Oh, I know my lib friends will tell me that all of this is either the result of the still eeeeevvvvviiiiilllll insurance companies and of course the fact that this is such a large program, this Obamacare.
Well today I will share two aspects of the so-called Affordable Care Act. One is this article from the Left Angeles Times and the other a personal true story.
The thrust of the Times article is that, surprise!, many of those enrolled the California state health insurance exchange, Covered California, are having trouble with doctors and whether or not they are actually a part of Covered California.
Take Danielle Nelson of Aliso Viejo in Orange County, California.
Miss Nelson signed up with Anthem/Blue Cross HMO and at the time of her sign-up already been diagnosed with non-Hodgkin's lymphoma. In January she discovered a lump near her jaw. When she signed up under Covered California Anthem/Blue Cross, she was assured multiple times that oncologists that she wanted were part of the network they work with. But she went to her oncologists office and, again surprise!, there is a nice bright orange sign saying that in fact they are NOT part of Covered California Anthem/Blue Cross. The sad part is Miss Nelson's reaction to this:
"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night. I can't imagine this is how President Obama wanted it to happen."
Yes, I am doing a major-league face-palm and a couple of SMHs*.
It does not matter what the Dear Leader, President Obama, wanted to happen. What is reality is because, in the immortal words of then Speaker of the House, Rep. Nancy Pelosi (D-Ca.), we have to pass the bill to see what's in it.
And of course this is what is in it.
Because the crony capitalist health care companies need to hold down costs, they are offering fewer doctors and hospitals that are in network.
Thus insurance companies are putting incomplete and uncorroborated information about doctor and hospital availability. And it is affecting real people. People like Miss Nelson.
But get a pant load of this from the California insurance commissioner, Democrat Dave Jones:
"It's a little early for anyone to know how widespread and deep this problem is. There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."
The now head-shaking face-palms and SMHs are getting stronger.
It is proof of what we who opposed the so-called Affordable Care Act warned long before now. It is one of the reasons that some people like Sen. Ted Cruz (R-Texas) and Sen. Mike Lee (R-Utah) wanted the whole hot mess repealed.
I highlighted the second part of Mr. Jones' comment because there is cost-containment right at the point of doctor and hospital availability. And Mr. Jones' is correct that hell yeah, this is a huge issue. And it is not limited to California.
In defense of the people that did sign-up in the health insurance marketplace, they went by information provided by the insurance companies and Covered California. The least that it can be is accurate, up-to-date information. Especially because many of those signing up are people with serious, preexisting conditions.
Again, we warned of these things happening not by error but by design. Because one can not expand a pool of people, many unhealthy to begin with, and expect Cadillac health care. Hell for many that do not get the federal subsidy, its not really all that affordable.
Now I would like to relate a direct effect of Obamacare on my household.
For about eight years now, we have been getting health coverage thru Mrs. RVFTLC's employer. It is an HMO and by and large we have not had any problem with it. Sometimes the referral process is a bit long, but otherwise it is great coverage for us.
Mrs. RVFTLC is diabetic and uses an insulin pump. The pump itself is constant, but the supplies that go with it to make it work are not and have to be ordered like a prescription. There is a needle attachment and the reservoir that goes in the pump for the insulin to be in. The insulin is essentially constantly pumping the insulin through a narrow tube and is part of the needle attachment.
There is some background.
Mrs. RVFTLC had been waiting for the replacement supplies since the beginning of the year. She contacted the pump company, Medtronic, and they had placed the order for the replacement supplies. Again, this was the first of the year. She was waiting. And waiting. And realized that she was running out. Without the supplies, she has to go back to shots which has it's own problems. Once again she contacted Medtronic and was told that they are waiting for authorization from the insurance company. She was told by Medtronic and her regular diabetic doctor/internist that this is due to all the enrollment into O-care. That the insurance companies are backed up in such authorizations. Now as I noted, Mrs. RVFTLC can use shots. But the interruption means that she has to essentially reset the pump, which is a long process and often requires phone assistance from one of Medronics very wonderful staff. If you are having to use an insulin pump, this company is awesome and I would recommend that you should get your pump through this company. We are not under any O-care plan. This is health insurance provided by Mrs. RVFTLC's employer. Yet because of all the changes wrought by O-care, Mrs. RVFTLC is a victim. It makes me wonder how many other diabetics are in a similar situation not just in California but in the United States?
These examples are but many highlighting the folly that has been and is health care now in the United States. The standards of those that already have insurance, whether it is a group policy provided by an employer at shared cost or on the open individual insurance market is clearly being lowered. At some point I will not be surprised if the insurance company will stop authorizing insulin pumps due to costs. What this health care scam does, as all government controlled plans do, is stifle any innovation. Better drugs? More expensive. New treatments? Too expensive. To keep everyone covered, costs are paramount, not patient care. And while the eeeeevvvvviiiiilllll health insurance companies have done that on more than one occasion, do you still really think that government controlled health care will do better? Of course not. It never does.
When this so-called reform truly affects real people and their health problems, the folly of it makes it all the more tragic and must lead to repeal the so-called Affordable Care Act and replace with real reform that will truly give those with no access to health care insurance coverage just that and not lower the plans that the vast majority of Americans have now.
*SMH-Slap My Head
Showing posts with label doctor shortages. Show all posts
Showing posts with label doctor shortages. Show all posts
Wednesday, February 05, 2014
Monday, September 23, 2013
Another Joy Of Obamacare: Primary Care Doctor Shortages
I'm sure that this is an unintended effect of the so-called Patient Protection and Affordable Care Act that there would be primary care doctor shortages, right?
I guess so since this article suggests that in the United States there needs to be 40,000 new primary care doctors just to maybe ease a shortage of said doctors as the implementation of Obamacare becomes a reality.
A little lesson in logic before I move on.
Again, you can not expand the pool of people that will be insured, offer supposed quality care without enough PCP (bad acronym, I know) to take care of said newly insured people.
Logic and liberal left Democrats, does not exist.
I guess that people who go to medical school should probably not bother to go into speciality fields where they may actually make money. That is probably what the liberal left Democrats will do next to make sure that there is not a shortage of PCP.
The PCP is the one that we just used to call the family doctor. You know if you are old enough that sometimes back in the day, many would actually come to one's home. Thus the expression about doctors making house calls.
Those days are long gone.
But the PCP today is what they are called. It is who we all go to when we have a medical problem to have an assessment. The PCP will do what he or she can and often refer patients to specialists that will be able to better treat said patients for long-term medical problems.
But there are not enough of these PCPs and one reason is simple.
They do not get good reimbursement from insurance companies and will more than likely get even less under Obamacare.
The PCP in the linked story, Dr. Reed Wilson, points this out.
The average debt for a PCP once they attain the necessary loans and complete their studies is a staggering $170,000 before they see one patient.
Thus a student needs to make a decision before they walk into medical school. And that is what field will they study. And now more than ever they are going into speciality fields because that is where the money is. And where the money is will pay off the loans that they had to take out to go to medical school in the first place.
So what to do about the problem?
Well, leave it to the liberal left Dems to come up with a solution in nurse practitioners being allowed a greater role in patient care.
That is the "solution" put forth by state senator Ed Hernandez, an optometrist.
As Dr. Wilson pointed out NPs are great for the basics. And I agree. Many nurses when it comes to the basics are very good. But for actually diagnosing patients the way that a PCP does, uh not so much.
To state Sen. Hernandez, don't address the real issue. And that is PCP shortages and or compensation, but throw out something that has a less paid, educated and trained person as a nurse practitioner to help, supposedly, ease doctor shortages.
If I went to Dr. Hernandez for eye care, would he let one of his assistants complete an eye exam and determine my eye-care needs?
I don't think so.
One aspect that the article did not address is that there is a growing amount of PCPs that are getting out of the insurance business and not accepting insurance patients. They are essentially seeing patients and only take cash for that. And a lot of people that can afford it are seeing these doctors. Is that a possibility as to why there are real doctor shortages in not just California but the United States as a whole?
So how much does a PCP make in comparison to specialists?
This link, while outdated by a year, illustrates that there is a serious divide.
Here is what the umbrella of PCPs made on average in 2012:
Pediatricians: $173,000 (up from $156,000 a year before)
Family medicine doctors: $175,000 (up from $158,000)
Internal medicine doctors: $185,000 (up from $165,000)
Oh, I know that sounds like a lot of money. But between repaying student loans and medical malpractice insurance and taxes, it is not all that much for someone fresh out of medical school. Remember this is an average and that a rookie PCP probably makes nowhere near this kind of money.
And specialists?
Here are what some specialists make in a year:
Dermatologists: $306,000
Plastic surgeons: $317,000
Urologists: $340,000
Radiologists: $349,000
Cardiologists: $357,000
Orthopedists: $405,000
So if I were thinking of becoming a doctor and looked at who makes what, I would more than likely consider a speciality over being a gatekeeper, which is what a PCP has become.
A PCP does a lot of work and really gets the shaft.
Yet they are the bulwark of the totally misnamed PPACA.
Dr. Wilson makes the obvious point that we will not attract good PCPs if there is not adequate compensation. And another fact that is truly disturbing is that only 30% of PCPs actually own their practice. In other words 70% of PCPs work for insurance companies and or medical groups.
And I let Dr. Wilson explain the obvious:
“I love taking care of patients. I’m in an area where I can take time with my patients. But how do you get the best and brightest if you don’t reward them?”
Yes, how do you do that? And how does Obamacare keep medical costs down while supposedly providing healthcare to all Americans?
It does not and it really counts on the PCP shortage to keep costs down.
And that is a scam if ever there was one.
I guess so since this article suggests that in the United States there needs to be 40,000 new primary care doctors just to maybe ease a shortage of said doctors as the implementation of Obamacare becomes a reality.
A little lesson in logic before I move on.
Again, you can not expand the pool of people that will be insured, offer supposed quality care without enough PCP (bad acronym, I know) to take care of said newly insured people.
Logic and liberal left Democrats, does not exist.
I guess that people who go to medical school should probably not bother to go into speciality fields where they may actually make money. That is probably what the liberal left Democrats will do next to make sure that there is not a shortage of PCP.
The PCP is the one that we just used to call the family doctor. You know if you are old enough that sometimes back in the day, many would actually come to one's home. Thus the expression about doctors making house calls.
Those days are long gone.
But the PCP today is what they are called. It is who we all go to when we have a medical problem to have an assessment. The PCP will do what he or she can and often refer patients to specialists that will be able to better treat said patients for long-term medical problems.
But there are not enough of these PCPs and one reason is simple.
They do not get good reimbursement from insurance companies and will more than likely get even less under Obamacare.
The PCP in the linked story, Dr. Reed Wilson, points this out.
The average debt for a PCP once they attain the necessary loans and complete their studies is a staggering $170,000 before they see one patient.
Thus a student needs to make a decision before they walk into medical school. And that is what field will they study. And now more than ever they are going into speciality fields because that is where the money is. And where the money is will pay off the loans that they had to take out to go to medical school in the first place.
So what to do about the problem?
Well, leave it to the liberal left Dems to come up with a solution in nurse practitioners being allowed a greater role in patient care.
That is the "solution" put forth by state senator Ed Hernandez, an optometrist.
As Dr. Wilson pointed out NPs are great for the basics. And I agree. Many nurses when it comes to the basics are very good. But for actually diagnosing patients the way that a PCP does, uh not so much.
To state Sen. Hernandez, don't address the real issue. And that is PCP shortages and or compensation, but throw out something that has a less paid, educated and trained person as a nurse practitioner to help, supposedly, ease doctor shortages.
If I went to Dr. Hernandez for eye care, would he let one of his assistants complete an eye exam and determine my eye-care needs?
I don't think so.
One aspect that the article did not address is that there is a growing amount of PCPs that are getting out of the insurance business and not accepting insurance patients. They are essentially seeing patients and only take cash for that. And a lot of people that can afford it are seeing these doctors. Is that a possibility as to why there are real doctor shortages in not just California but the United States as a whole?
So how much does a PCP make in comparison to specialists?
This link, while outdated by a year, illustrates that there is a serious divide.
Here is what the umbrella of PCPs made on average in 2012:
Oh, I know that sounds like a lot of money. But between repaying student loans and medical malpractice insurance and taxes, it is not all that much for someone fresh out of medical school. Remember this is an average and that a rookie PCP probably makes nowhere near this kind of money.
And specialists?
Here are what some specialists make in a year:
So if I were thinking of becoming a doctor and looked at who makes what, I would more than likely consider a speciality over being a gatekeeper, which is what a PCP has become.
A PCP does a lot of work and really gets the shaft.
Yet they are the bulwark of the totally misnamed PPACA.
Dr. Wilson makes the obvious point that we will not attract good PCPs if there is not adequate compensation. And another fact that is truly disturbing is that only 30% of PCPs actually own their practice. In other words 70% of PCPs work for insurance companies and or medical groups.
And I let Dr. Wilson explain the obvious:
“I love taking care of patients. I’m in an area where I can take time with my patients. But how do you get the best and brightest if you don’t reward them?”
Yes, how do you do that? And how does Obamacare keep medical costs down while supposedly providing healthcare to all Americans?
It does not and it really counts on the PCP shortage to keep costs down.
And that is a scam if ever there was one.
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