Good news Obamacare gets even better!

[ApatheticNoMore]

One of them said today that their obgyn office is turning away any new patient with "Medicare or Obamacare plans" (her words) because they cannot make any money on them. They are told sorry, go find another doctor.

Pretty extreme if they are actually turning away all Obamacare plans, even silver plans and up? Those aren't great plans (deductibles tend to be high etc.) but most doctors can hardly afford to turn them away and most here aren't I'm sure (look it's not like everyone has a great top fo the line soon to be Cadillac insurance plan via work, most don't - I do and it costs me - but most doctors don't want to turn away so much of the population). The issue with doctors not seeing *Medicaid* patients has long been an issue though - Medicaid really doesn't reimburse the doctors enough to want to see Medicaid patients, especially in this state, which is particularly bad.

Oh and I doubt the obgyns are actually losing business from the ACA, they must have seen a spike in business with the promise to cover birth control (think long lasting birth control with an initial up front cost).

The point made up-thread was that many people are having a hard time receiving services due to the way Medicare reimburses, as well as the ridiculous malpractice insurance required of any practitioner (how long has it been since any meaningful discussion of tort reform?).

Isn't this an issue doctors can bypass anyway? I mean the last doctor I went to I HAD to sign an agreement agreeing all disputes would go to arbitration (not court) to even get treatment. So isn't that in some sense legally (I have to assume they are operating legally) bypassing the whole tort issue anyway, making it kind of a non-issue (ok even arbitration isn't free but it isn't actually a tort!). Do I have any great desire to sue a doctor? No, but how does not having access to courts and having to sign an arbitration agreement make you feel? Um actually in some sense like I may as well be seeking care in Mexico!!! 3rd world America. Kind of like what kind of shady practitioners am I seeing .... sigh. Ok I saw them anyway (and crossed those fingers hard).

[rodeosweetheart]

Pretty extreme if they are actually turning away all Obamacare plans, even silver plans and up? Those aren't great plans (deductibles tend to be high etc.) but most doctors can hardly afford to turn them away and most here aren't I'm sure ).

Yes, in SC, this particular practice is turning away anyone with an "Obamacare" plan, along with anyone with Medicare. I don't know if they used to take Medicare patients.

We have had trouble finding any doctors who will see us up here in Michigan after our move--most seem closed to new patients, some bizarrely so--they wanted a health history before would agree to see us, and one asked my husband, first thing out their mouth-- Do you have medical marijuana card?

I am think WTF is this place we have moved to? We have Blue Cross Blue Shield employer provided plan.

[JaneV2.0]

...I think we forget that the ACA's promise of "affordable health care" is mis-leading. What they're actually promising is "affordable health insurance" and neglecting the barriers it places in front of actual health care. ...

Good point. We should just institute single-payer, and remove the insurance middle man. We've experimented with insurance, and it hasn't served us well.

[rodeosweetheart]

I agree, Jane!

[sweetana3]

Well, some doctors are turning away any patient that is not a retainer paid member of their group. Concienge medicine anyone?

[Alan]

Good point. We should just institute single-payer, and remove the insurance middle man. We've experimented with insurance, and it hasn't served us well.

I'm not sure how single-payer would solve the problem. It would only replace a private sector bureaucracy with a government bureaucracy, while broadening the disincentives to practitioners. I suppose it would have to require the vast majority of health care providers become government employees (wage slaves), another disincentive to future practitioners.

[ApatheticNoMore]

Well, some doctors are turning away any patient that is not a retainer paid member of their group. Concienge medicine anyone?

So a few rich people will have conceirge medicine (and if you think you are one of them, well you are probably not, unless you really are rich - if the middle class wants to think they are rich they are badly deluded). And that will be of little concern whatsoever to most people, as they not being conceirge class, will still have to have whatever they are able to get if anything I guess (even if it's going to Mexico if it comes to that eventually I suppose, until then employer plans I guess).

[bUU]

Before we could say that we would need to assess whether those with Obamacare had previously had other insurance that made higher payments for doctor's services.

Good point, and the inescapable fact is that some folks went from no options to some options. Given all the possible scenarios, that scenario is the one that all reasonable people would prefer to be removed from by such a change, if they began there.

[JaneV2.0]

If nothing else, getting rid of the insurance companies would reduce costs considerably. Or it should.

[bUU]

People try to avoid considering two aspects at the same time, but looking at this matter without holding both aspects in mind together at the same time is itself a corruption - the two aspects being cost efficiency AND universal access. The moral imperative recognizes that people shouldn't die, or suffer a second-class physical existence, because they're poor. The reality is that most of the benefit we gain from improving the efficiency aspect of this naturally will go towards remedying the moral failing of society with regard to the access aspect. That really frustrates those who just want to gain for themselves some marginal advantage in terms of cost of their own healthcare. So much change and they don't see how it benefits them personally, because they're actually not hurting as badly as others.

Single-payer itself won't overcome that. That would require UHC. Basic healthcare can be provided more efficiently when offered to all, like the US armed forces protects the nation efficiently, because it provides the same service predicated on everyone getting it. Economies of scale are real, but it requires acknowledging the value of building a system that doesn't need to police access, doesn't have to have a huge infrastructure to channel funding and payments, etc.

And remember that people who opt-out by securing their own service doesn't really degrade from that efficiency. By paying their own way for concierge services, they're actually relieving some pressure on the provision of basic service, and don't obviate the benefits of efficiency.