Five MORE Failures of the American Healthcare System

Second part in a series.

Supporting direct care is imperative to American healthcare success. It’s about empowering patient and doctor, and yes, taking back control from healthcare’s crony oligarchs: insurance & government. The fact is, if we use insurance for primary care — things like a physical, blood panels, monthly prescriptions, a splint for a sprained ankle — the only buyer and seller is the insurance company and/or the government. Why? It’s because we’re looking at a subsidized system involving the general public.

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Five Failures of the American Healthcare System

First part in a series.

We started practicing direct care because we knew there were major problems with American Healthcare. So what’s wrong with our profit-maximizing system. For starters, here’s five startling realities of our healthcare model:

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Still Think Health Coverage Is Health Care? Ask Obamacare Enrollees Who Can’t Find A Doctor.

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Terri Durheim and her family now have health insurance, courtesy of Obamacare. But what they don’t have are local doctors and hospitals who will take it.

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Fee-For-Service Private Practices Face Dark Times.

Dr. Tracy Ragland, 46, an independent primary care physician, is anxious about the future of her small practice. The law is bringing new regulations and payment rates that she says squeeze self-employed doctors out of even practicing medicine. She cherishes the autonomy of private practice and speaks darkly of the rush of independent physicians into hospital networks, which she sees as growing monopolies.

“The possibility of not being able to survive in a private practice, especially primary care, is very real,” she said.

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Direct Care Is Actually Affordable. Direct Care Is Actually Care. Something The ACA Wishes.

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When Blue Shield of California was designing the new health plans it would offer individuals under the Affordable Care Act (ACA), the insurer made a simple request to doctors and hospital in its network — lower your prices or get left behind. The insurer asked providers to accept reimbursement rates as much as 30 percent lower than what Blue Shield previously paid through plans sold on the individual market. Keep in mind that billing through a third-party-payer is about to multiply tenfold in complexity (from ~15,000 to +155,000 billing codes with ICD-10), meaning that getting paid will require more work for fee-for-service docs. In fact, providers are attending training seminars, paid for out of pocket, to learn how to deal with this billing beast.

Some providers got on board with Blue Shield, but not all of them.

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Posted by: AtlasMD

December 11, 2013

1 Comment

NPR Visits ACA Prison Glitch. Gets Touche.

In the mood for some high brow hahas? Then you’ll want to read NPR’s “prison glitch” coverage. Have you experienced this malfunction yet? Wait, that would mean you were actually signing up on the Federal insurance exchange (jk). Either way, according to NPR, the Obama administration says it has patched hundreds of software bugs infecting the government’s health insurance website.

What’s the “prison glitch”? We’re glad you asked. Evidently, Martha Freeman of Pennsylvania encountered the bug while signing up for coverage for herself and her adult children. The insurance website asked for documentation of the children’s incarceration status. It’s worth noting that her kids have never been to prison.

Freeman figured she was “stuck in solitary,” says NPR, until she called a toll-free help line and found out she wasn’t alone. Others have been experiencing this bug, too.

We do have to hand it to NPR. Their tone is hilarious. “Stuck in solitary” is only the first of prison-themed puns in the article.

Posted by: AtlasMD

November 12, 2013

2 Comments

Have You Heard About The “Cadillac Tax” Yet?

Here’s a funny development in the Obamacare story that’s emerging (actually more like shipwrecking than emerging, but that’s just semantics). Check out this article from CBS going over a law that’s set to be in effect come 2018. Evidently companies providing insurance benefits to employees might face what’s termed the “Cadillac tax” if they offer TOO MANY BENEFITS to their employees. Wait what? So CBS says, “The ‘Cadillac tax’ is one of the tools in the Affordable Care Act designed to bring down costs — by encouraging people to cut down on unnecessary health care expenses.”

First off, that’s silly. That means you’re going to tax companies and dissuade them from offering benefits.

Second, this is coming from an administration that’s FORCING people to buy better insurance plans, with more benefits. And sometimes these better plans are forcing single men to pay for MATERNITY LEAVE, when they can never have a child.

READ THE COMPLETE CBS ARTICLE HERE

We Love The Smell Of Red Tape In The Morning

Okay, so the title’s a bit sarcastic. But for anyone following the Obamacare debacle, you’ll want to get your head around CNN’s helpful article, “5 Things We Learned From Sebelius Obamacare Hearing.

Our favorite item is number 5, where we find out that, yes, it would be illegal for Sebelius to sign up for an exchange plan, but not for the original reasons that she used to justify her seeming hypocrisy (She’s eligible for Medicare so that’s what disqualified her from the exchange). Of course she still claimed that Obamacare’s great and that she’d sign up if she could. Although, if it was so great, why would Congress write its own members out of the plan?

Now we wouldn’t go this far, but wouldn’t it be great if a cash-only doc offered Sebelius such a low-cost membership that she opted for direct care over Medicare? Maybe that type of publicity stunt could turn all this media fervor into a more productive conversation.

READ THE COMPLETE CNN ARTICLE

Health Care Exchange Website Builders In The Hot Seat

USA Today reports from Washington that many of the problems that have plagued the HealthCare.gov website stemmed from high demand for health insurance coupled with confusion between contractors. So an official with a top government contractor will say in prepared testimony to a House panel on Thursday.

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Even The New York Times Is Suggesting Catastrophic Insurance Plans

In his new New York Times healthcare piece, “Driving a New Bargain on Health Care,” Tyler Cowen spells out the hard truth of Obamacare failings. Based on his prognosis, a lack of states extending Medicaid coverage will leave millions uninsured. This isn’t something that should excite anyone. However, it’s leading to wake up calls from top journalists. In his assessment Cowen offers a reaction to this shortcoming:

“At the same time, I’d recommend narrowing the scope of required insurance to focus on catastrophic expenses. If insurance picks up too many small expenses, it encourages abuse and overuse of scarce resources.”

As you know, we’ve been suggesting this for years now. When we as a nation can’t provide care for our own, that’s failing. But when we know something isn’t working (health insurance as health maintenance, for one) and we keep doing it, that’s even worse. So yes, while we’re nowhere near a solution, we’re moving towards a society that recognizes one thing: coverage is not care. It’s a point worth mentioning, because to many people, the idea that EVERYONE is insured sounds like utopia. For now, we’ll be the squeaky wheel reminding you that this isn’t really the case.

READ THE FULL NEW YORK TIMES ARTICLE HERE