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View Diary: No 'rate shock' for Obamacare in California (204 comments)

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  •  Covered California's doing a great job... (7+ / 0-)

    ...of rolling out the state's plans on its website.

    I have a question, though: I was reading the plans booklet and on page 8, there's a list of how the plans will improve care:

    Covered California and each health plan selected are committed to ensuring high quality of care for all enrollees. Specifically, each plan must:

    • Ensure that each enrollee has had a preventive health and wellness visit during the first year of enrollment;

    • Identify and proactively manage all “at-risk” enrollees;

    • Determine enrollee’s health status and proactively develop a plan to manage their individual health care needs;

    • Promote the use of best practice models for continuity of care and care coordination that are proven to improve quality of care;

    • Be transparent about plan performance at the point of enrollment, specifically regarding standard measures of prevention, access, and clinical effectiveness; and,

    • Be certified by the National Committee for Quality Assurance or URAC (formerly known as the Utilization Review Accreditation Commission) to meet quality standards.

    I bolded the portion that concerns me, for various reasons. Are mandated physicals written into PPACA or is that only applicable for California?

    (Don't get me wrong; I think it's wonderful to include free preventive exams to people. I just don't like the idea of compulsory free preventive exams, and I also think that would be a boneheaded requirement from a political POV.)

    •  A patient can never be forced (7+ / 0-)

      to have anything done to them. I think it means it must be offered.

      The good thing about science is that it's true whether or not you believe in it.― Neil deGrasse Tyson

      by maggiejean on Fri May 24, 2013 at 11:03:21 AM PDT

      [ Parent ]

      •  You can be forced into underwriting exams... (5+ / 0-) a condition of insurance acceptance, but that was pre-PPACA.

        I just thought the wording was sort of odd if it was meant to say, instead, that preventive care was encouraged. The wording's pretty clear that the state wants insurers to make sure people have their annual exams; I just don't know if there's coercion behind it (i.e., requiring physicals in order to qualify for the subsidies or to stay on a plan from year to year).

        •  Great point about 'underwriting' exams pre-PPACA. (3+ / 0-)
          Recommended by:
          deep info, Laconic Lib, maggiejean

          And one would HOPE that this would be a 'thing-of-the-past,' but who knows, unless they delve into the fine details of the bill.

          Let's remember--a VP from WellPoint basically wrote this legislation--that's a matter of record.  Heck, at one time (the video we 'killed') Jane Hamsher had the actual video of Max Baucus thanking her for doing that.  I just posted it with Jane's diary here several days ago.

          I just remembered that a friend enrolled in Medicare last year.  Will see what they say about a 'wellness exam.'  Hasn't mentioned it, now that I think about it.  (And I think that this person probably would have said something.)

          But, anyway, I prefer to see 'policy,' rather than go on anecdotes.  ;-)


          "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


          by musiccitymollie on Fri May 24, 2013 at 11:40:36 AM PDT

          [ Parent ]

          •  I have the impression that the annual (2+ / 0-)
            Recommended by:
            maggiejean, Willa Rogers

            "wellness" exam isn't much.  No tests are included, for example.  It's basically a conversation with one's doctor in which lots of questions are asked and, presumably, advice given, along with a minimal physical exam.  Are you safe at home?  Do you smoke tobacco?  How much alcohol do you consume.  

            When I scheduled what I thought was my "free" wellness exam, I, unknowing, called it my annual physical. It was billed to Medicare as "extended office visit" at $180.  So, I'm thinking, if someone on Medicare doesn't actually say "wellness exam" when making the appointment, at least some doctors are taking things into their own hands to be certain they get paid as if there has been no change in the law.

            If someone out there has actually had one of these, please let us know what it included.

            The good we secure for ourselves is precarious and uncertain, is floating in mid-air, until it is secured for all of us and incorporated into our common life. Jane Addams

            by Alice Olson on Sat May 25, 2013 at 07:07:44 AM PDT

            [ Parent ]

      •  True in the past, as far as I've ever 'heard.' (1+ / 0-)
        Recommended by:

        And, if my memory serves me correctly, some plan that would have included 'mandatory' home medical visits was rejected by the Administration, recently.

        Hope that trend continues. ;-)


        "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


        by musiccitymollie on Fri May 24, 2013 at 11:43:09 AM PDT

        [ Parent ]

        •  Although (4+ / 0-)
          Recommended by:
          DSPS owl, SoCalSal, mamamedusa, maggiejean

          Interestingly enough, it turns out that regular home visits by a nurse are more effective than anything else we've tried at keeping older people healthy.

          •  I'm sort of curious--do you have a link to any (2+ / 0-)
            Recommended by:
            Laconic Lib, maggiejean

            studies showing this?

            I've 'Googled the topic, and came up with a study in the Netherlands with rather ambiguous results.

            Of course, that is not totally unexpected, since like many things, there are studies to support both 'sides' of an argument.

            Here's an excerpt:


            Preventive home visits to elderly people by public health nurses aim to maintain or improve the functional status of elderly and reduce the use of institutional care services.

            A number of trials that investigated the effects of home visits show positive results, but others do not.

            The outcomes can depend on differences in characteristics of the intervention programme, but also on the selection of the target population.

            A risk group approach seems promising, but further evidence is needed.

            We decided to carry out a study to investigate the effects in a population of elderly with (perceived) poor health rather than the general population.

            Also, we test whether nurses who are qualified at a lower professional level (home nurses instead of public health nurses) are able to obtain convincing effects.

            The results of this study will contribute to the discussion on effective public health strategies for the aged.

            Research in the Netherlands showed that preventive home visits do not seem to be useful for the general population of elderly people [5].

            In that trial, experienced public health nurses visited the intervention group (n = 300) at least four times a year over a period of 3 years. The control group (n = 300) received usual care.

            After 3 years, no or hardly any effects were demonstrated on the health and service use of the total group of visited elderly (see table 1).

            However, a subgroup analysis indicated that the visits seemed to be effective for elderly with a poor (perceived) health status.

            Visited persons with poor health at baseline scored considerably better on several health measures (e.g., functional status) compared to similar persons in the control group. Mortality rates after three years were lower (24% versus 40%) and substantial effects were found for referrals to outpatient clinics (61% versus 79%) and also for hospital admissions, especially re-admissions. In the intervention subgroup 47% were admitted at least once to the hospital, with a total of 1,134 days; in the control subgroup these figures were 74% and 2,043 days (table 1). These effects emerged already during the first year of the intervention period [6].

            Table 1. Mortality and use of services (percentages) for all participants and for those who rated their health status as poor at the start of the study

            The probable usefulness of home visits for a high risk group was confirmed in five controlled studies [7-11]. However, the results of three other trials did not support this assumption [12-14].

            Although home visits for a restricted population seem a promising approach, further evidence is needed.

            Now, if a service like this is used as a voluntary 'supplement,' it would be nice, I would think.

            But one concern that I would have is the 'level' of nursing care--would it be substantial?

            IOW, if the home care was provided by someone at the very lowest level of expertise (which is not to put off on the fine folks who work in this field), I would have concerns.

            And because our health care system if 'profit-based' (not sure how the one in the Netherlands if set up), I would be concerned about 'depending upon' home health visits.

            I would definitely be worried that a CNA (Certified Nursing Aide) would not have enough knowledge to make some of the judgments required in an unsupervised home setting.

            My observation is that even LPNs are pretty closely monitored in SNFs (by RNs).

            And honestly, as lousy as our healthcare system is, I simply can't imagine that overnight American citizens are going to have a 'brigade of RN's' provided to make house calls.'

            It would simply be such 'a stretch.'

            When I listen to health reform forums on C-Span, most of the experts are wringing their hands over what will happen in January of next year, when millions more folks will descend upon our patchy system.

            I referring to the shortage of health care providers, in general, that work in offices and hospitals.

            Personally, I would rather be able to access a doctor at an office once or twice a month (if needed, that is), than have a home health care worker treat me at home weekly.

            Although I acknowledge that CNAs provide a very valuable and wonderful service in skilled nursing facilities, I would be hesitant to depend upon them to carry out diagnostic treatment or evaluation.

            Even though I'll gladly acknowledge that most of these folks are 'among the most kind and most compassionate people that I have been privileged to know.'

            And, one last concern.

            Could this 'home visit' service give very busy (and overstretched) adult children a 'false sense of security' that their elderly parent is 'being looked after,' causing them to 'drop the ball.'

            All issues which I believe bear at least some consideration.


            "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


            by musiccitymollie on Fri May 24, 2013 at 08:32:29 PM PDT

            [ Parent ]

    •  This concerns me also. Great question. Plan to (2+ / 0-)
      Recommended by:
      Willa Rogers, Eric Nelson

      research this.

      That is undisputedly the direction that the PPACA takes us in, however.

      I say that because the PPACA's aim is to transition into 'managed care.'

      And that means (does it not?) that the main goal is to 'prevent' illness, and therefore the need for treatment.

      How can you accomplish this, unless health insurance plan participants get annual (compulsory, if necessary) checkups?

      We're not old enough (yet) to draw early age Soc Sec, much less Medicare.

      But some of the language that I've seen regarding the ACA changes to Medicare were very concerning to me, as well.

      I say this because the language regarding some of the proposed Medicare reforms is rather 'ambiguous,' in regard to the 'initial preventive health and wellness visit during the first year of enrollment,' that is included in the Medicare program, now.

      Even when I hear so-called 'health reporters' on this topic, they are very careful to not say 'optional OR mandatory.'  

      Folks like Julie Rovner (very knowledgable) seem to parse' their words on this topic.  And naturally, none of the interviewers every pin them down, LOL!

      Agree with you Willa--great, as an 'option.'

      Not great, if 'mandatory.'  ;-)

      Interesting topic.  Will see what I can find on this.


      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


      by musiccitymollie on Fri May 24, 2013 at 11:15:30 AM PDT

      [ Parent ]

      •  Thanks, Mollie! (1+ / 0-)
        Recommended by:

        My concerns, in part, derive from those "wellness" plans employers offer for discounted health insurance... it's not a huge leap from compulsory health exams to "Take your Lipitor or you don't get your subsidy."

        •  Nailed it again, LOL! Mr. M and I are 'on' one of (0+ / 0-)

          those lousy 'consumer driven' plans.

          If we submit to having complete blood panels (and some other test, don't remember which ones) each year, we have a discounted annual deductible.

          And, of course, they want to see these so that a 'health coach' [by phone and email] can 'keep you on the straight and narrow,' LOL!

          We've gotten the blood tests, etc., during the course of our own voluntary health exams, but neither of us believe that it is appropriate for the company to 'demand to see' our physical exam outcome.

          I truly have concerns that the push for 'managed care' will, in time, diminish some of our 'rights.'  I hope this concern is unfounded.


          "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


          by musiccitymollie on Fri May 24, 2013 at 11:51:33 AM PDT

          [ Parent ]

        •  Take your Lipitor or you don't get your subsidy. (0+ / 0-)

          I LIKE that approach.
          Like it or not we're all in this together when it comes to health coverage.
          If you want to be a slug and not take care of yourself that's fine - you just have to pay a higher rate so the rest of us don't have our rates go up because you wanna be a slug.

          •  I disagree. (5+ / 0-)

            It's not up to PhRMA to determine which of their costly drugs makes me "healthy," whether I can tolerate its side effects, or whether their metrics are legitimate or a passing fad.

            As I said, it makes sense to encourage people to go to their doctors, but there are a heap of unintended consequences to forcing it.

            •  It's not the drugs - it's the cholesterol (2+ / 0-)
              Recommended by:
              wmspringer, FindingMyVoice

              If you've got high cholesterol, and you're not doing anything to lower it, your premiums should be higher.

              And by doing things to lower it I don't mean unproven methods.

              Like it or not we are all in this health care cost together. If you're engaging in behavior that has been proven to damage your health then it costs the rest of us money.

              You've gotta carry your portion of the load.

              That's why we have the motorcycle helmet laws. I remember when all the hew and cry went up about the motor cycle helmet laws. If that infringes on their freedom - tough.

              It's not up to PhRMA to determine which of their costly drugs makes me "healthy," whether I can tolerate its side effects, or whether their metrics are legitimate or a passing fad.
              It's not Pharma that determines which drugs make you healthy. It's the program administrators that make that judgment. That's how it works in Medicare.
              As I said, it makes sense to encourage people to go to their doctors, but there are a heap of unintended consequences to forcing it.
              I really don't think there are a lot of unintended consequences to this. The research is all there.
              •  "Proven" today = tomorrow's recall (nt) (2+ / 0-)
                Recommended by:
                musiccitymollie, mmacdDE
                •  Simply not true (2+ / 0-)
                  Recommended by:
                  SoCalSal, FindingMyVoice

                  and you have nothing to back that up.

                  Lipitor has a decades long proven track record.

                  As do certain lifestyle changes.

                  While it may feel good to say

                  "Proven" today = tomorrow's recall
                  it has no basis in reality as a blanket statement about this subject matter.
                  •  I wasn't talking specifically about Lipitor... (3+ / 0-)

                    ...but about the number of both prescription drugs and medical trends the efficacy of which has changed over time.

                    For example, new studies show that being fat isn't the death sentence commonly ascribed to the condition--which flies in the face of every employee "wellness" program that's been created to date.

                    12 years ago it was common practice for doctors to urge menopausal women to take synthetic hormones--but the side effects turned out to be so lethal that one study was stopped midstream and women then urged to not take the hormones.

                    Medicine evolves, as it should. But it's not the state's job to force me to take particular meds--especially in a for-profit medical system such as ours, where most of the pre-market testing is performed by those with financial interest in particular outcomes.

                    As I said, we'll have to wait and see whether my concerns are warranted. I don't doubt that others will share my concerns if they are warranted.

                    •  I wasn't talking specifically about Lipitor (0+ / 0-)

                      but rather the cholesterol reducing drugs and lifestyle changes that have been proven over decades.
                      The study you reference doesn't "show that being fat isn't the death sentence" as you state.
                      The article refers to that ONE study which is very much in dispute. Reference paragraph 16 of the article.

                      The reference to menopausal hormone treatment really doesn't compare to the decades of research and experience concerning heart disease.

                      I never said the sate should force you to take meds or develop a healthy life style. I said YOU should pay for the extra health care expense you most likely will incur - not me.

                      Thus the higher premiums.

                      In a way I'm saying you can't have your cake and eat it too.

                      •  Your saying that is fine... (0+ / 0-)

               concern was the government telling me I can't have my cake and my insurance subsidies too!

                        Like I said, we'll have to wait and see how this shakes out. I'm hoping my concerns are for naught and that there won't be mandatory physicals or mandatory "wellness" edicts--not in the least because of the public shitstorm that would ensue and jeopardize other parts of the Act.

                        Until then, ciao!

                  •  lipitor - not all roses (5+ / 0-)

                    We’re overdosing on cholesterol-lowering statins,” Topol writes, “and the consequence could be a sharp increase in the incidence of Type 2 diabetes.”

                    As a former medical librarian and evidenced-based medicine geek, I'll chime in here that having everyone "take your Lipitor" is not such a great idea.  Unfortunately, many of our research studies are tainted by "ghost writers" from Big Pharma. Studies that disprove what a drug company wants are simply not published, so that when a meta-analysis is performed, it looks like all the research is glowing.  My sister suffered from severe muscle pain from Lipitor, could have led to kidney failure if she had not stopped taking it.

                    •  You don't understand what I was saying (0+ / 0-)

                      Or what the article you reference says.

                      First - I wasn't saying that everybody should be taking Lipitor.
                      I said that people with high cholesterol should be engage in cholesterol lowering behavior or pay higher health care premiums.
                      Cholesterol lowering behavior includes a number of possibilities. Taking statins, changing diet, and exercising are all factors - proven factors.

                      If people don't want to engage in those behaviors they should pay higher health care premiums.

                      Second, that article in Forbes is simply voicing the highly disputed contention of ONE person about statins. The opening of the article even stated that that person had broken ranks with most others in his profession. It quotes others directly contradicting him.

                      •  I really do understand... (1+ / 0-)
                        Recommended by:
                        Willa Rogers

                        I understand your argument about healthy lifestyle choices - my point was the problem with prescribing drugs to solve all our health issues - the link was just one example of what can go wrong with jumping on a current drug as a lifesaver without good evidence, and our evidence is not good.  The link to the sci-am article about poor quality and tainted evidence was my main point.  sorry it wasn't evident in such a short post.

                  •  Lipitor has unwanted effects (5+ / 0-)

                    like all medications.

                    "Proven" today = tomorrow's recall
                    No basis? Lots of drugs have been taken off the market. I was on one of them. My doctor called me one day and told me to stop taking it - today, not tomorrow - as it was found to sometimes cause liver failure.

                    Unlike many people I know, I am a believer in modern medicine and take drugs. But even I can plainly see that the drug companies cannot be trusted; they conceal negative research and exaggerate benefits. And drug interactions are largely untested and unknown.

                    Moreover there are many people who dispute the significance of cholesterol levels in causing disease.

                    We open up a huge can of worms if we start coercing people into taking drugs and/or punishing them for health risks that may or may not be ascertainable and may or may not be under their control.

                    We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

                    by denise b on Fri May 24, 2013 at 04:55:56 PM PDT

                    [ Parent ]

              •  It's an incredibly bad idea to tie (6+ / 0-)

                one's health care fees or subsidies to the taking of a particular drug for an ailment.  Very bad politically and very bad for the feeding frenzy it would set off for the drug companies to get that drug qualified for subsidy offsets

                That's absolutely the worst idea I have ever heard of in this healthcare debate.

                Right man, right job and right time

                by Ianb007 on Fri May 24, 2013 at 05:57:41 PM PDT

                [ Parent ]

                •  Well, I was just doing the "slippery slope" thing (0+ / 0-)

                  ...from requiring annual physicals to requiring that you follow your doctor's (or insurer's) recommended course of treatment.

                  Right now I'm more interested in the former, since Covered California included the language I referenced, than in the latter (which could--but hasn't--come to pass).

            •  Hear, hear! N/T (0+ / 0-)


              "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


              by musiccitymollie on Fri May 24, 2013 at 03:26:04 PM PDT

              [ Parent ]

          •  Hey, CC. Isn't it just a bit 'over-the-top' to (4+ / 0-)

            call us 'slugs?'

            I mentioned that we have exams, which include blood tests, etc.

            We simply don't choose to have them submitted directly to an employer to 'pour over them.'

            That is an 'option' in our plan.  If we choose to pay more out-of-pocket for that privilege, why would it concern you?

            It is sort of humorous that you should mention 'Lipitor,' since I have a cholesterol readings 'to die for,' according to our internist.  [I am a lifelong vegetarian.]

            And Mr. M had a slightly elevated cholesterol reading one year, but instead of running up a pharmacy bill, he went on a low cholesterol diet--and it is now back in the normal range.

            So what makes us deserving of being called 'slugs,' you say?

            Seriously, there is no reason that adults should not be able to discuss the PPACA, and have honest differences of opinion, without attacking one another personally.


            "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


            by musiccitymollie on Fri May 24, 2013 at 02:02:48 PM PDT

            [ Parent ]

            •  Yeah - slugs was over the top (2+ / 0-)
              Recommended by:
              musiccitymollie, FindingMyVoice

              I apologize for that. In fact it was waaaay over the top!

              As for cholesterol - there are low cholesterol diets with proven results. It's really tough to get people to stick to them.

              As a vegetarian it's not surprising you have a really good cholesterol count.

              I'm on Lipitor too. While not a vegetarian 90% of what I eat is veggies and fruits and grains. That means I get to take a lot less Lipitor. It's basically the Pritikin diet.

              When I mentioned the Pritikin approach to my Dr. the reaction was that it was a great, and proven, diet that nobody stuck to.

              BTW - one thing I would like to do with the extra dollars coming in from those refusing to do anything about high cholesterol and blood pressure  is blanket advertising promoting good food habits.

              Not those dreary public service announcements. Yech. REAL advertising and product placement by the same ad agencies that make the fast food and pizza commercials. Use the same talent to sell good food.

              •  Hey, thanks very much--I appreciate it. ;-) (2+ / 0-)
                Recommended by:
                SoCalSal, mamamedusa

                BTW, not 'bragging' about my cholesterol reading--just happens to be the case.

                And the funny thing is that a bit of 'trauma' is mostly responsible for my good readings.

                My fourth grade elementary school class went on a 'field trip' to a 'packing plant' (read:  bovine slaughterhouse), and we actually witnessed 'cows being killed with airguns, and being dropped down chutes.'

                My Mother happened to be one of the 'Room Mothers' that went on that trip that day.  She was absolutely appalled that 9-years-olds would be exposed to that.  Heck, it almost made her sick.

                There were employees wearing rubber 'fishing waders' because of the pools of blood they worked in.

                No more meat for me.  That did it!

                And that includes fish and fowl, as well.

                So, I had to laugh years later when I first heard of my 'healthy' cholesterol stats.  

                It's nice that something 'positive' came out of that awful experience, after all.  ;-)


                "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


                by musiccitymollie on Fri May 24, 2013 at 03:52:16 PM PDT

                [ Parent ]

    •  I wish they would force yearly physicals. (1+ / 0-)
      Recommended by:

      They probably won't but I hope they do.

      We're all in this together when it comes to medical coverage. Folks that don't get yearly physicals are not holding up their end of the bargain.

      That's why we've got motorcycle helmet laws here in California. It's also why we've got seat belt laws.

      •  I expect most people agree with you... (2+ / 0-)
        Recommended by:
        CS in AZ, Odysseus

        ...but there could be a lot of unintended consequences, from metrics for "health" being set by Pharma to the security of electronic medical records.

        It also would be a political disaster for the state to require annual physicals.

        In any case, I never heard of compulsory physicals being a part of PPACA before now, which is what triggered my question. I'm sure we'll hear more--pro and con--in the coming months during the rollout.

        I do disagree that it should be framed as people "holding up their end of the bargain." Maybe that would be the case in a system were medical services and products were not-for-profit, but it isn't the case in a system where doctors, until recently, were financially rewarded for pushing brand-name prescription drugs.

      •  Respectfully, have to 'agree to disagree.' (2+ / 0-)
        Recommended by:
        deep info, Willa Rogers

        In the first place, much of the problem with 'run away' health care costs COULD BE eliminated if we were to have meaningful 'health care' reform.

        Which the PPACA really is not.  

        It's more of a 'rearrangement of the deck chairs' in a 'broken for-profit health insurance industry.'

        What would be next?  

        'Minders' to see that every American 'eats right?'   ;-)

        No thanks!


        "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


        by musiccitymollie on Fri May 24, 2013 at 12:02:26 PM PDT

        [ Parent ]

        •  Coulda woulda shoulda (2+ / 0-)
          Recommended by:
          musiccitymollie, FindingMyVoice
          In the first place, much of the problem with 'run away' health care costs COULD BE eliminated if we were to have meaningful 'health care' reform.
          I will assume that you're talking about single payer.
          Yes, single payer would be the way to go.
          However, even with single payer in place, healthcare costs would be held down if everybody had to go through regular preventive health care procedures.
          As to what would be next - yeah, I would like to see measures taken to improve the eating habits of Americans. That would help to reduce the epidemic of obesity you should have heard about.
          •  Please excuse the snark. N/T (2+ / 0-)
            Recommended by:
            musiccitymollie, FindingMyVoice
          •  Preventative care is the way to go (4+ / 0-)

            This is why in European countries where providers get a fixed amount per person you'll see doctor's offices covered with information about preventative care; it's cheaper to keep someone from getting sick than to take care of him after he gets sick. If we could put a dent into the incidence of preventable chronic diseases, we could drive down healthcare costs quite a bit.

            My health insurer gives a rebate on doing healthy things (exercise, joining a CSA, whatever) - it's not a ton of money (increased to $150/person this year, from $100/person or $200/family last year) but it's still enough to change behavior, presumably enough to pay for itself in the long run.

            •  Euro system is different... (2+ / 0-)
              Recommended by:
              mmacdDE, musiccitymollie

              ...beginning with the fact that most doctors don't have financial incentives to recommend testing and procedures. U.S. doctors and hospitals do have that incentive, and as I said, the trend is toward doctors' becoming employees of huge for-profit systems.

              And, like I said, requiring mandatory physicals would be pretty much guaranteed to cause a political shitstorm, jeopardizing other parts of PPACA.

            •  Yes, and your description of 'rebates' is one (2+ / 0-)
              Recommended by:
              T Maysle, Willa Rogers


              I don't know anyone who's not 'in favor of' all Americans (except some conservativces, LOL!) having access to both preventive and full medical services.

              However, a word of caution regarding 'mandatory' medical care.

              Here's an ugly page out of world (and US history) regarding this.  Frankly, I don't want 'to go there,' ever again.  [BTW, this is not to imply that I WAS there, LOL!]

              Compulsory sterilization

              Compulsory sterilization, also known as forced sterilization (or compulsory sterilisation respectively forced sterilisation – see spelling differences), programs are government policies which attempt to force people to undergo surgical sterilization.

              In the first half of the 20th century, several such programs were instituted in countries around the world, usually as part of eugenics programs intended to prevent the reproduction and multiplication of members of the population considered to be carriers of defective genetic traits.

              So, let's just keep a reasonable 'sense of proportion' about this.  

              Personally, I have no desire to live in a country which exercises 'totalitarian control' over its people, from 'the left or from the right.'

              And, btw, European health care models are largely successful because, in so many of those countries, they have either a single-payer system, or the insurance industry is strictly not-for-profit.

              If it seems 'impossible' that we could ever 'go back there'  [compulsory sterilization]--don't forget that abortions were mostly outlawed here until Roe v Wade--when they were 'liberalized.'

              Yet, over my lifetime, the trend has reversed itself. In many states today, abortions are legal only by the most narrow definition.

              I just read the other day that, I believe in North Dakota--it was one of the Dakotas--the legislature has outlawed abortion after 6 weeks!  

              So, IMHO, we collectively need to exercise a bit of 'constraint' when it comes giving 'the government' that much control--especially, in the field of health care.

              And, don't forget--Republicans will be 'in control' again!

              Once you cede authority to the government, it won't give it back.

              Does anyone at DKos really want a bunch of Conservatives 'dictating' their medical treatments?

              Speaking only for myself--I'd say an unqualified, 'no way.'  ;-)


              "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


              by musiccitymollie on Fri May 24, 2013 at 04:46:24 PM PDT

              [ Parent ]

      •  Another thought: (3+ / 0-)
        Recommended by:
        musiccitymollie, Ianb007, linkage

        Now that most doctors are employed directly by for-profit hospital groups (with the trend only growing), what happens when those mandatory physicals lead to further testing or utilization that enhances those doctors' employers' bottom lines?

        •  Further testing - (1+ / 0-)
          Recommended by:

          Well, hopefully that would lead to catching things before they get too advanced.
          As to unnecessary testing - yeah, that's a definite concern. But do we not do preventative screening?

          Seems like there's gotta be a better answer.

          OK - I hear my donut calling! Ha!  

          •  I think a free preventative healthcare (2+ / 0-)
            Recommended by:
            Willa Rogers, linkage

            screening and check as is now the law under Obamacare is as far as the govt should go in encouraging better preventative action..  Educational campaigns for the masses is also great way to n urge behavior in the right direction.

            Right man, right job and right time

            by Ianb007 on Fri May 24, 2013 at 06:08:27 PM PDT

            [ Parent ]

      •  The benefits of yearly exams (2+ / 0-)
        Recommended by:
        Willa Rogers, linkage

        We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

        by denise b on Fri May 24, 2013 at 05:02:33 PM PDT

        [ Parent ]

    •  This will probably be on the IRS's questionaire re (1+ / 0-)
      Recommended by:

      whether or not one has a 'qualifying' health plan. after all, it says "must", and these use federal guidelines, no?

      If a health and wellness visit isn't a physical exam, what is it? A little chat, with no labs?

    •  They can't make you do anything (2+ / 0-)
      Recommended by:
      Onomastic, linkage

      But they can hound you to do so, to the point where you just give in. Especially since it won't cost anything out of pocket.

      That was the point of having no copays for preventive care - to make it a no brainer for people to get regular checkups.

      •  It'd be easy for them to withhold subsidies... (1+ / 0-)
        Recommended by:

        ...if you refuse to have your "government-mandated physical."

        (I use the quotes to show how it would/will be framed politically if this indeed is the case.)

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