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About NMpackalum

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  1. The vast majority of probably "unnecessary " but indicated procedures are done for medical legal defensive purposes. Any doctor who has been sued frivolously will practice defensively. So yes, doctors contribute to the problem out of self preservation. Seriously you would consider an appropriate analogy of a car with new technology to that of abdominal pain and fever. Sure the odds of the person surviving is pretty good without a CT but boy, I'd like to know if you have a ruptured appendix or gastroenteritis so I can do surgery or not.
  2. Your largest benefit means absolutely squat. If there is no access to care, what's the difference between getting coverage and showing up to the ER vs having no coverage and showing up to the ER? The benefit goes to the hospital which might get reimbursed. Hence the Hospital Lobby jumping all over the ACA.
  3. I don't think people understand that you can't have a public option in the US that will address patient access, coverage and cost containment unless you outlaw private practice and insurance companies from participating. Who will then deliver services? I've said it many times, the government has no infrastructure to deliver healthcare unless you want to expand the IHS or VA. You are mistaken that doctors are the gatekeepers for cost containment. I would consider it unethical to consider costs over best practices. Medicare pay for performance will fall flat on it's face unless you're ok with getting fired as a patient for smoking, being overweight or having some chronic disease. Who is going to employ doctors, the government? Do you realize that Medicare already supports the vast majority of training programs. The ACA has already sucked the budget from Medicare. The Tort lobby would fight to the death to prevent changes to the malpractice gravy train.
  4. You have some valid points but you are mistaken that physicians have much control over procedure costs and pharmaceuticals anyore. Most procedures over a certain amount require prior authorization before they approved by the Insurance company. Do I make a cent off an MRI or prescription. Heck, I can't even take a free lunch from a drug rep anymore. Yes, we order CTs and MRIs more and more but there doesn't seem to be any way to have meaningful Tort reform to protect against the rare brain tumor or bleed when someone shows up in the ER with a headache that results in a malpractice suit. The vast majority of drugs we prescribe anymore are generics since they are the first tier on every formulary. This is probably the biggest change in patient behavior in my career. 5 years ago you couldn't get anyone to take a non branded drug. Tort reform is a huge necessity to drive prices down for pharmaceuticals as many companies have been driven out of business from lawsuits often leaving only one company making a drug. Look at the prices of doxycycline and Epipens over the last few years. Insurance companies really haven't taken a haircut as they were being subsidized by the ACA for their losses. Now that the subsidies have expired, they are leaving the marketplace in droves. The timing isn't coincidental. Not to mention the DOJ has chosen to turn a blind eye to anti competitive behavior among insurance companies until this last Aetna attempted merger. You are right about this being universal coverage reform. They just forgot the universal access to care part. Good luck with reforming the medical establishment part. You'll have to outlaw private practice and private/corporate business first.
  5. You confuse what people charge and what people get. For instance, anesthesia charges are $1300 for a labor epidural but medicare reimburses a little over a hundred dollars yet they stay in house while you're in labor for several hours. I charge $800 for a tubal ligation and get big fat 0 when I do it after a cesarean. The average charge for pelvic sonogram is roughly $600. Guess what, I get $60 bucks from Medicaid. No negotiations, take it or leave it. People wonder why they can't find providers to take Medicare/Aid.
  6. Just did, just crashed. I had to log out then in again and still couldn't reply. I had to change browsers to Firefox in order to post. It's really unusable for me on Chrome.
  7. Well back in 1990, the "experts" thought we were going to enter a new ice age too. Hormone replacement, mega doses of vitamins, margarine and sit ups were good. Red meat, eggs and nuclear power were bad. Your last comment about how Republicans have refused to fix it is solely propaganda or your inability to get past your vacuum. Paul Ryan among others has had a very sensible plan for many years including optional vouchers for medicare recipients to purchase commercial plans for those who could not find a provider willing to take Medicare. Honestly, I don't give a crap about the ACA or exchange plans since they only account for 10-11 million people if you believe government statistics. That group except those with pre-existing diseases unable to get insurance will always go to the ED sometimes not of their choice because the ACA does nothing about patient access to care. My beef is what the ACA has done to private commercial insurance. Unless you are a business owner or purchase your own insurance, you really can't comprehend the radical changes to purchasing commercial insurance. Pre ACA, I bought monthly insurance for $500 for singles and $850 for families. For that I had $10 dollar copays and $10-$20 tiers for drugs with 80/20 coverage to a 1000 dollar max out of pocket. $100 for out patient surgeries and $500 for inpatient surgeries or hospitalizations. Forward to present, I pay $2200/month for family with $500 deductible with 80/20 coverage with max out of pocket of $6500, very limited formulary. I paid $7700 out of pocket for my son's recent foot surgery despite paying that kind of premium. I would say 30% of my surgeries cancel because they can't come up with that money despite paying their portion of insurance. The only people who don't worry about the costs are those on medicaid and they only show to their appointments half of the time. Doesn't seem fair to those employees that work hard to pay their premiums to subsidize others. Not to mention the $10-25,000 cost to employers per employee. All for what? More ER utilization? Decreased access for specialty care and needed surgeries.
  8. I don't think it's fixed yet. Maybe a little better on lag and scrolling but it still crashes regularly
  9. Where do you think the newly minted medicaid insured people are going for their care? I don't know UMC visit totals year over year but I do know that our local hospital has had ED visit increases every year despite (or because) the ACA. With regard to the losses for unnecessary ED visits, our local hospital used to receive county indigent funds from the state which was removed after implementation of the ACA thinking that people would have medicaid/exchange plans. Of course no one signs up for it until they need it so the net 6 million dollar deficit resulted. Those not very well thought out (though predicted) consequences are the norm for the ACA.
  10. The site keeps crashing on all browsers. Seems the worse on Chrome and best on safari. I get a shockwave crash notice regularly. It's really hard to type responses as the cursor disappears for 10-15 seconds at a time. I even bought a new computer thinking that it was time to upgrade.
  11. Again, they all have to use the RB RVS set by medicare. They pay based on a percentage or set their own system based on conversion factors added to RBRVS. CMS runs the healthcare system whether directly or indirectly. Prank your local hospital administrator by saying you want to schedule a CMS audit. Watch the panic start.
  12. I saw about 15 minutes of his reality TV show. His mental makeup is of a 16 year old.
  13. You truly need to be educated about Medicaid and Medicare with regards to how much they control the healthcare system. Reimbursements/payments for procedures, diagnosis and visits etc are based on a relative value scale established by CMS and are used as a reference for every healthcare entity. Just to start. And it goes much deeper. It is difficult to comprehend unless you are in the industry so I'll give people who don't understand a pass but it's frustrating hearing completely inaccurate things expressed. It's as if I posted inaccurate things about accounting or oil and gas production.
  14. I must have gotten it wrong. My impression that when one entity controls who can enroll, what services you must provide, dictates what they will pay you, limits your formulary and decides which providers are eligible to see patients all while having access to all your records, claims data and penalize you for patient non compliance then that entity would be the one running the show. Considering providers are at risk for "criminal" charges if they do not comply, I would say that the government has a little influence. The only thing that they can't do is coerce providers, hospitals and insurance companies from participating against their will which is the flaw that is sinking Obama care. If you think that the only reason Aetna is getting out of the exchanges is that they want leverage for their merger, go right ahead and believe it, it probably is the only way they can make their exchange plans come close to break even. You would then have to come up with why Blue Cross, United, Cigna and the majority of state run exchange plans are dropping or bankrupt. The unintended consequence, (predictable) is the consolidation of the insurers which increasingly is acting as an anticompetitive monopoly that the DOJ and FTC have said they wouldn't prosecute from the beginning. If the goal of healthcare reform was provide greater access at a cheaper cost, well they missed on both accounts. There are much simpler ways to achieve those goals so is there truly a more important goal for the architects?
  15. Dude, you don't understand Obamacare. ACA rules govern everything now. In order to sell an insurance product, it has to be a "qualified" ACA plan. In effect, the government pays the insurance companies to implement their system since the government has no infrastructure to deliver healthcare as the Canadians or British do. We get government healthcare through expensive middlemen. And it doesn't even guarantee access like other countries, just a shiny card. So before calling people out about inane ramblings, read something other than Obamacare talking points.