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

[Anonymous]

I would love to see our healthcare system do more to reward doctors (and patients) for proactive, preventative care to keep patients healthy. As it currently stands, our systems is pay for procedure, so doctors and hospitals make more by doing more, not by preventing more. (Before anyone flames me - I am not saying that this is what motivates doctors, but this is how the system pays doctors). It's one of the reasons we have such a shortage of internal medicine specialists. Sub-specialties are more lucrative when you have lots of loans to pay.

[Anonymous]

jsteele wrote:

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).

I'm not saying that my illustration of the "call from the ambulance" is a good thing. It's very concerning but I don't see anything is this legislation that will prevent that exact scenario from happening over and over again. (perhaps with the patient's wife making the call should he be unable). But the point being, an insurance system can't be solvent if it allows people to enroll at the very moment that they are about to have a zillion dollar claim (having previously paid in nothing or next to nothing via fines).

I agree 100% with you Jeff that what we need (needed at this point) is a true, single payer system. I am just very concerned about what we ended up with.

[Anonymous]

Anonymous wrote:
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?

I also request to see the NP instead of the doctor at all my visits. To me, she seems just as knowledgeable and more friendly.

[Anonymous]

Anonymous wrote: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.

The next time you need surgery, let an NP do it.

[Anonymous]

Anonymous wrote:I would love to see our healthcare system do more to reward doctors (and patients) for proactive, preventative care to keep patients healthy. As it currently stands, our systems is pay for procedure, so doctors and hospitals make more by doing more, not by preventing more. (Before anyone flames me - I am not saying that this is what motivates doctors, but this is how the system pays doctors). It's one of the reasons we have such a shortage of internal medicine specialists. Sub-specialties are more lucrative when you have lots of loans to pay.

If you don't already know, patients should keep themselves healthy. You know, don't smoke, don't get fat, don't drink, don't use drugs, low salt and so on.
This idea that seeing a doctor is going to take away the bad habits that we have that take years off our lives is ludicrous. Each person has the power to ward of MOST illnesses today. I am not sure why these politicians don't preach more about lifestyle choices and poor health. Keep in mind that an educated person with no health insurance lives longer than an uneducated one with health insurance.

[Anonymous]

http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/?hpid=topnews

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

The next time you need surgery, let an NP do it.

Now that's just silly. Most lines of work have divisions of labor. Is it that hard for you to envision it in a doctor's office?

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

The next time you need surgery, let an NP do it.

I think the poster was talking about basic well-child/well-adult visits. I have an NP as my primary, and she certainly knows when to refer me to someone else.

If we had more NPs/PAs working as primary care providers, that would free doctors to do the things that actually require that much training.

[Anonymous]

I'm having a really hard time with the argument that insuring more people is bad because there aren't enough doctors to treat the currently uninsured. It seems to me that it's a good idea to have enough doctors to treat everyone, and therefore the doctor shortage isn't related to who does & doesn't have insurance, it's related to this nation's entire population.

So in light of this disconnect, I see two ways to handle changes in healthcare:

1. We insure the uninsured, then the medical community responds by accelerating training. Result: a temporary (10-year?) acute shortage of doctors.
2. The medical community accelerates training, then we insure the uninsured. Result: a temporary glut of doctors.

...I guess there's also:

3. Status quo: doctors are overworked, and people go bankrupt as a result of heart attacks, car accidents, etc. Meanwhile, assuming no expansion of medical training programs, as the nation's population increases we eventually get to the acute shortage of doctors.

Personally, I think Option 1 is the best long-term solution.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

The next time you need surgery, let an NP do it.

I think the poster was talking about basic well-child/well-adult visits. I have an NP as my primary, and she certainly knows when to refer me to someone else.

If we had more NPs/PAs working as primary care providers, that would free doctors to do the things that actually require that much training.

The potential problems with this is 2 fold:

1) Midlevels (NPs and PAs) have been used extensively in several national healthcare system for the past decade. The VA system and Kaiser are two such entities and both are now trending AWAY from hiring midlevels (and back to all physician staffs) because they found that using midlevels actually INCREASED the costs of health care delivery because midlevels are much more likely to refer patients to specialists immediately whereas a good internist will judiciously refer but manage many things independently.

2)Primary care as referred to in this post---annual exams, sinus infections, conjunctivitis) could easily be managed by an NP. Heck, everyone could diagnosis their own sinus infections and conjunctivitis (via Dr. Google) if they had access to antibiotics. (not suggesting this should be done but ultimately, these types of things aren't rocket science). What you're generally not going to get from an NP but you will from a good internist is any sort of outside-the-box thinking of diagnoses that aren't immediately apparent. Things that a physician only saw a few times during residency and that an NP would never have seen in 18 months of training. A rash that turns out not to be a superficial issue at all but actually the result of a far more serious underlying rheumatologic issue. Things that only become apparent when the right questions are asked and the right tests ordered by someone who has seen it all in training and as a result recognizes it when he sees it again. Seeing an NP for annual exams, etc. is great until something obscure is missed or mismanaged because of inexperience or a fundamental lack of knowledge. Then suddenly it's not so great. Sometimes it's already too late to go running to the back-up physician.

[Anonymous]

If business people hate this health care reform so much, why haven't the stock markets reflected that today? I was expecting them to completely tank. But they are actually up.

[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.

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.

I have little sympathy for you, PP. And I'm glad you are not my doctor (yes, I'm sure you are not). My doctor turns away patients when his practice is full. He gets enough rest and sees his family. Yes, he has to work some weekends and evenings, but he's not worn down to the bone, nor is he overwhelmed by patients. You obviously don't know my doctor. Health care reform will not affect the hours my doctor works, which are longer than say, a teacher's hours, but he gets paid a lot more than most teachers.

Capitalism works on a supply and demand system. More patients, more doctors, more jobs. It will take time for the system to adjust, but adjust it will. And it won't be on your poor tired back, PP, because you can choose not to see so many patients or work so many hours. Spend time with your kids. Make less money. It's a choice.

In response to the OP's question, we have great insurance, and we're going to pay more for it under the new program. Yipee!! I am so happy we will pay a teensy bit more for our health insurance if it means that my self-employed BIL can now get insurance for a pre-existing condition. He and his family have been living in fear that his condition will return and bankrupt them all. He can afford the premiums, but all insurance companies he's applied to have turned him down. Until now. Hurray!! He's going to apply as soon as he can. And no insurance company will be allowed to turn him (or anyone else with a pre-existing condition) down again.

[Anonymous]

Anonymous wrote:

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.

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.

I have little sympathy for you, PP. And I'm glad you are not my doctor (yes, I'm sure you are not). My doctor turns away patients when his practice is full. He gets enough rest and sees his family. Yes, he has to work some weekends and evenings, but he's not worn down to the bone, nor is he overwhelmed by patients. You obviously don't know my doctor. Health care reform will not affect the hours my doctor works, which are longer than say, a teacher's hours, but he gets paid a lot more than most teachers.

Capitalism works on a supply and demand system. More patients, more doctors, more jobs. It will take time for the system to adjust, but adjust it will. And it won't be on your poor tired back, PP, because you can choose not to see so many patients or work so many hours. Spend time with your kids. Make less money. It's a choice.

In response to the OP's question, we have great insurance, and we're going to pay more for it under the new program. Yipee!! I am so happy we will pay a teensy bit more for our health insurance if it means that my self-employed BIL can now get insurance for a pre-existing condition. He and his family have been living in fear that his condition will return and bankrupt them all. He can afford the premiums, but all insurance companies he's applied to have turned him down. Until now. Hurray!! He's going to apply as soon as he can. And no insurance company will be allowed to turn him (or anyone else with a pre-existing condition) down again.

How do you know this? Are you having an intimate relationship with him?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

The next time you need surgery, let an NP do it.

I think the poster was talking about basic well-child/well-adult visits. I have an NP as my primary, and she certainly knows when to refer me to someone else.

If we had more NPs/PAs working as primary care providers, that would free doctors to do the things that actually require that much training.

The potential problems with this is 2 fold:

1) Midlevels (NPs and PAs) have been used extensively in several national healthcare system for the past decade. The VA system and Kaiser are two such entities and both are now trending AWAY from hiring midlevels (and back to all physician staffs) because they found that using midlevels actually INCREASED the costs of health care delivery because midlevels are much more likely to refer patients to specialists immediately whereas a good internist will judiciously refer but manage many things independently.

2)Primary care as referred to in this post---annual exams, sinus infections, conjunctivitis) could easily be managed by an NP. Heck, everyone could diagnosis their own sinus infections and conjunctivitis (via Dr. Google) if they had access to antibiotics. (not suggesting this should be done but ultimately, these types of things aren't rocket science). What you're generally not going to get from an NP but you will from a good internist is any sort of outside-the-box thinking of diagnoses that aren't immediately apparent. Things that a physician only saw a few times during residency and that an NP would never have seen in 18 months of training. A rash that turns out not to be a superficial issue at all but actually the result of a far more serious underlying rheumatologic issue. Things that only become apparent when the right questions are asked and the right tests ordered by someone who has seen it all in training and as a result recognizes it when he sees it again. Seeing an NP for annual exams, etc. is great until something obscure is missed or mismanaged because of inexperience or a fundamental lack of knowledge. Then suddenly it's not so great. Sometimes it's already too late to go running to the back-up physician.

I disagree. There are many illnesses that you don't get a second chance on like Kawasaki's disease if missed, it could mean bad news.

[Anonymous]

FYI everyone, the NPs ARE smarter. They make a ton of money, get a full night's sleep, don't pay malpractice insurance (the doctor gets sued), and all this with a master's degree.