that the most essential healthcare services should be affordable and accessible for anyone.

Define "essential". In medical terms, anything anyone needs to prevent their death is essential - and some would argue that they absolutely need a breast augmentation to boost their self-esteem, otherwise they'd be depressed and suicidal (yes, breast augmentations are offered on the NHS). Define "affordable and accessible for anyone". In financial terms, that's free...

And I'm also arguing that there should be some means of ensuring that the prices for these services are affordable.

This cannot happen in a monopolistic, governmentally-controlled system. There is no competition - competition drives prices down and quality of service up.

I think people have a right to basic, essential healthcare services.
If they can't afford to pay, I don't mind paying for it out of my taxes.

What if you did mind paying for it out of your taxes? What choice would you have?

How about not making that decision for everyone and, if you don't mind contributing to others, do so in a charitable fashion?

Some people look at healthcare as a right, some people view it as a privilege.

The reality is that it's neither.

 

[Biggles]

Say I wanted your house or car. I mean, what do you expect, that you should be able to charge whatever you want and I should have to pay it?

Once again you offer a completely unrealistic, reductionist analogy.

A financial transaction involving the sale of a house or car is intrinsically different from the relationship between a physician & a patient. When was the last time you walking into a doctor's office or emergency room & haggled over the price?

I don't think it's unreasonable to expect the medical profession to be set up on a different basis from businesses selling a consumer product. Medicine is a profession. By its very nature it is tightly regulated & controlled, rather than "free-enterprise". Perhaps you would prefer a situation where anyone could offer medical advice for a fee & as a consumer you would be free to shop around to find the right combination of price & expertise? Not very realistic (or safe) from a practical point of view. The examples that are constantly brought up by the libertarians here have got little to do with practical reality & everything to do with advancing an single-minded ideology.

 

[FoolKiller]

When was the last time you walking into a doctor's office or emergency room & haggled over the price?

My wife's orthodontist, last year. Elective, cosmetic braces were not covered under our insurance, nor should they have been. We negotiated a favorable price and payment plan. We are paying less than they normally charge, but more than insurance would pay them.

I don't think it's unreasonable to expect the medical profession to be set up on a different basis from businesses selling a consumer product. Medicine is a profession.

How does medicine practiced by a trained professional differ from any other job practiced by a trained professional?

By its very nature it is tightly regulated & controlled, rather than "free-enterprise". Perhaps you would prefer a situation where anyone could offer medical advice for a fee & as a consumer you would be free to shop around to find the right combination of price & expertise? Not very realistic (or safe) from a practical point of view.

Oh, I see now. You once again have misconstrued (I could almost argue purposely) the point to be what you want to argue against, rather than what it really is. No one here has said that someone should be able to practice medicine without being a trained doctor. If you want to make that accusation then I challenge you to back it up.

But of course, even in today's system, anyone can offer medical advice, doctor or not.

The examples that are constantly brought up by the libertarians here have got little to do with practical reality & everything to do with advancing an single-minded ideology.

The examples of libertarian ideology that you constantly bring up have little to do with reality and appear to have everything to do with you spreading misinformation.