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Obama Administration to spy on Physicians

Jun 26, 2011 - 42 comments







medicare reform


obama administration

As we continue in what can only be characterized as a tumultuous time in healthcare the NY Times reports that the Obama administration is scheduled to role out a "secret shopping" program to investigate physician availability and whether there is any biased treatment against those with Medicare or Medicaid.

U.S. Plans Stealth Survey on Access to DoctorsBy ROBERT PEAR
Published: June 26, 2011
WASHINGTON — Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem of P.C.P. shortages in the United States,” the Department of Health and Human Services said in a description of the project that it submitted to the White House.

Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.

“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.”

According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.

Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”

Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”

Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”

In response to the drumbeat of criticism, a federal health official said doctors did not need to worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.

Administration officials said the survey would yield an enormous benefit to the government while imposing an extremely limited burden on doctors.

The new health care law includes several provisions intended to increase the supply of primary care doctors, and officials want to be able to evaluate the effectiveness of those policies.

Federal officials said the initial survey would cost $347,370. Dr. Hogue said the money could be better spent on the training or reimbursement of primary care doctors.

Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut the fees paid to doctors treating such patients. Congress usually steps in at the last minute to avert such cuts.

In many parts of the country, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.

Access to care has been a concern in Massachusetts, which provides coverage under a state program cited by many in Congress as a model for President Obama’s health care overhaul.

In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists.

Source NY Times

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by margypops, Jun 26, 2011
I am not surprised by this ..Big Brother has indeed come to America ...this Obamacare needs repealing anyway ..I have lived with the plan they modelled it on ..the UK's... they want out now and Cameron is looking to the private sector .We do need a good healthcare plan ..not this one ..Repeal it I say...

Avatar universal
by doctornick178, Jun 27, 2011
Indeed, the plan is not all that good. All you have to do to understand this is to simply ask the vast majority that support the plan as it now exist and you'll quickly agree that 83% of all Americans approving it are wrong. After all, since when do the majotity of American's know anything anyway.

The goal of these crazy and confused Americans all want to do away with Insurance of all kinds. Heck, that would put ten's of thousands of rich spoiled citizen out of work, can we really afford this? The best plan is to keep it all in the private sector, (i.e. the rich group) then set back and relax and count your blessing. When asked, "Are you better off now"? tell them sure, just like back in 1801 when my great grandfather had the best.

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by Mom2four85, Jun 27, 2011
While I do find this kind of tactic deplorable, I have been on the end of being told a certain doctor would not take my health insurance after sitting in the office at my appointment time and they called for benefits.  

I'm on the gov't PCIP plan and was paying $352 monthly when this happened, so I was shocked and told my primary who referred me to the dr and asked why I didn't see the doctor...she replied well yeah; because that plan pays out similar to what medicaid does

which really made me wonder where my $$ went for it...maybe for this new spy program? :P

Avatar universal
by teko, Jun 27, 2011
Maybe it has more to do with all those doctors billing for dead people and making stuff up and, and and....Your republican arent you? I say good for the Obama administration, or is this another way of pushing Ryans plan. Dont bother to answer. But in order to fix the problem we got to know what and how wide spread the problem is right? Basic common sense but with some people, there is a conspiracy around every corner. c ya.

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by Mom2four85, Jun 27, 2011
"there is a conspiracy around every corner" Oh I thought that was part of Politics 101....

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by margypops, Jun 27, 2011
Of course there is'nt the facts are out there people can look and see for them selves what is happening to this country ..they can read  the Obama care plan for them selves ..It was on the news this morning regarding the mystery shoppers to snoop on Doctors ....

Avatar universal
by teko, Jun 27, 2011
mystery shoppers take no prisoners. Or havent you heard.

Avatar universal
by teko, Jun 27, 2011
and for those not realizing that help for pre existing is out there like me, here is the link pcip.gov

Avatar universal
by mlkinmb, Jun 27, 2011
Many pros and cons. More regulations need to be in place, and followed. Not just with doctors, insurance is the biggest problem. My local hospital applies a 56% discount if you don't have insurance. This just shows how much they are making, if they give a discount, you know they are still making a profit.
Mom, as far as the PCIP, I had the worst time with those people, had to reapply when they had the paperwork in hand. When I was approved it was a little under $500.00 monthly. This approval was in October, and I was informed that a new deductible year began on January 1st! So they expected me to pay 3 months of premiums, then have over $2,500.00 in covered costs paid out of pocket in less than 3 months BEFORE they would pay a dime! I told them they could shove the plan, they were crazy. I wrote letters about the deductible year, nobody ever replied. I even filed a report with the BBB, they never even responded to that. Oh well, sorry to ramble, Take care!

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by merileegal, Jun 27, 2011
I just thought Obama's magic wand would sprinkle good fortune all over our free land. We will all just be so happy when everyone has the healthcare given to them. la, la, la,..... and then there are all of the other bailouts. Not to worry though, we won't have to worry about voting for a new president, because China will own us and we can all use chinese medicine.

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by Mom2four85, Jun 27, 2011
mlkinmb; I know what you mean, I had to jump through some hoops to get approved for mine last year; however they did just lower the premiums 40% starting July 1, 2011because they saw people would not go for their pricey plan and take out where you have to send in a letter showing you were denied by another insurer.  Mine went from $352 monthly down to $211, which does make it more affordable but the pharmacy plan needs to be reworked.  

For instance my mother in law who falls between the cracks at age 63 and no healthcare; her premiums were going to be $776 just for coverage...not to mention $2,000 medical then $500 pharmacy deductible yearly;  then after all your medical and pharmacy is paid, you still pay 20% up to $5,950 per year co-insurance.  

The pharmacy plans leaves alot to be desired - quite a few I've found aren't covered at all and most others after the 2nd prescription is filled the 3rd one goes up dramatically in price if you don't go through their Medco plan, so there really is no shopping around for medication prices unless you pay out of pocket for them.

but I can't complain much at least I have health insurance even if it does cost my family to go bankrupt paying for it [insert sarcasm here] lol

Avatar universal
by mlkinmb, Jun 27, 2011
I can see that the 40% drop likely did get more people on board. I did have to get the denial letter, so now I do know that I'm uninsurable with HCV, and other issues. I see that the $2,500.00 has remained, along with the 20% up to $5,950.00. I just could not, and will not, understand the calander year deductible starting January 1st and ending December 31st, no matter when your coverage begins, that's just unreal. I do remember reading something about the prescription plan, but when I learned of the calendar year I pretty much wrote them off. I may have to look into the plan again at some point, but I hope to avoid that.
How are they treating with coverage for visits, testing, and all the medications? I hope that everything is going well for you. As for me, still waiting for the next step, Take care

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by Mom2four85, Jun 28, 2011
I understand that also...United Healthcare was like that when we first started years ago and cost us an additional $3,500 deductible because our agent didn't put physical year instead of calendar year deductibles so they restarted after 4 months and I didn't find this out until April of the next year why - even the supervisors at UHC couldn't figure it out until some really smart CSR said this is why.  

We ended up paying 7k deductible for 8 months of coverage basically but that was ok with us after that was paid they paid 100% of the $350,000 bill I had; I can't imagine paying 20% of that now with the PCIP plan.

Avatar universal
by teko, Jun 28, 2011
I was reading yesterday on the home site that pcip premiums were dropping due to the reasons talked about here. For me it would be 500 a mo and same for my husband which still leaves me out of the ballpark of affording it. OH well, maybe someday....

Avatar universal
by daisyrock, Jun 28, 2011
Margypops, I have to take issue with you. The UK does not want out of our healthcare system (the NHS), across all parties on the right and left, there is one thing that unites everyone, and that is the value placed on the NHS. It is our most prized asset and I doubt you would find a single British person ready to scrap it. It would be like asking an American to scrap the constitution I expect.

Avatar universal
by lnammike, Jun 29, 2011
I am not a fan of Obama, but to have him checking in on our nation's doctors is brilliant.  There are some decent dr.'s, but too many have become too powerful.  I have read horror stories of medical record tampering and fraud-and realize the guy on the other side is INNOCENT.
Teachers have had some restructuring which is starting to show a difference.  Absolutely, get in there, shake the idiots up with their "God complex".  Puuleezz!

Avatar universal
by curly1b13, Jun 30, 2011
I think there's a misunderstanding about why doctors have a hard time with Medicaid (and Medicare). I work in a hospital, and yes, these programs pay a small portion of the "usual and customary" fees. The problem is multi-faceted. If the doctor already has some Medicaid patients, he cannot afford his rent, salary to office staff, equipment, repairs, computers, re-payinghis education, etc. if he has too large a percentage of them. This is because the government programs are so painfully slow at paying, the hospitals are currently being paid for 2009. If a hospital or a doctor are to keep up with the cost of running an office, it's impossible to maintain a practice without being paid in a timely fashion. This will only get worse under Obamacare because EVERYTHING will be a government program. I already respond to several denials a week for patients in the unit under Medicare and Medicaid, AFTER they have already approved the patient's stay. This is in the fine print of your insurance statement as well, "this letter is in no way a guarantee of payment....." or words to that effect. I am getting a little tired of the doctor being the evil one. He gave up almost ten years of his life making very little, working ridiculous hours, put him/herself into debt, sticks his hands where most people wouldn't want to, and because he wants a nice house and car, he's called selfish.  I don't believe that for a second.

Avatar universal
by Weffette, Jul 02, 2011
My hats are off to Obama and his plan to "spy". For those that have "commercial" health insurance...their treatment is done with respect and in a timely manner.  I know this for a FACT! I had BC/BS for several years...when I became too ill to work, I had to go on a county health plan...the difference in treatment is AMAZING!  Low income people have to wait longer, cannot choose their doctors, and for special testing...there is a tremendously long wait because very few doctors will accept medicaid and county health plans.  I have been treated with much disrespect...as if I am a "low life" at SEVERAL doctors offices. Its degrading, humiliating and adds to the stress of my illnesses, 10 fold.
Secret Shoppers for quality healthcare...? YES  YES  YES    The health care professionals are so wrapped up in making money...they are forgetting their primary reason for becoming doctors...unless it was for monetary reasons to begin with (SAD).  Their staff are RUDE, IMPATIENT and more than LESS COMPASSIONATE.
As I said earlier...I have witnessed ALL of the pro's and con's of the medical community...working in it and being a patient with good insurance and county/state insurance.  Its a fact that DISCRIMINATION exists!!!

Avatar universal
by Weffette, Jul 02, 2011
These doctors have PLENTY of patients with decent paying health insurance. The few Medicaid and Medicare patients they have are NOT going to break their bank. Perhaps if the doc didn't take such a big mortgage on his 7 bedroom home and 4 new cars or open a practice in an extravagant office building...he wouldn't need to worry about paying his own bills by giving poor people health care.
When doctors made the decision to go to medical school...they KNEW how long it would take AND how much it would cost....those are NO excuses to ignore the ethics of providing a service designed to help HUMAN BEINGS of ALL financial backgrounds.
I'm sorry if this offends anyone...but I have been on both ends of the spectrum....I have seen doctors offices totally discriminate against people because of their insurance, or lack of, and their ability, or lack of, to pay. It makes me SICK.

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by margypops, Jul 02, 2011
I have to take issue with you Daisyrock I suggest you get your facts straight ..ask Cameron your Prime Minister ..in fact why not do research about it, Cameron is making changes , you are way behind .my family live there the brits are sick of huge waiting to have anything small done including my brother ...

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by margypops, Jul 02, 2011
Daisyrock heres a link so you know whats going on in UK     www.bbc.co.uk/news/-politics-13757380     the heading is Cameron backs changes in the NHS plan  

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by LosingMyMindInGA, Jul 02, 2011
I've thought Obamacare was a load of crap from the get go.  Repeal it, shred it and torch it.  Older workers are ALREADY seeing much higher insurance premiums.  Now the government is snooping around and eve's dropping.  What next?  We already know that the government plans to control who can get what treatment and who will just be left to die.  The last time I checked GOD Was the only one who had the right to make that decision.  If there is a treatment to help someone, the government should have NO say so in whether or not they receive it.  

With that said, there IS discrimination against people with medicare and medicaid, however *I* don't feel it's nearly as prominent NOW as it was several years ago. I experienced it firsthand when I was 19 and had to have a major dental work done while on medicaid.  I was given substandard service and the cheapest of the cheap materials.  Things would be a lot different for me now, had I had a dentist who didn't look down on me for having medicaid.  Even still I do NOT agree with the goverment snooping.  If they stick their noses in here, it's going to give them the confidence they need to continue doing it elsewhere.  What's next? Before you know it we'll be having police raids to arrest people for doing it doggy style.  COME ONE NOW, where do we draw the line?  Give em an inch and they'll take a thousand miles!

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by Mom2four85, Jul 02, 2011
I don't think it's just medicare/medicaid; it's any insurance that pays less than what they expect out of the other insurers.

What I said above is just an example of the treatment I've received on the pre-existing plan insurance, the girl at the cardiologist's office told me in no uncertain terms they did not WANT to accept my insurance so they didn't have to...their office was taken off the PCIP list.  My primary told me the reason the cardiologist would not accept it because the payout was similar to medicaid/medicare.

What stinks is I was paying $352 through PCIP for less coverage than I did on United Healthcare - I only paid $209 per month 100% co-insurance whereas the PCIP is a 80/20.  I was kicked off the UHC plan because I had to quit work because I was so sick.

Regardless of the payout, we should all be treated equally by doctor's and their staff, but I don't condone the "spying" by any means...why not send out anonymous surveys to patients instead and set up a program to get the real story of what's going on from patients themselves or something similar?

I shudder to think what's going to happen in 2014.

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by margypops, Jul 02, 2011
I think I heard that they, the Obama government, is backing off the spying on Doctors now ..

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by babygirlyoyo2002, Jul 02, 2011
My 2 cents worth...with that said, isn't this sort of like the census that we get every 10 years? how many doctors and how many of them not taking patients who can't afford to pay? This is a real problem and it's about time someone in washington has given a darn to take it on. This problem didn't just start today but it is slated to only get worst. Although I am not in the same boat as most of my medicare wielding peers, medicare is my secondary, I have found some doctors who are just simply not taking medicare patients and this includes me even though medicare is only secondary for me. In my area it is hard to find a doctor that takes medicaid or any of it's affiliates such as United Health Care. ObamaCare as everyone calls it that don't like just probably don't understand it...how many of you actually read the bill? I would bet my whole check that not many of you have actually read the bill...not a website that is summarizing the bill for you but the actual bill...I read the whole bill yes all 1000+ pages of it. Why?....because it affected me tremendously...I have 2 kids in college who get to stay on my health plan until they graduate....I get medicare...we have employer paid insurance. And the fact that I didn't want no one giving me only part of the bill or what they thought was the important part, and that is what summaries are what somebody else thought was important for you. I do question how they will go about it, why not just ask for volunteers with the profile that they are looking at and give them a list to call on, or even give a small stipend...kind of like when you get in for a research study. That way they would be paying people that actually need money and they would get the information they were seeking...an interesting concept  

Avatar universal
by Weffette, Jul 04, 2011
Touche` babygirlyoyo!!!   I feel the same way!
Surveys? HA!  I worked in a medical clinic and had patients fill out surveys...know what they did with the negative ones? Guess...straight to the shredder.
Have you ever noticed when you go to the doctors, they want your co-pay BEFORE you see a doctor? I tell them I will pay AFTER my appointment. Signs read "Co-pays are due when services are rendered".
Rendered = performed or completed.  Do Not ask for my money UNTIL I have seen a doctor...simple...effective...final.

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by Mom2four85, Jul 04, 2011
what's it going to take for them to find out what patients really think and what really goes on in dr's offices? spying isn't the answer because it doesn't give the "real" answer what we patients have to go through...so how do they fix problems like this and really find out what's going on?

No way I'm going to read the 1,000 page info and understand it all not sure I could; my cognitive function is on the fritz the majority of the time; who knows if I would interpret correctly.  Obviously we know there's a problem and many of us have encountered some of these problems.

dr's can argue they went into the medical field to make money, it's a business after all and why shouldn't we expect them to make as much money as they can; as any business should...running a business and what it entails is alot and I bet they don't make as much as we think they do after all the overhead costs of that "business".

are there any easy answers?

Avatar universal
by brice1967, Jul 04, 2011
Mom2, that is my impression as well.  If you pay someone to spy, the only information you'll get is what you're looking for.  That isn't necessarily the truth or the whole story.

Everything revolving around health care needs an overhaul. Tort reform... a ceiling on malpractice suits needs to be a consideration...

Avatar universal
by Londres70, Jul 04, 2011
I totally agree with babygirlyoyo and weffette!!!!!!  About time someone did something about these physicians not doing what they need to be doing.  I worked in America/USA for 10 years and witnessed some of the stuff physicians got away with.  I even witnessed physicians documenting based on my notes; I am an RN, before they saw the patient.  

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by allaboutmary, Jul 04, 2011
If Doctors are doing their job , they shouldn't be worried about this.  I say go for it Pres. Obama.

Avatar universal
by brice1967, Jul 04, 2011
I don't think it is about worrying about doing their job.  I think it is about worrying if the spy knew enough about medicine to pass fair judgement.  I mean, you wouldn't hire a plumber to do brain surgery.  What would a plumber even know about brain surgery?  

I'm not stupid.  That however does not qualify me for the position of spying on a doctor and assuming if he/she was doing his/her job.  I know nothing about medicine, surgery, or any medical procedure.... to me that screams that I am not qualified to critique a doctors performance.

Avatar universal
by teko, Jul 04, 2011
You dont have to know about medicine. To be a secret shopper you must act like a patient and report how your experience went. Right? I have been a secret shopper in other situations where you eat at restaurants, grade the service, cleanliness, etc. I am assuming it is the same only based on one being a medicaid/medicare carrier. I think its a great idea!  And no I do not agree that we have a shortage of doctors. I do believe tho tht is thelatest scam to have us think there is. imo

I will be a secret shopper! Im not on medicaid or medicare but they can fix me up right? Where do I sign up? I got the summer to volunteer!

Avatar universal
by brice1967, Jul 04, 2011
If that is the case though, we are judging physicians on their bedside manner so to speak?  I have no idea what purpose that serves.  I don't really care if a doctor comes off as a jerk.... I just want to get well.  And if we are going to judge physicians bedside manner, why aren't we doing that with everything... starting with politicians.  I'd volunteer for that.

Avatar universal
by teko, Jul 05, 2011
I dont agree. You are reporting about how easy it was to make an appointment, if that doctor were taking new patients, and especially medicare patients. How soon you could get in to see the doctor. How were you treated? Equal to other patients or lesser than? Was the exam thorough, what was the procedure, were you asked back for follow up, did the treatment fit the ailment,  and was it billed appropriately? Things like that?

I truly think this is a good thing and should have been done way before now.

Avatar universal
by Weffette, Jul 06, 2011
Brice,  To evaluate how a doctor AND its office treats you, accepts you, and delivers care to you is the MAIN OBJECTIVE of such a "study".  I wouldn't even call it "Spying"...its  an inside look at different ways the medical community reacts to different circumstances in regards to a "patients  care.  Of course a "secret shopper" isn't going to evaluate a surgery...its NOT about that...at all.  Its much more basic and ANYONE can answer questions like, "How long did it take to get an appointment?" and "Were you treated with respect by staff?" and "Was your particular insurance accepted?" and "Were your health concerns validated or ignored?".  I am sure there would be a "universal" questionaire for the "shoppers" to fill out. Also, I doubt anyone without some kind of ailment would be asked to be a "secret shopper"...unlike someone going to a resturaunt or retail shop.
Why so worried about a doctors office being anonymously evaluated? I think this should have been done YEARS AGO!!!!!  Someone has to shake things up and hold those certain doctors accountable, somehow.
I worked with doctors that over charges medicaid AND medicare, performed tests AND procedures that were NOT necessary and ,even, did experimental procedures but billed as something else.  There IS alot of fraud and misuse of medical lisencing out there. perhaps that is why malpractice insurance has sky rocketed.
I also know of a clinic that prescribes narcotics to ANYONE willing to pay $80.00 for an office visit. All the "patient" has to say is, "My back hurts" or "I am ridden with anxiety". Once these "patients" have become addicted...they are then referred to a program to be weaned off the narcotic...the drug they use for that is...METHODONE!   OMG...I personally know 3 people that were given Vicodin for back pain...without ANY X-rays or proof of their pain...became addicted and had to go on Methodone...for a vicodin addiction!  Would you want to know WHY or HOW this doctor runs their office???  I can bet NONE of those patients would be willing to be honest if asked to be a "secret shopper" because they would be afraid of losing their drugs.  I have complained to the liscensing board, the governor, and the medical board...with no response. It seems some of these inappropriated practices are being swept under the rug and ignored.  Although, this particular clinic is currently under investigation...but the process has been going on for over a year now. Its SICKENING. I can BET there are more than this 1 clinic doing the EXACT same thing...all over the country.
I really hope the Obama Admin decides to go ahead and do the "secret shopper" with the current health care crisis being as it is...EVERYWHERE! I would LOVE to be a shopper!

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by margypops, Jul 06, 2011
This crazy obamacare will be repealed before too long ...we have no money folks are you going to pick it off trees in Obama's garden

Avatar universal
by FrancesStein, Jul 08, 2011
Have relatives in the medical field, there are physicians who prefer not to see Medicaid and Medicare patients due to low reimbursement.   And there are physicians who do not accept certain insurances/patients.  That's understandable because physicians should not be expected to bear the costs of all of this.   But what is the answer?   No one wants to be the one who has to pay.   No one.   It's the same old story--not in my backyard but please let me have some of your barbeque.   Consumers don't want their premiums raised....no one wants higher taxes to cover the poor, the elderly and the disabled...physicians can't be expected to cover more than their fair share.....drug companies and device industries want to push their expensive new products and make huge profits...they don't want to pay.   Employers are struggling to meet higher and higher premiums for their workers, and employees are incurring more and more of the cost.

So, who is going to pay?    Blaming President Obama for this situation is not helpful.   He and his administration did not create this problem, and I give them credit for at least trying to do something about it.   All other Presidents, especially Republicans, have been too cowardly to tackle this.  But of course, no one minds that we spent trillions invading a country that had posed no direct harm to us.  

Avatar universal
by FrancesStein, Jul 08, 2011
P.S.   Just think what changes could have been made in this country were it not for the decision to invade Iraq at the cost of trillions, to say nothing of the lives lost and maimed.  

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by Mom2four85, Jul 08, 2011
What will happen in 2014 when people are made to buy into healthcare plans...will they be the same type of plans that they made for the PCIP (pre-existing condition insurance plan)?

If so, we're going to see alot more problems with this type of thing especially against patients on PCIP or other lowered reimbursements. I've gone through this with dr's in the past 6 months of being on the plan.  

My primary said this plan has a lower reimbursement and that's the reason some of the dr's I've seen refused to take it, much like medicare/medicaid, even though I was paying double premiums I did on group health insurance through United Health Care when I was working.  I didn't ask for the plan to pay poorly, I found that out quite by accident and was really shocked that I was paying $352 monthly and thought it was a good plan.

Will this make dr's go into pools I've read about that they won't accept insurance and we have to pay to see them out of pocket [forgot what it's called].  

The insurance companies themselves should take the blame - PCIP/First Health Network are the ones who determine what to pay dr's and I'm really wondering where the bulk of those premiums go when I know it's not being paid to the providers, which leaves us patients in the middle.

Avatar universal
by teko, Jul 08, 2011
The pcip was something designed to cover pre existing and was never a claim it would be affordable as well. It is something when insurance companies wont cover due to pre existing. Didnt help me cause my income doesnt allow to put out 1000 more a month and pay thelight bill. When the exchanges are in place and everyone is on them, the cost will be covered better and there are other things in it that explain how it is paid for. However it will still be giving insurance companies revenue and is not a government plan like people think. Free enterprize mostly. I tho still vote for single payor.

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by Mom2four85, Jul 08, 2011
So those of us who are sick and on the PCIP plans will convert to the exchanges? I get confused over all this stuff; and reading a 1,000+ pages isn't an option to try and understand...don't think I would even fathom it, so I ask alot of questions =)

I can relate to the car insurance analogy because it makes sense but some of the health insurance stuff I've read/seen doesn't make sense.

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by LivingInHope, Jul 10, 2011
From originial post: "In many parts of the country, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid. "

It greatly concerns me as someone who has a family member on Medicaid that in 2014, this program of our country, our country already being in so great of debt it transcends my ability to even comprehend, would be expanded when it is already in grave jeopardy of being able to exist at all.  Medicare as well is already in grave jeopardy, prior to the full implementation of the new law.

Without being solvent, the federal government, already being inadequately funded for it's debts by that dwindling percentage of citizens who are still paying taxes, has decided to further jeopardize the care of the current patients on medicare plans and on medic-aid plans by plunging our country deeper  into what I guess they feel is a bottomless abyss of debt.

  You think the care is not timely and there are not enough doctors now with how many, such as my family member, medic-aid recipients there are now, I hope you never have to experience the outcome of implementation of this unaffordable, unsustainable expansion.  I have a sibling living under an abysmal socialized medicine plan in a european country.... with extremely long waits for tests and care, such as it is.  

We in this country, broken as our system is, do not realize just how blessed we are compared to so many in the world when it comes to medical care.  And many people come here for the medical care they can get in the United States.  I sincerely hope that the Obama health care reform, which I believe many in Congress voted for without knowing what all was in it, gets repealed and they come up with fiscally sound reforms that will not cost this country so dearly.  

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