Obamacare

[Wneglia]

Hey Doc - we know you're busy, but when you get a chance, could you post your own view as to why universal single payer medical coverage is acceptably workable in so many other places, but would not work equally well in the US?

I would not oppose Medicare for all if it could be run efficiently. It would be better than the system that is being implemented, and better than the status quo. It works fairly well in Canada, but people there are accustomed to longer waiting times and it would take a while for the US to adjust to that.

[Wneglia]

Wneglia, is your practice part of one or more networks that insurers currently penalize policyholders for going outside of?

Not that I'm aware of.

All your patients have to cover out of network costs or does the network thing not apply to your specialty?

I don't know the details of our patients' policies, but I believe we are in the network for most policies. I have not heard of our patients having out of network expenses.

[Wneglia]

...I believe we are in the network for most policies...

So, if for whatever reason a patient wishes to see a competitor of yours that's out of network s/he pays a lot more out of pocket. How is that different from your "Out of Network? Shit out of luck!" link?

I think most of the practices down here are in the same networks. I know our local competitor is in the same network for the major carriers in this area. The only difference is that our competitor doesn't see Medicaid, and we do.

[O Really]

but people there are accustomed to longer waiting times and it would take a while for the US to adjust to that.

I guess wait time is relative. If I call my dermatologist for an appointment, unless I tell them my skin is falling off in chunks like a zombie, it's about six weeks. Several weeks out for my wife to schedule a thyroid test. Same for scheduling the dreaded colonoscopy at Asheville Gastro. Nice people, but not exactly instant service. What do they do in Canada?

[Wneglia]

I think most of the practices down here are in the same networks...

So, we might see the exact same thing with the New York Health Exchange and Murdoch's NYP could just be engaging in deceptive fear mongering, right?

It would all depend upon who signs up as a provider in the NY network. I don't forsee doctors rushing to sign up for plans that pay Medicaid rates. So far, less than 25% of doctors surveyed by the NY Medical Society say they are definitely signing up. Some are still deciding.

[Boatrocker]

but people there are accustomed to longer waiting times and it would take a while for the US to adjust to that.

I guess wait time is relative. If I call my dermatologist for an appointment, unless I tell them my skin is falling off in chunks like a zombie, it's about six weeks. Several weeks out for my wife to schedule a thyroid test. Same for scheduling the dreaded colonoscopy at Asheville Gastro. Nice people, but not exactly instant service. What do they do in Canada?

That's why we have fuggin Emergency Rooms. I have been able to get same-day, non-ER response to a couple of torn retinae, though. They just treat me like an urgent case and work me right in for a nice, painful-as-hell zap with the laser. Having walked the walk with both my parents and my MiL, I can say that Medicare/Medicaid waiting times were no longer than what I've come to expect for my own routine health care visits.
Why is it some folk act as though they expect to be seen immediately for non-urgent care?

[rstrong]

but people there are accustomed to longer waiting times and it would take a while for the US to adjust to that.

I guess wait time is relative. If I call my dermatologist for an appointment, unless I tell them my skin is falling off in chunks like a zombie, it's about six weeks. Several weeks out for my wife to schedule a thyroid test. Same for scheduling the dreaded colonoscopy at Asheville Gastro. Nice people, but not exactly instant service. What do they do in Canada?

The rule of thumb in Canada is that emergencies are taken care of immediately, and at no cost. Our emergency room wait times are the same or better than in the US.

(If you're doing a comparison, watch for HOW the wait times are calculated. In the US it's usually the wait until the patient first sees a doctor. In Canada it's the wait until the END of the visit, when the patient is either released or admitted into the general hospital. When I went in with chest pains a few years ago I was triaged by a doctor within five minutes, had a more thorough checkout in twenty, and had the results back from an EKG, blood tests and X-Rays in about three hours. By most US standards I had a five or twenty minute wait. By most Canadian standards I had a three hour wait.)

On the other hand, the less of an emergency you have, the more likely you are to encounter wait times and fees. Sleep apnea for example has a waiting time for testing approaching two years.

But hold on there... I didn't wait two years. I didn't even wait two weeks.

Instead I went to a private clinic (RANA Medical) and had the overnight respiration, heart rate and blood oxygen test within a week. It cost me under $200, and my private insurance paid that. Insurance that cost FAR less than similar insurance in the US, because of what the public system covers. And it paid for my CPAP machine. (The test actually cost a bit more, but the government paid RANA what it would have cost had I stayed in the waiting list.)

Compare that to a friend in the US: It took three years of phone calls and letters to convince his insurer that he had a problem, and that he should get tested for sleep apnea. His insurer was billed $7000 for the same test. He then got immediate treatment. (A CPAP machine.)

So I encountered a two-year waiting list. But I only had to wait a week. My American friend had no waiting list. But he had to wait three years.

[O Really]

That's why we have fuggin Emergency Rooms. I have been able to get same-day, non-ER response to a couple of torn retinae, though. They just treat me like an urgent case and work me right in for a nice, painful-as-hell zap with the laser. Having walked the walk with both my parents and my MiL, I can say that Medicare/Medicaid waiting times were no longer than what I've come to expect for my own routine health care visits.
Why is it some folk act as though they expect to be seen immediately for non-urgent care?

And don't forget the Doc in a Box urgent care centers. Seems to me from rstrong's comments that the waiting issue is at worst a wash. I've had miserable-but-not-real-emergency care in the UK - maybe I'm just lucky, but it was quick and capable.

[bannination]

If MDs stop accepting Medicare/Medicaid in Henderson County they'll go broke, the economy will crash and half the residents will leave or die.

Boy is that the truth.

[neoplacebo]

Sure sounds like death panels to me.

[Wneglia]

Top Hospitals Opt Out

[neoplacebo]

Yep, death panels.

[Mr.B]

Wow! Six people signed up for Obamacare on the first day!!

Wow!

[Wneglia]

AmazonCare

[rstrong]

It's fun to watch the Republicans get upset about the ObamaCare web site, because something they tried to stop keeps stopping.

(The Republicans in Congress voted to repeal ObamaCare again and again and again, 40 times. It’s less a governing philosophy, and more like Charles Manson applying for parole.)

[Roland Deschain]

Wow! Six people signed up for Obamacare on the first day!!

Wow!

Hey give them credit..they wre up to 248 by the end of day two....that is only 77,000 and change short of what is needed!!

[Wneglia]

Aside from the political hype, assuming this gets traction and is adopted by multiple states, is it a violation of the 13th amendment?

I don't have a dog in this fight as I accept Medicaid patients, but I don't think doctors should be forced to do likewise and accept pennies on the dollar for reimbursement.

[rstrong]

I don't know how it works in single-payer countries. Are MDs required to see anyone in Canada rstrong?

Since in American terms we have "Medicare for all", doctors refusing to treat Medicare patients isn't an issue here since everyone has it.

Back in 2009 we had a recently arrived and recertified Egyptian doctor refuse to treat a legally married lesbian couple. I can't find a source for how the story ended, but it's a safe bet that the doctor was taken aside and had the Charter of Rights explained to her. By the clinic owner, let alone by the government. As the article states:

Manitoba doctors can accept or refuse a patient based on their current patient load, but can't discriminate based on race, gender, sexual orientation or anything else enshrined in the Charter of Rights and Freedoms.

Dianna Scarth, executive director of the Manitoba Human Rights Commission, would not confirm a complaint had been filed. But she maintained doctors and other health-care providers can't refuse to treat people based on their sexual orientation under the human rights code.

This happened at the Lakewood Medical Centre, a strip-mall clinic a couple hundred feet from where I used to live. It was my clinic before I moved to Toronto for high school, and for a few years after I came back.

[rstrong]

Another Obamacare horror story debunked

Deborah Cavallaro is a hard-working real estate agent in the Westchester suburb of Los Angeles who has been featured prominently on a round of news shows lately, talking about how badly Obamacare is going to cost her when her existing plan gets canceled and she has to find a replacement.

(Plans compared...)

Is that better than her current plan? Yes, by a mile.

[Wneglia]

Poll: 78% of uninsured not interested in Obamacare