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View Diary: Health Care: All this effort... for what? (24 comments)

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  •  Not true (5+ / 0-)
    For that reason, we are moving more and more to hospital and emergency room based care than ever before, and Obamacare not only doesn't solve that problem, it actually makes it worse.
    NO ONE with insurance goes to an ER over a doctor because, gee, their PCP just doesn't spend enough time with them.

    They go to their PCP, pay a co-pay, and are seen. The fact that MORE people will have insurance means that more people will choose the $30 copay over the $3000 ER bill.

    Sometimes I get a report, and I know the instant I got it that the doctor was barely conscious when he made it.  Sometimes it's because they've been on the floor for days, and are describing a patient's visit that happened a full 24 hours ago.  I wonder if he forgot any details while he was constantly working over that time?
    Again, you're describing a very unfortunate fact about ER care that will be decreased under Obamacare. How in FSM's name do you suppose that by increasing access to insurance, we increase visits to the ER AS A PREFERENCE TO A PCP?

    Finally, you're writing all of this from the perspective of a medical transcriptionist, which I don't condemn at all.

    But do you realize that all the things you claim have been made worse by Obamacare are actually things that have been ADDRESSED by Obamacare- but you're not going to see that until 2014, when the major provisions kick in.

     

    P.S. I am not a crackpot.

    by BoiseBlue on Thu Oct 25, 2012 at 06:58:38 PM PDT

    •  The problem is that fewer and fewer people are (4+ / 0-)

      becoming GPs or going into Family Practice. That's because as the diarist says, they earn less. As it's harder to find a GP, people will go to the ER.

      There is more money to be made in specialties for the number of hours the work.

      If payment to doctors is squeezed, as is happening under Medicare, fewer doctors will accept Medicare/Medicaid patients.

      I'm in a very large metro area and am having trouble finding an Internist in my neighborhood who accepts new Medicare patients.

      When payments are restricted, so are services.

      It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

      by auapplemac on Thu Oct 25, 2012 at 07:12:16 PM PDT

      [ Parent ]

    •  When you have a heart attack (4+ / 0-)

      you are most likely going to an emergency room, and you probably won't see your doctor of choice there.  It's not a matter of choosing one over your doctor, it's simply how it usually works out.  That's all I mean.  What that specifically means is that no matter rich you are, the decision to not worry about universal healthcare can have a very real effect on your life, just as it would if you get into a car accident and find yourself at the hospital at 2 a.m.

      Don't get me wrong, I'm glad that Obamacare is making it through, and it will help things for some people.  However, new changes in Medicare are in fact not addressing chronic complaints of the amount of money a general doctor is paid when they see someone on Medicare, and some specific parts of it can be described as making it worse.

      I know why that is of course, and so do you; it's because the money just isn't in the budget at this point.

      Ignorance more frequently begets confidence then knowledge. Charles Darwin

      by martianexpatriate on Thu Oct 25, 2012 at 07:18:48 PM PDT

      [ Parent ]

      •  Of course you go to the emergency room for (4+ / 0-)

        an emergency. I'm not disputing that- and I'm not arguing against single payer. I support single payer and believe that it's the only rational way to go.

        My dispute is that you lay out a list of ills that you claim have only been made worse by the ACA. They were not made worse.

        Covering pre-existing conditions, getting more people on insurance, getting rid of the lifetime cap, etc, are all things that help people be more proactive about their health and avoid the ER.

        I absolutely support a single payer system. I am also realistic enough to notice that it's not going to happen anytime soon. Look how hard it was to get a half-measure pushed through.

        But the things that you highlight in your diary as problems that the ACA has only made worse are just wrong. They are not being made worse by Obamacare, they've been addressed my Obamacare.

        P.S. I am not a crackpot.

        by BoiseBlue on Thu Oct 25, 2012 at 07:40:53 PM PDT

        [ Parent ]

        •   No, thats really not what I was ever saying. (2+ / 0-)
          Recommended by:
          Sunspots, cynndara

          I'm not saying it was made worse by the ACA.  I'm saying that the ACA went into place to give more people medical coverage, but it utterly failed to deal with the issue of the pay of general practitioners, and that is an issue which we are eventually going to have to deal with.

          And don't kid yourself... they have not been addressed by Obamacare, not at all.  General practitioners are exceedingly dissatisfied, and the ability to retain doctors in that position is a problem which has been developing for years and is growing worse.  The doctors who are practicing now certainly don't feel that it's been addressed.  Go talk to some general practitioners sometime and see if they feel it's been addressed.

          Giving everyone coverage is a fine thing, but if you can't get enough doctors to take part in the medical system, that's a  whole other problem.

          Ignorance more frequently begets confidence then knowledge. Charles Darwin

          by martianexpatriate on Thu Oct 25, 2012 at 07:51:06 PM PDT

          [ Parent ]

          •  You said that moving more towards (0+ / 0-)

            ER/hospital care was made worse by the ACA, and I pointed out that's not true.

            As far as the pay of PCPs, I actually do know a bit about this. I recognize that this is a problem. We also have a shortage of nurses. And, yes, the ACA contributed to that.

            With more people able to access health care, more doctors and nurses are needed. Again, that's not in dispute, and I grant you that it wasn't, to my knowledge, addressed by the ACA.

            But your essay focuses solely on ER care, which will go down when people have access to insurance, so that they can take advantage of preventative care.

            Will we need more medical professionals in the future? Absolutely. We need a lot more of everything in the future. We need more teachers, firefighters, construction workers, etc.

            We do that by expanding opportunities for education.

            This is not a simple subject.

            The nurse shortage, for example, is driven more by the lack of nurses willing to teach the courses. They make more working in the trenches, so to speak, than they do teaching a course.

            And since we don't have enough nurses willing to give up the practice of nursing in order to teach other nurses, we have to limit the number of nursing students that are accepted to nursing school.

            I'm not sure how Obamacare could have addressed education issues. I agree with you that it needs to be fixed, but I don't think that it could be written into the bill.

            What I do think can solve the problem is better access to education. You know, stop treating public employees like shit and all that.

            We get that with only one candidate this year.

            Only one.

            The issues are tied, but they can't be solved in one fell swoop. We have to accept that this is a framework we were given to build upon. It wasn't meant to be the ultimate answer.

            P.S. I am not a crackpot.

            by BoiseBlue on Thu Oct 25, 2012 at 08:08:32 PM PDT

            [ Parent ]

            •  You keep seeming to want to tell me what my diary (0+ / 0-)

              was about.  Frankly your conclusions as to the number of candidates we have this year are not different from mine, you can go read my other diaries if you'd like to confirm that.

              There is a fairly direct way to answer the particular problem I'm discussing... which actually is not focused solely on ER care at all.  It has to do with the amount of money doctors are paid for taking care of a medicaid patient.  If you increase it, you would make it possible for a doctor to make money and give patients more time, which I suspect would result in better care.

              I don't think that better access to education is going to have much of a direct influence on what I'm talking about, but I'm certainly not opposed to it.  

              I'm not certain why you reacted this way to my diary.  But frankly, the shortage of doctors is not new information, it's pretty well known, and they tell me that between the cost of college education and malpractice premiums, declining pay is becoming a huge issue, and it is in fact getting worse.

              Ignorance more frequently begets confidence then knowledge. Charles Darwin

              by martianexpatriate on Thu Oct 25, 2012 at 10:17:42 PM PDT

              [ Parent ]

              •  You said several times in your diary (0+ / 0-)

                that Obamacare has made things worse, and the things you highlight are things that Obamacare will actually make better.

                I'm not misreading your diary. You said over and over that X is a problem that Obamacare made worse, when Obamacare specifically addresses X and reduces the problem.

                P.S. I am not a crackpot.

                by BoiseBlue on Fri Oct 26, 2012 at 05:01:15 PM PDT

                [ Parent ]

                •  When people are underpaid, (0+ / 0-)

                  and you can't get sufficient staff to man the system, and you then add 30 million people to the rolls you make things worse.  Medicaid/medicare compensation for doctors is trending downwards by every metric I can identify.

                  I don't believe education is sufficient, you have to actually invest money into the system.

                  I get that you don't agree with me.

                  Ignorance more frequently begets confidence then knowledge. Charles Darwin

                  by martianexpatriate on Sun Oct 28, 2012 at 03:53:59 PM PDT

                  [ Parent ]

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