Is anyone one a little concerned that the new healthcare reform could hurt you more than help you?

[Anonymous]

Anonymous wrote:You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.

What a coincidence--I was looking at this thread a few hours ago, and just now jumped on to write about nurse practitioners as an alternative to MDs. I see an NP right now, and absolutely love the care I get from her. Unlike any doctor I've seen in the past decade, she actually has time to listen to me, and we have actual conversations about the state of my health and lifestyle changes I should be making. My insurance allows me to go out-of-network and see whoever I want--but my NP is the person who provides the best possible care for me.

I see two things contributing to the doctor shortage (which I agree will be acute in the next few years): The difficulty in establishing new medical schools/residency programs, and the ridiculous length of time it takes to get an MD. Both I blame on the anti-competitive practices of the AMA.

For basic checkups, I really don't need someone who knows how to perform surgery or deliver a baby. Well-patient care belongs in the hands of professionals who are good at taking care of human beings, not ludicrously over-educated MDs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm worried that if more people get health insurance, they will start going to see doctors more and trying to get more access to health care. Good for them, of course, but we're going to need more doctors or else waiting times will get longer. especially if you want to switch to a new doctor.

Of course, it may mean less time in the emergency room when you have a true pediatric emergency because there won't be a guy ahead of you with the sniffles who decided to come ot the ER because he doesn't have a primary care physician because he lacks health insurance.

And all those new primary care physicians are going to come from where? I made my "well woman' appointment and the earliest date was 12 weeks! Before "reform"! So much for using my birthday as a reminder for a well woman appt ... way off the calendar schedule now.

Create the market and they will come. And there will be a much larger use of nurse practitioners and physician assistants as well. Lots of new career opportunities.

You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.

I really don't need a doctor telling me I've got pink eye or a sinus infection. It's stupid to overpay for services. If you actually need a physician, they call one into the office. No big deal.

[Anonymous]

Anonymous wrote:
You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.

Sweeitie, you don't think what we have right now IS a tewo-tier system??

Some people have health insurance and get to be seen by doctors and others don't have health insirance and get turned away by the ER until they are at death's door, then have to be treated.

The one tier system would have involved a public option, but that was a non-starter and was dismissed as "ObamaCare". We aren't getting that.

[Anonymous]

(sorry for typos, I have a kid on my lap)

[Anonymous]

Yeah I have to agree - we love seeing the NP at our pediatrician's office. Very qualified, she knows her stuff - which is more than I can say about some of the doctors there! My favorite is still when I brought my 2 year old in for a very red itchy eye with lots of gunk coming out of it. The doctor diagnosed an ear infection. Shockingly, the rest of us got pink eye within a few days. The NP cleared us all up.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.

What a coincidence--I was looking at this thread a few hours ago, and just now jumped on to write about nurse practitioners as an alternative to MDs. I see an NP right now, and absolutely love the care I get from her. Unlike any doctor I've seen in the past decade, she actually has time to listen to me, and we have actual conversations about the state of my health and lifestyle changes I should be making. My insurance allows me to go out-of-network and see whoever I want--but my NP is the person who provides the best possible care for me.

I see two things contributing to the doctor shortage (which I agree will be acute in the next few years): The difficulty in establishing new medical schools/residency programs, and the ridiculous length of time it takes to get an MD. Both I blame on the anti-competitive practices of the AMA.

For basic checkups, I really don't need someone who knows how to perform surgery or deliver a baby. Well-patient care belongs in the hands of professionals who are good at taking care of human beings, not ludicrously over-educated MDs.[/quote]




They have tried the moderately trained doctors and well trained NPs and PAs elsewhere (Africa), it does not work.

[Anonymous]

As an NP whose patients tell me they prefer to see me over the doc who never listens or spend any time with them, I take offense at the PP's insults. The majority of complaints that bring people in for medical care can be handled by an NP or PA.

[Anonymous]

I love our NP at our pediatrician's office. My kids are (so far) healthy and I have no problems or questions. Why bother the doctor when a NP is sufficient for annual checkups?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm worried that if more people get health insurance, they will start going to see doctors more and trying to get more access to health care. Good for them, of course, but we're going to need more doctors or else waiting times will get longer. especially if you want to switch to a new doctor.

Of course, it may mean less time in the emergency room when you have a true pediatric emergency because there won't be a guy ahead of you with the sniffles who decided to come ot the ER because he doesn't have a primary care physician because he lacks health insurance.

Actually we will likely all spend MORE time in the ER because they will be inundated by newly insured patients who want to see a physician but can't find primary care physicians to see them. As a physician, every physician I know is wondering who the heck is going to take care of the newly insured? And this is the hot topic in the editorial sections of most journals and on physician geared websites/message boards. Most hospitals are prepping for a deluge of new ER patients.

This is the most oddest argument I have heard against health reform. No that you do not have the "you do not have insurance" excuse, you and your fellow doctors will just have to work a little bit harder (sorry about that tee time you will have to miss). Isn't that the reason you went to medical school - to treat the sick.

[Anonymous]

Ok the arguments that doctors aren't working hard enough are just silly. I don't know of any slacker doctors who spend all their time golfing and not enough time taking care of patients.

Secondly - there will be lots more jobs created - more nurses, more NPs, more PAs, more MDs, etc. Where there is a market, there will be jobs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm worried that if more people get health insurance, they will start going to see doctors more and trying to get more access to health care. Good for them, of course, but we're going to need more doctors or else waiting times will get longer. especially if you want to switch to a new doctor.

Of course, it may mean less time in the emergency room when you have a true pediatric emergency because there won't be a guy ahead of you with the sniffles who decided to come ot the ER because he doesn't have a primary care physician because he lacks health insurance.

Actually we will likely all spend MORE time in the ER because they will be inundated by newly insured patients who want to see a physician but can't find primary care physicians to see them. As a physician, every physician I know is wondering who the heck is going to take care of the newly insured? And this is the hot topic in the editorial sections of most journals and on physician geared websites/message boards. Most hospitals are prepping for a deluge of new ER patients.

This is the most oddest argument I have heard against health reform. No that you do not have the "you do not have insurance" excuse, you and your fellow doctors will just have to work a little bit harder (sorry about that tee time you will have to miss). Isn't that the reason you went to medical school - to treat the sick.

So you actually think that when your primary care doctor isn't taking new patients or is booked for 3 months it's because he/she is out golfing and/or slacking off? No, we all have more patients than we know what do with right now. At present I work 12 hour weekdays plus 4 hours every other Saturday. But perhaps you would prefer that I work around the clock. I could see patients all evening and night as well as all day!! See my children? Sleep? No, that would be selfish in your eyes.

Or perhaps losers like you could go to medical school if it's such the life of leisure that you imagine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can someone explain why they want to tax "expensive" health plans?

Also, why does the family who decides not to buy insurance have to pay a penalty?

Because, if you only add a bunch of previously un-insurable people (with expensive pre-exisiting conditions) into the risk pool, your expenses will go WAY up and everyone will end up paying more in premiums. You also need to add in a good number of the young and healthy who will pay premiums but not utilize care. These young and healthy people are exactly those who might chose not to purchase insurance without a mandate/fine.

Also, if a young healthy person doesn't have to buy insurance, he/she will wait until they get really sick and then buy insurance. So they're benefiting by working the system but the system gets screwed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Can someone explain why they want to tax "expensive" health plans?

Also, why does the family who decides not to buy insurance have to pay a penalty?

Because, if you only add a bunch of previously un-insurable people (with expensive pre-exisiting conditions) into the risk pool, your expenses will go WAY up and everyone will end up paying more in premiums. You also need to add in a good number of the young and healthy who will pay premiums but not utilize care. These young and healthy people are exactly those who might chose not to purchase insurance without a mandate/fine.

Also, if a young healthy person doesn't have to buy insurance, he/she will wait until they get really sick and then buy insurance. So they're benefiting by working the system but the system gets screwed.

The joke among some physicians I know (who are all self-insured) is that they will drop their current insurance policies, pay the fines (tiny when compared to the policies they currently pay) and then make the call to re-enroll when they're "in the ambulance" with a life threatening emergency and about to need care. You just have to remember to have the insurance companies number on your cell phone speed dial! That way, you pay in nothing and the insurance "system" pays all your big bills.

How long before this is common place and the "system" implodes?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Can someone explain why they want to tax "expensive" health plans?

Also, why does the family who decides not to buy insurance have to pay a penalty?

Because, if you only add a bunch of previously un-insurable people (with expensive pre-exisiting conditions) into the risk pool, your expenses will go WAY up and everyone will end up paying more in premiums. You also need to add in a good number of the young and healthy who will pay premiums but not utilize care. These young and healthy people are exactly those who might chose not to purchase insurance without a mandate/fine.

Also, if a young healthy person doesn't have to buy insurance, he/she will wait until they get really sick and then buy insurance. So they're benefiting by working the system but the system gets screwed.

The joke among some physicians I know (who are all self-insured) is that they will drop their current insurance policies, pay the fines (tiny when compared to the policies they currently pay) and then make the call to re-enroll when they're "in the ambulance" with a life threatening emergency and about to need care. You just have to remember to have the insurance companies number on your cell phone speed dial! That way, you pay in nothing and the insurance "system" pays all your big bills.

How long before this is common place and the "system" implodes?

I'd be VERY surprised if there aren't crowd-out provisions and mandatory open enrollment periods in all of this, which are designed to prevent specifically what you are talking about.

[jsteele]

Anonymous wrote:
The joke among some physicians I know (who are all self-insured) is that they will drop their current insurance policies, pay the fines (tiny when compared to the policies they currently pay) and then make the call to re-enroll when they're "in the ambulance" with a life threatening emergency and about to need care. You just have to remember to have the insurance companies number on your cell phone speed dial! That way, you pay in nothing and the insurance "system" pays all your big bills.

How long before this is common place and the "system" implodes?

It will be longer than it would have been for the system to implode without reform. Also, just hope your medical emergency allows you to use the phone. If you are are unconscious, speed dial won't be much help.

The irony of all of this is that none of these scenarios that anti-reformers come up with would matter if we would implement single-payer (the one option Obama refused to consider).