http://www.boortz.com/weblogs/nealz-nuze/2012/jun/26/obamacare-republicans-blowing-it/
By Neal Boortz
I'll expand on this on the show today .. but the more I watch the dog and pony show going on this week in the wonderful world of politics and the law over ObamaCare, the more I realize that the Republicans --- whichever way the court decides – will be completely unable to take advantage of the ruling.
It's the same scenario we've seen play out over the past 12 days regarding Obama's illegal decision to order an end to deportation of certain illegal immigrants in this country. After Obama's statement what we have in the U.S. is a system of laws where the president can just decide not to enforce any law that he doesn't like. Can you imagine how this is going to play out after he's reelected?
Yes .. I said "after he's reelected." That's because right now I'm thinking that's the way November is going to work out. Why? OK .. why don't you fill me on the Republican response to Obama's complete disregard of our rule of law? Oh! You can't! Well that would be because it's been almost two weeks now, and the Republicans HAVE no response.
And so it shall be with ObamaCare. The court may very well turn over the entire law --- but it is abundantly clear that the Republicans will be totally unprepared to step in and seize the advantage. They have NO plan. All we will get is "Well, we are going to address this right after the election." Fine! Address it with WHAT?
Why is this happening? The quest for ideological purity would be one reason. Yes – the Tea Parties certainly helped take control of the House away from the Democrats --- but now their intransigence is going to help hand the presidency back to Obama. It's time to form a coalition in the GOP --- Tea Parties and Republicans who might be defined as more moderate --- even RINOS. Times a-wasting.
Quote from: RecycleMichael on June 26, 2012, 09:23:28 AM
http://www.boortz.com/weblogs/nealz-nuze/2012/jun/26/obamacare-republicans-blowing-it/
By Neal Boortz
I'll expand on this on the show today .. but the more I watch the dog and pony show going on this week in the wonderful world of politics and the law over ObamaCare, the more I realize that the Republicans --- whichever way the court decides – will be completely unable to take advantage of the ruling.
It's the same scenario we've seen play out over the past 12 days regarding Obama's illegal decision to order an end to deportation of certain illegal immigrants in this country. After Obama's statement what we have in the U.S. is a system of laws where the president can just decide not to enforce any law that he doesn't like. Can you imagine how this is going to play out after he's reelected?
Yes .. I said "after he's reelected." That's because right now I'm thinking that's the way November is going to work out. Why? OK .. why don't you fill me on the Republican response to Obama's complete disregard of our rule of law? Oh! You can't! Well that would be because it's been almost two weeks now, and the Republicans HAVE no response.
And so it shall be with ObamaCare. The court may very well turn over the entire law --- but it is abundantly clear that the Republicans will be totally unprepared to step in and seize the advantage. They have NO plan. All we will get is "Well, we are going to address this right after the election." Fine! Address it with WHAT?
Why is this happening? The quest for ideological purity would be one reason. Yes – the Tea Parties certainly helped take control of the House away from the Democrats --- but now their intransigence is going to help hand the presidency back to Obama. It's time to form a coalition in the GOP --- Tea Parties and Republicans who might be defined as more moderate --- even RINOS. Times a-wasting.
I agree 100%. The Republicans should have had something ready to go on day one, and they should have been detailing it to the American people for the past few months. Instead, they have several broken plans and concepts, but nothing that would pick up the pieces immediately. Even if they do have a "secret plan" they now have no time to market it.
The one measure they could pose is to, upon the demise of Obamacare, introduce a bill de-regulating the purchase of medical insurance across state lines. That would force the insurance company to compete with hundreds of other offerings instead of just a few, and the massive competitive pressure would break the current medical monopolies held by companies in many states. Unfortunately, again, this would require and education process for the people, otherwise Pelosi and the likes would come out saying that they were trying to remove the "protections" that government places on the purchase of medical care and allow companies and individuals to buy "cut-rate" plans.
It's lose/lose for the Republicans. The only bright side is that once Obamacare is overturned insurance companies will immediately be able to issue long term plans to their customers and companies will have definitive forecast numbers on benefit plans, so that they can hire with some degree of confidence.
Laziness is a characteristic of obstinacy.
Quote from: Teatownclown on June 26, 2012, 11:04:07 AM
Laziness is a characteristic of obstinacy.
As is disorganization. The Republican party is fractured.
Medicare for all! Er, single payer is the only healthy solution. Just change some parameters and move FORWARD.
Quote from: Teatownclown on June 26, 2012, 11:38:02 AM
Medicare for all! Er, single payer is the only healthy solution. Just change some parameters and move FORWARD.
No. It's the worst option because it will ultimately eliminate competition and we will be left in the same situation as Canada and other countries who are clawing their way back out of collective medicine.
Additionally, the only reason the strive for new medicine and new advances has continued is because of the existence of profit. Remove that and our medical advances will essentially halt.
There has never been a single government controlled industry that has been a success, even the most simple of organizations grow in size and shrink in service, and fiscally ridiculous.
Why would you think medicine would be different?
Quote from: Gaspar on June 26, 2012, 11:52:45 AM
No. It's the worst option because it will ultimately eliminate competition and we will be left in the same situation as Canada and other countries who are clawing their way back out of collective medicine.
Additionally, the only reason the strive for new medicine and new advances has continued is because of the existence of profit. Remove that and our medical advances will essentially halt.
There has never been a single government controlled industry that has been a success, even the most simple of organizations grow in size and shrink in service, and fiscally ridiculous.
Why would you think medicine would be different?
Nonsense. Only big pharma and big insurance stand to lose. The government will not be controlling anything but the way services are paid .... So, here we go again. Why haven't you been the least bit consistent in your desire to eliminate socialism? And where are the GOP/Teabagger ideas to insure the 30,000,000? Or, do the righties just want them all to suffer?
Here's why it's a problem TTC, people refusing to enter the medical profession and capable professionals leaving it due to diminishing returns:
My daughter's boyfriend decided to decline his acceptance to OU Med this fall mostly due to the prospects of high debt load and diminishing salary projected for the years to come. He is one of the brightest young men I've had the pleasure to meet and it's disappointing people like this are passing on med school. He's likely going to end up in real estate or finance. He has no shortage of options available. It's not simply stupid speculation on his part, his father is a very well-respected cardiac surgeon and he sees the writing on the wall.
I'm also aware of many other physicians planning an early retirement should single payer become a reality.
QuoteNo one ever said being a doctor was easy. School and training go on seemingly forever, and once graduation arrives, doctors work long hours and are faced with life-and-death decisions daily.
There were once rewards. For decades, doctors earned hefty paychecks, had autonomy and respect. Those benefits are fading, and as a result, so is the number of doctors. Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America's Looming Doctor Shortage.
The American Medical Association recognizes there are shortages in certain geographic areas and in certain specialties. Part of that is due to the aging population and a stagnant number of medical school applicants.
See the galleries: Reasons Not To Become A Doctor
bigger reasons not to become a doctor
There are, however, other significant reasons not to become a doctor. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for.
This is not just a question of career choice -- consumers will be affected greatly by this shortage. If you think there's a long wait for an appointment now, it could be nothing compared with 15 years down the road. The three coauthors of Will the Last Physician in America Please Turn Off the Lights, all from the physician-staffing firm Merritt, Hawkins and Associates, say the wait will jump to three to four months or more to see a doctor for a non-emergency, and a routine doctor's visit will cost two to three times what it does now -- whether you are insured or not, they say.
insurance cutting into salary
Insurance has become a loaded word. One-third of the country is insured by Medicare, and over the next nine years, the government program plans to cut payments to physicians by about 40%, while practice costs are projected to increase 20%, according to the American Medical Association. The first of those cuts will take place in July, when the reimbursement rate to doctors will drop by 10.6%. The next cut of 5% will occur in January.
It's expected to have a trickle-down effect. "If Medicare makes a change to their reimbursement, other insurance companies follow their lead, since Medicare drives the marketplace," says Lawrence Smarr, president of the Physician Insurers Association of America, a trade association for medical malpractice insurance companies.
As costs continue to rise, many doctors say they need to see more patients in order to maintain their salaries and cover basic practice costs.
"We used to have a lot of respect for doctors, but now they seem like easy targets," says Phillip Miller, an author of Will the Last Physician in America Please Turn off the Lights. "There's a perception among patients that, 'I went to a doctor's appointment and he was 45 minutes late. He's probably on the golf course or driving his Mercedes.' The truth is, they're probably busy with patients."
medical school enrollment is down
The Association of American Medical Colleges projects that America needs a 30% annual increase in medical-school enrollment in order to keep up with need for doctors. In 2012, compared with 2002, medical-school enrollment will be up 21%.
Potential physicians face a future of looming medical-school debt, which is higher than ever. Students who graduate from a public medical school have a median debt of $100,000 and private-school students graduate with a median debt of $135,000, according to a 2003 study by the Association of American Medical Colleges. Compare that with 1984, when median debt for public-school graduates was $22,000 and private-school students was $27,000.
Monthly payment on a debt of $150,000 at the end of residency at an interest rate of 2.8% is $1,761, according to the study.
The amount of time it takes to pay off debt depends on the specialty. The average physician's net income, adjusted for inflation, declined 7% between 1995 and 2003, according to the Center for Studying Health System Change. In order to enter the most lucrative specialties, like radiology, ophthalmology, anesthesiology, and dermatology, doctors must continue with their training into their 30s. That means they can't start chipping away at their debt -- let alone make money -- until a time by which their counterparts in law or business are usually prospering.
Read more: http://www.askmen.com/money/career_200/210_career.html#ixzz1yvClyP68
Quote from: Conan71 on June 26, 2012, 12:36:39 PM
Here's why it's a problem TTC, people refusing to enter the medical profession and capable professionals leaving it due to diminishing returns:
My daughter's boyfriend decided to decline his acceptance to OU Med this fall mostly due to the prospects of high debt load and diminishing salary projected for the years to come. He is one of the brightest young men I've had the pleasure to meet and it's disappointing people like this are passing on med school. He's likely going to end up in real estate or finance. He has no shortage of options available. It's not simply stupid speculation on his part, his father is a very well-respected cardiac surgeon and he sees the writing on the wall.
I'm also aware of many other physicians planning an early retirement should single payer become a reality.
Two words - tort reform. Do that and reduce the malpractice premiums that most physicians pay and I bet the pool would increase over time. But I agree here.
Quote from: Conan71 on June 26, 2012, 12:36:39 PM
Here's why it's a problem TTC, people refusing to enter the medical profession and capable professionals leaving it due to diminishing returns:
My daughter's boyfriend decided to decline his acceptance to OU Med this fall mostly due to the prospects of high debt load and diminishing salary projected for the years to come. He is one of the brightest young men I've had the pleasure to meet and it's disappointing people like this are passing on med school. He's likely going to end up in real estate or finance. He has no shortage of options available. It's not simply stupid speculation on his part, his father is a very well-respected cardiac surgeon and he sees the writing on the wall.
I'm also aware of many other physicians planning an early retirement should single payer become a reality.
Good for the lad exercising his right to choose. I hope he's willing to suffer the consequences for his decision....and I can't condemn individual choice when it seeks higher income over the desire to help others. I do recall growing up and understanding that doctors do it to make the world a better place.
I know more young people entering science and medicine than any other field. Guess it's who you know.
Quote from: Hoss on June 26, 2012, 12:39:55 PM
Two words - tort reform. Do that and reduce the malpractice premiums that most physicians pay and I bet the pool would increase over time. But I agree here.
That will certainly help.
Quote from: Teatownclown on June 26, 2012, 01:16:48 PM
Good for the lad exercising his right to choose. I hope he's willing to suffer the consequences for his decision....and I can't condemn individual choice when it seeks higher income over the desire to help others. I do recall growing up and understanding that doctors do it to make the world a better place.
I know more young people entering science and medicine than any other field. Guess it's who you know.
Who says there are consequences to his decision? The way he views it the other way would have been full of consequences. Why bust your balls for eight years, go $150K in debt, work 120 hour weeks, etc. for what is forecast as much less pay than what physicians enjoy now? My PC got out a few years ago. Quite a shame, she was a great doc.
Quote from: Conan71 on June 26, 2012, 02:11:52 PM
Who says there are consequences to his decision? The way he views it the other way would have been full of consequences. Why bust your balls for eight years, go $150K in debt, work 120 hour weeks, etc. for what is forecast as much less pay than what physicians enjoy now? My PC got out a few years ago. Quite a shame, she was a great doc.
It's actually kind of funny. I have lots of friends that were in the medical profession and they typically use terms like "I escaped" or "I got out before it was too late" to describe their career changes. That's kind of sad for what used to be a respected profession.
The big insurance groups linked to clinics are importing a lot of physicians now from other countries as well as taking advantage of Nurse Practitioners and PCs to treat patients. While many of them are highly trained they do not have near the training or discipline required of an actual MD, but the big clinics can charge the same rates and pay them far less.
We are coming very close in Oklahoma to only having two or three medical insurance companies. Universal will probably ultimately be the only survivor, and own the industry. When Prudential dropped out last year, Universal immediately raised their rates, knowing that thousands of companies would have little choice but to transition to them.
We need to return BACK to a time when insurance was shopped, and purchased by the consumer, and they were free to choose whatever program best fit their family's needs, and they were free to purchase from the insurance provider they believed gave them the best service, the best price, or the most reliable coverage. Collectivism will ultimately produce a degraded product. Always has, always will.
Quote from: Conan71 on June 26, 2012, 02:11:52 PM
Who says there are consequences to his decision? The way he views it the other way would have been full of consequences. Why bust your balls for eight years, go $150K in debt, work 120 hour weeks, etc. for what is forecast as much less pay than what physicians enjoy now? My PC got out a few years ago. Quite a shame, she was a great doc.
Oh, don't get your balls in an uproar. I was thinking in terms of the lad desire for giving care and later on regretting his decision to go for the money.
How old was your vet when she retired?
Quote from: Gaspar on June 26, 2012, 02:31:44 PM
It's actually kind of funny. I have lots of friends that were in the medical profession and they typically use terms like "I escaped" or "I got out before it was too late" to describe their career changes. That's kind of sad for what used to be a respected profession.
The big insurance groups linked to clinics are importing a lot of physicians now from other countries as well as taking advantage of Nurse Practitioners and PCs to treat patients. While many of them are highly trained they do not have near the training or discipline required of an actual MD, but the big clinics can charge the same rates and pay them far less.
We are coming very close in Oklahoma to only having two or three medical insurance companies. Universal will probably ultimately be the only survivor, and own the industry. When Prudential dropped out last year, Universal immediately raised their rates, knowing that thousands of companies would have little choice but to transition to them.
We need to return BACK to a time when insurance was shopped, and purchased by the consumer, and they were free to choose whatever program best fit their family's needs, and they were free to purchase from the insurance provider they believed gave them the best service, the best price, or the most reliable coverage. Collectivism will ultimately produce a degraded product. Always has, always will.
Why do you guys hate medicare and refuse to offer up any amendments to redirect it's scope to include everyone or even just those who can't get insurance?
Quote from: Teatownclown on June 26, 2012, 03:51:35 PM
Oh, don't get your balls in an uproar. I was thinking in terms of the lad desire for giving care and later on regretting his decision to go for the money.
How old was your vet when she retired?
No uproar here, there's always time to go back. I know two engineers who both turned in their slide rule in their 30's go to to med school.
My vet. Cute. She was 51 or 52 when she left Omni. Last I heard she's doing "industrial medicine a few days a week" which I believe is doing employment physicals.
"Turn your head and cough."
Quote from: Teatownclown on June 26, 2012, 03:55:33 PM
Why do you guys hate medicare and refuse to offer up any amendments to redirect it's scope to include everyone or even just those who can't get insurance?
1. It's essentially bankrupt. Paying out far more than it takes in.
2. It pays physicians 20% less than the typical cost of their services, so they shift that cost to the rest of us.
3. It only covers a portion of necessary services. Most smart patients also choose to add a supplement.
4. It requires a medicare coding system with tens of thousands of codes for each procedure/treatment/exam/medication that requires a full time staff for physicians and clinics to manage.
5. Any error in coding results in delayed payment, audits, and challenges, the majority of which are settled but only after significant administrative expense.
6. It only offers a strict formulary of treatments and medications and is slow to adopt new treatments (having worked in a hospital, I know that Medicare patients are given a lower priority because they are not candidates for the most advanced treatments or procedures unless they have a supplemental plan).
7. . .and finally, medicine, pharma, therapy, and biochemistry, and biotechnology are driven, like any other industry, by profit.
Remove the profit, or regulate it heavily, and you remove the incentive. If it costs you $780 million dollars to produce your new cancer drug, but you know that it can't go to market because it's only 15% more effective than chemotherapy and the government will only pay for chemotherapy, why bother? Most medical breakthroughs are not Earth shattering, they are baby steps. One drug leads to another drug that may only work 10% better or may work 100% in only 5% of the affected patients. Insurance companies have to compete for accounts and contracts. At least that offers some competition. It used to be they had to compete for individual families. If your insurance company pissed you off because they wouldn't pay for your BP medicine, you said "good bye" and went to another carrier willing to compete for your business.
What you are proposing is not going FORWARD, it's going AWAY!
Quote from: Gaspar on June 26, 2012, 04:34:30 PM
1. It's essentially bankrupt. Paying out far more than it takes in.
2. It pays physicians 20% less than the typical cost of their services, so they shift that cost to the rest of us.
3. It only covers a portion of necessary services. Most smart patients also choose to add a supplement.
4. It requires a medicare coding system with tens of thousands of codes for each procedure/treatment/exam/medication that requires a full time staff for physicians and clinics to manage.
5. Any error in coding results in delayed payment, audits, and challenges, the majority of which are settled but only after significant administrative expense.
6. It only offers a strict formulary of treatments and medications and is slow to adopt new treatments (having worked in a hospital, I know that Medicare patients are given a lower priority because they are not candidates for the most advanced treatments or procedures unless they have a supplemental plan).
7. . .and finally, medicine, pharma, therapy, and biochemistry, and biotechnology are driven, like any other industry, by profit.
Remove the profit, or regulate it heavily, and you remove the incentive. If it costs you $780 million dollars to produce your new cancer drug, but you know that it can't go to market because it's only 15% more effective than chemotherapy and the government will only pay for chemotherapy, why bother? Most medical breakthroughs are not Earth shattering, they are baby steps. One drug leads to another drug that may only work 10% better or may work 100% in only 5% of the affected patients. Insurance companies have to compete for accounts and contracts. At least that offers some competition. It used to be they had to compete for individual families. If your insurance company pissed you off because they wouldn't pay for your BP medicine, you said "good bye" and went to another carrier willing to compete for your business.
What you are proposing is not going FORWARD, it's going AWAY!
Great example of lazy right wing thinking. More a whine than an idea about what to do. I want to remind you we are far from first in health care compared to the rest the world.
How about means testing?...how about setting new standards for qualification as well as establishing new actuarial tables for care. There's much room for flexibility, re-balancing, and calibration to Medicare. If only there wasn't obstinacy at every turn.... The only thing going away is gouging the middle class. :o
Quote from: Teatownclown on June 26, 2012, 06:25:42 PM
Great example of lazy right wing thinking. More a whine than an idea about what to do. I want to remind you we are far from first in health care compared to the rest the world.
How about means testing?...how about setting new standards for qualification as well as establishing new actuarial tables for care. There's much room for flexibility, re-balancing, and calibration to Medicare. If only there wasn't obstinacy at every turn.... The only thing going away is gouging the middle class. :o
It's lazier to simply say: "Let's put everyone on Medicare!"
First, we do have one of the the best if not the best healthcare system in the world. The problem is, not enough people take a pro-active approach to their health nor do they prioritize it. People who sit around eating poison-laden crap, drinking a 12 pack a night, and smoking a carton of cigs a week either are or will be a drag on the system and will add to the "poor outcomes" tally every time because they wait until their body is so broken there's little you can do other than pump it full of one drug after another.
When I worked for a company too small to afford health benefits and even when I had my own business, I felt it was a priority to have health insurance for my family. I paid out of pocket and did without new cars, big screen TV's, and eating out seven nights a week. I really have no pity for people who are making very good income but cannot "afford" health insurance. It's simply a bigger priority to them to drive a new Mustang GT, live in a newer home, and have a large balance on their Best Buy card. Sure there are people who do need publicly-funded health insurance, but do understand there's a decent percentage of young Americans who simply don't buy health insurance because they have materialistic priorities greater than health insurance.
It's no secret that obesity stats run inverse to longevity stats. Pick any country with a "better" health care system than the U.S. and I guarantee you will find their obesity rates are far lower, their diets are far healthier, and people don't smoke and drink as heavily as we do here in America.
Let's say we do go single payer, there will still be two tiers of healthcare in this country: those who can afford to pay cash for their care and those who will get the care with a government-mandated discount. Guess who is still going to get preferential treatment? It's not going to be the person on Medicare.
Just because the government dictates procedures should cost a certain amount doesn't mean they can be done profitably. Yes, I understand that medicine should ascribe to the higher calling of helping our fellow man, however, it can't run at a break-even or a loss.
One thing I believe really drove up the cost of care in the last 20 years or so is all the specialty hospitals. Our health care system has become so far flung and there are so many facilities to maintain and operate, I suspect that alone could account for as much as 25 to 30% of the rise in costs in the last two decades. Doctors are becoming partners in these hospitals as another profit base. I don't fault them for this, but it's something the government could have taken a long look at and attempted to regulate before it got out of hand. Take a look at how many specialty hospitals we had in 1992 in the Tulsa Metro and how many we have today, it's pretty amazing the growth we've seen. Great for the construction industries and it's no doubt created new support staff, PT, and nursing jobs but it's definitely added to the costs.
Hospice and home healthcare have also exploded in that time, all feeding off the teat of Medicare and Medicaid. What's sad is watching a nursing home, a hospital, a hospice, and a home healthcare company all fighting over the same patient in the days immediately preceding their death so they can get their government-funded billing. Medicare and Medicaid are just as much to blame as the providers for the explosion in HC expenditures simply because they have allowed such an expansion of hospice and home healthcare. Sure there's a need for both services but the bar is set so low for eligibility, there are people who end up on hospice long before it's really needed, and who stay on home health care long after it's no longer needed.
Single payer isn't the panacea you think it is. All parties need to come to the table instead of a bunch of legislators who understand no more about healthcare than their lobbyists tell them to think trying to overtake the entire system.
As a country, we also need to take a much more proactive approach to our health instead of a reactive one.