The Affordable Care Act II - Because Mr. Obama Loves You All

[birdog1960]

I just interviewed a couple from St Louis today that is closing their concierge practice. What people miss is that even concierge practices bill insurance including Medicare, and cannot stay open even with 10k -20k annual memberships. Doctors expect to make 250-300k in primary care and have small panels of patients (under 2,000)- but in reality, the economics don't work and working 7-9 days a week gets old fast.

 

To be honest, the ACA plans are consistent with the reality of Heathcare financing. Premiums will be expensive and deductibles will be high, our system is outrageously expensive, poorly utilized, communicates poorly, and we spend far too much on end of like care. I have a Medicaid patients in his late 70's (long story how he got to me to manage), but he's been at our hospital 3 weeks and had 200k worth of surgeries. If we intend to continue to treat everything until death, we'll need to rethink how much of our national and personal budgets are allocated to Healthcare.

 

Everybody wants to make money in the game, everybody wants extensive care until they croak and Americans in my experience don't want to personally pay for it.... That's a powder keg right there.

concierge can work even without billing medicare but only in very wealthy communities. and the patients expect a pound of flesh from their docs and service equivalent to a five star resort. 300 pt's paying $2000 each will do just fine. but yeah medicare will need to generally be billed for all tests and hospitalizations. if i were to do it i'd send all that stuff out and not bill medicare eat all. but i'd never do it. treating the privileged can be a royal pita,

 

the whole model is a symptom of the pus ridden septic condition of the us healthcare system. docs can't make it private without catering exclusively to the rich. and the rich can't get enough exclusive care without a second or third tier. so most everyone that can't practice on the west side of manhattan jumps and asks how high when a bunch of suits that don't know squat about medicine and don't really care about people in general, tell them to.

[DC Tom]

the real point is that these companies are no more trustworthy than the gov't and don't answer in any way to the public except thru the free market which doesn't exist in healthcare. i'd argue that the big insurers are less desirable healthcare puppet masters ([for both patients and doctors) than elected officials.

 

I don't know that anyone's going to argue that point. I just think we'll all argue it for different reasons.

[3rdnlng]

.I just interviewed a couple from St Louis today that is closing their concierge practice. What people miss is that even concierge practices bill insurance including Medicare, and cannot stay open even with 10k -20k annual memberships. Doctors expect to make 250-300k in primary care and have small panels of patients (under 2,000)- but in reality, the economics don't work and working 7-9 days a week gets old fast.

To be honest, the ACA plans are consistent with the reality of Heathcare financing. Premiums will be expensive and deductibles will be high, our system is outrageously expensive, poorly utilized, communicates poorly, and we spend far too much on end of like care. I have a Medicaid patients in his late 70's (long story how he got to me to manage), but he's been at our hospital 3 weeks and had 200k worth of surgeries. If we intend to continue to treat everything until death, we'll need to rethink how much of our national and personal budgets are allocated to Healthcare.

Everybody wants to make money in the game, everybody wants extensive care until they croak and Americans in my experience don't want to personally pay for it.... That's a powder keg right there.

 

That's pretty arbitrary.

Edited April 12, 2016 by 3rdnlng

[B-Large]

.I just interviewed a couple from St Louis today that is closing their concierge practice. What people miss is that even concierge practices bill insurance including Medicare, and cannot stay open even with 10k -20k annual memberships. Doctors expect to make 250-300k in primary care and have small panels of patients (under 2,000)- but in reality, the economics don't work and working 7-9 days a week gets old fast.

To be honest, the ACA plans are consistent with the reality of Heathcare financing. Premiums will be expensive and deductibles will be high, our system is outrageously expensive, poorly utilized, communicates poorly, and we spend far too much on end of like care. I have a Medicaid patients in his late 70's (long story how he got to me to manage), but he's been at our hospital 3 weeks and had 200k worth of surgeries. If we intend to continue to treat everything until death, we'll need to rethink how much of our national and personal budgets are allocated to Healthcare.

Everybody wants to make money in the game, everybody wants extensive care until they croak and Americans in my experience don't want to personally pay for it.... That's a powder keg right there.

 

That's pretty arbitrary.

Yes, yes it is. But if you're going to consider healthcare costs overall, it's a discussion to be had.

concierge can work even without billing medicare but only in very wealthy communities. and the patients expect a pound of flesh from their docs and service equivalent to a five star resort. 300 pt's paying $2000 each will do just fine. but yeah medicare will need to generally be billed for all tests and hospitalizations. if i were to do it i'd send all that stuff out and not bill medicare eat all. but i'd never do it. treating the privileged can be a royal pita,

 

the whole model is a symptom of the pus ridden septic condition of the us healthcare system. docs can't make it private without catering exclusively to the rich. and the rich can't get enough exclusive care without a second or third tier. so most everyone that can't practice on the west side of manhattan jumps and asks how high when a bunch of suits that don't know squat about medicine and don't really care about people in general, tell them to.

Wealthy committees still don't want to pay out of pocket for stuff.

[birdog1960]

Wealthy committees still don't want to pay out of pocket for stuff.

they may not want to but they often will for exclusivity and "better" (read "more") care. if you don't have your health, you don't have anything....true dat. and the rich know that better than most. more to lose.

 

and it matters. nice synopsis of a paper from jama about life expectancy between rich and poor: http://www.nytimes.com/interactive/2016/04/11/upshot/for-the-poor-geography-is-life-and-death.html?_r=0. that's the ultimate outcome, non?

Edited April 12, 2016 by birdog1960

[3rdnlng]

Yes, yes it is. But if you're going to consider healthcare costs overall, it's a discussion to be had.

 

 

Go back and read it carefully. End of "like"? So your likability determines your healthcare? I was being sarcastic. So, now blame it on your phone.

[reddogblitz]

Just like our vets would never give up their socialized medicine

The vets eaned theirs pal.

[Pine Barrens Mafia]

The vets eaned theirs pal.

 

Earned what? Waiting lists that have dead people ahead of them?

[unbillievable]

So people with money should not be able to buy better service... We should make those rich bastards pay more of course, but only to subsidize the free loaders. It's only fair.

[Tiberius]

.I just interviewed a couple from St Louis today that is closing their concierge practice. What people miss is that even concierge practices bill insurance including Medicare, and cannot stay open even with 10k -20k annual memberships. Doctors expect to make 250-300k in primary care and have small panels of patients (under 2,000)- but in reality, the economics don't work and working 7-9 days a week gets old fast.

 

To be honest, the ACA plans are consistent with the reality of Heathcare financing. Premiums will be expensive and deductibles will be high, our system is outrageously expensive, poorly utilized, communicates poorly, and we spend far too much on end of like care. I have a Medicaid patients in his late 70's (long story how he got to me to manage), but he's been at our hospital 3 weeks and had 200k worth of surgeries. If we intend to continue to treat everything until death, we'll need to rethink how much of our national and personal budgets are allocated to Healthcare.

 

Everybody wants to make money in the game, everybody wants extensive care until they croak and Americans in my experience don't want to personally pay for it.... That's a powder keg right there.

 

That's pretty arbitrary.

Like care? I like Mike...

[birdog1960]

So people with money should not be able to buy better service... We should make those rich bastards pay more of course, but only to subsidize the free loaders. It's only fair.

people with lots of money should be means tested for medicare. (btw, susan Collins voted for medicare means testing) if they can afford concierge services, they can pay what medicare actually costs (most peop[le take far more from medicare than they ever put in). so yes, they should be able to get tiered service if those conditions are met. but remember, every doc that sees 300 pt's in a concierge panel is one less doc able to see the unwashed masses like me and presumably you. there's already a shortage of primary care. this exacerbates it. kinda reminds me of the threat of avian flu epidemic and elderly and pregnant were first priority to get the immunization. but the young bucks at goldman sachs jumped the line and got theirs first. maybe that's ok with you but it's not ok with me.

[TakeYouToTasker]

people with lots of money should be means tested for medicare. (btw, susan Collins voted for medicare means testing) if they can afford concierge services, they can pay what medicare actually costs (most peop[le take far more from medicare than they ever put in). so yes, they should be able to get tiered service if those conditions are met. but remember, every doc that sees 300 pt's in a concierge panel is one less doc able to see the unwashed masses like me and presumably you. there's already a shortage of primary care. this exacerbates it. kinda reminds me of the threat of avian flu epidemic and elderly and pregnant were first priority to get the immunization. but the young bucks at goldman sachs jumped the line and got theirs first. maybe that's ok with you but it's not ok with me.

Medicare for all, but means testing to further soak people who actually responsibly planned?

 

!@#$ you.

[Azalin]

Like care? I like Mike...

 

 

Edited April 12, 2016 by Azalin

[Tiberius]

Medicare for all, but means testing to further soak people who actually responsibly planned?

 

!@#$ you.

You mean those born on third base

[Chef Jim]

You mean those born on third base

 

Yes because all rich people were given their wealth.

[Tiberius]

 

Yes because all rich people were given their wealth.

most were

[birdog1960]

 

Yes because all rich people were given their wealth.

no. the implication is that those that would pass a means test for medicare did not actually plan ahead. most likely it would be a small percentage of people that would fail the means test meaning the rest of us didn't plan. pure horse shite. most of us planned, won't have concierge care and would pass means testing.

[Chef Jim]

most were

 

Oh they were? The government has a very low threshold of what they consider rich.

[Tiberius]

 

Oh they were? The government has a very low threshold of what they consider rich.

How do you define "rich"

[Chef Jim]

How do you define "rich"

 

It's not about my definition. It's about the government's definition.