Found this:
http://www.reddit.com/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
It obviously contains some heavy biases when the author makes some side notes as well as some of the less-than-stellar economic analysis made also by the author ("there wont be rationing of care because there are safeguards in place to make sure this doesn't happen"), but if the basic info is good (dates when certain aspects take effect, how money will/is intended to flow, etc.), I will use it in the future for future reference.
Wanted to see if you guys can see any other, more technical, flaws in this laymen's terms summary of Obamacare. Again, I know it is rife with economic illiteracy. I just want to know if the basic, bare bones, undeniable aspects of Obamacare are true here. From what I can tell, that part at least seems like its on the up and up, but I am no expert. Maybe some of you guys know more. The author claims that he is no expert on the law either, and got most of his info directly from the law's own language (suspect already), readers who have corrected certain points, as well as wikipedia (perhaps suspect).
basically, how well does the summary do at summarizing the actual language of the law (however bullshit) in laymen's terms?
"If men are not angels, then who shall run the state?"
My wife is a clinical pharmacist in the cardiology unit of a major regional hostpital, and I am a retail pharmacist. Her and I are very familiar with this stuff, and on October 1st some major changes went into effect in the hospital setting. If you would like me to go over some practical, specific examples of how this affects our practice I would be more than willing. As for what the guy posted on reddit, it looks to be accurate. Of course, the conclusions he draws are all bogus. But for the most part, what he typed is what is getting implemented.
For example there is this: "A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover."
This is inaccurate. This law applies to health savings accounts or flexible spending accounts. These, of course, are not insurance. They are accounts that you personally deposit money from your pay check into, and are tax deductible. So when he makes comments about aspirin and hangovers, he's just totally misleading you. You literally have to get a Rx from your Dr. now to use those accounts to purchase Tylenol or Benadryl. Obviously, nobody is going to do this. And it is completely separate from your actual insurance company.
Edit: If you would like a better timeline from the government itself, see here : http://www.healthcare.gov/law/timeline/index.html
Prime: My wife is a clinical pharmacist in the cardiology unit of a major regional hostpital, and I am a retail pharmacist. Her and I are very familiar with this stuff, and on October 1st some major changes went into effect in the hospital setting. If you would like me to go over some practical, specific examples of how this affects our practice I would be more than willing. As for what the guy posted on reddit, it looks to be accurate. Of course, the conclusions he draws are all bogus. But for the most part, what he typed is what is getting implemented. For example there is this: "A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover." This is inaccurate. This law applies to health savings accounts or flexible spending accounts. These, of course, are not insurance. They are accounts that you personally deposit money from your pay check into, and are tax deductible. So when he makes comments about aspirin and hangovers, he's just totally misleading you. You literally have to get a Rx from your Dr. now to use those accounts to purchase Tylenol or Benadryl. Obviously, nobody is going to do this. And it is completely separate from your actual insurance company. Edit: If you would like a better timeline from the government itself, see here : http://www.healthcare.gov/law/timeline/index.html
How would you guys like to go back to a pure cash basis for working with patients?
I'm setting up a permanent seastead off the California coast within the next few years. It occurred to me that at least some doctors and healthcare providers might enjoy escaping the Obamacare system by moving just into international waters, 14 miles out, and doing business outside the healthcare law there, for profit again, with clients as customers and none of the red tape.
I can see a market for all sorts of high-end procedures, surgeries, and drugs that will be price-controlled, tamped down, or rationed under obamacare.
Prime:If you would like me to go over some practical, specific examples of how this affects our practice I would be more than willing.
Personal anecdotes and stories from the front lines are always useful. Please fill me in.
Also, I have another question for you. If this is too personal I understand: is your wife austrian like you? Reason I ask is because I am getting married in about a year and I am kind of trying to prepare to navigate marital waters when pulling into the port of politics. My fiance is mostly totally apathetic, so most of the time she just defers to me, but on a few key issues, we differ; intellectual Property being chiefest among them. She works in the music industry like I do, so IP is near and dear to her, unlike it is to me.
"Anti-fraud funding is increased and new ways to stop fraud are created."
Let me start with this little gem right here. After all, who doesn't want to end fraud? This is how Medicare perfroms an audit on me:
A random fax shows up from I don't know who and it says that I have to provide all the pertinent information in regards to prescription number X, and I have maybe a week to do this. So what are they looking for? Well, the actual prescription for starters. Now remember, I have to legally store these prescriptions for 5 years. If I fill 100k scripts a year, well, you can imagine how much storage this takes.
So I go into some storage closet, dig through a bunch of boxes, and hopefully I can find a 2 year old prescription. Then, I have to have proof that the patient actually picked the darn thing up (you know how you have to sign the electronic signature pad when you purchase an rx). Well lets just hope my technician actually got this signature 2 years ago, and that there were no electronic malfunctions at the time of the transaction.
Now it gets really good...sometimes, and I don't know what the trigger is for this, but sometimes they actually want the Physician's progress notes on the patient. Now I'm a retail pharmacist, does anyone in their right mind think I have access to the physicians freaking progress notes!? Well, I don't. So now the burden falls on me to call the Dr. and hope he has time to pull the progress notes and fax them to me, so I can then fax them to some random auditor. Lets just say this has never happened, and I don't know if Medicare is going to take back the reimbursement or not.
These audits randomly show up, usually in groups of 2 or 3. But what about accreditation? Not just anyone can bill Medicare, so this involves an actual on site visit from an auditor. We literally got dinged, I kid you not, because we didn't have an EXIT sign above the door in our pharmacy. Now my pharmacy is maybe 10x20'. There is nobody in universe who doesn't know where the exit is. And what does an EXIT sign have to do with providing healthcare? You get the picture....
At the end of the day, compliance takes time, and time costs money. I literally have to pay to have this crap done, and at the end of the day, it leads to taking time away from patient care. I work non-stop almost every day at work. Corners get cut to make time for this.
Oh, and perhaps the most important thing...I would say 80 or 90% of the time Medicare reimburses me below the actual cost of the diabetic test strips. So I lost money from the outset of this.
Prime: At the end of the day, compliance takes time, and time costs money. I literally have to pay to have this crap done, and at the end of the day, it leads to taking time away from patient care. I work non-stop almost every day at work. Corners get cut to make time for this. Oh, and perhaps the most important thing...I would say 80 or 90% of the time Medicare reimburses me below the actual cost of the diabetic test strips. So I lost money from the outset of this.
Right, pretty clear case of unpaid slavery, which the bill of rights supposedly prevents.
So, what do you think about moving your practice to a seastead? ;)
Anenome,
I would certainly welcome the day where I only took cash transactions and had no laws restricting what I can do. It's sad, really, because I could do so much to lower the cost of healthcare for my patients if I only had the authority. Now I am not an expert in diagnosis, but I am an expert in treatment. But do we always need an expert to diagnose? For example, if you are on a hike and brush up against a vine with 3 leafs on it, and now you have an itchy red rash, what would you think that is? Does it require a $100 office visit to get a Rx for a $20 Medrol dose pack and a $5 tube of triamcinolone cream? If I could just sell the stuff outright we could dramatically reduce costs. I envision a scenario where I act more as a primary care doctor for a 1/10 the cost.
Now to your original question about seasteading, I would love it, but I don't think I could get the wife on board. And I don't know that my skills would be as usefull for medical tourism because the patients wouldn't be allowed to take any medications back into the U.S.
Wow, that is insane that they ask for the patient's progress report. As if it wasn't bad enough that the government has any right to look at this (HIPAA apparently doesn't apply to the state), they then treat the patient like a middle schooler; a progress report?!?!?!?! Than, to top it all of, they ask the wrong guy for the information.
Question: when you say a retail pharmacy, does that mean you own a building that is simply a pharmacy and that is all? When you first said it, I pictured a CVS or something.
I know that is a lot of typing (I am no stranger to that), but these are great ammunition (and ammo you really can't get any other way). Can you tell us any more?
Ah well, getting the wife on board can come once there's an established seastead with a decent population and amenities. Wives won't want to be a part of the early risky pioneering part of the venture, understandably.
As for patients not being able to take medication back to the US, understandable. But that could work to the seastead's favor. It will have very low entry costs to buy a house there and stay, seeing as there's no land shortage, no rent, etc. People who desperately need medical care of a certain sort may end up moving to the seastead for the duration of treatment, and then may like it enough to stay when they're healthy again.
Sounds good to me :)
Prime:Now to your original question about seasteading, I would love it, but I don't think I could get the wife on board. And I don't know that my skills would be as usefull for medical tourism because the patients wouldn't be allowed to take any medications back into the U.S.
Correct me if I am wrong, and I very well could be, but it seems to me that if you lived in a sovereign state, such as the espoused by aenome, couldn't the patient smuggle the drugs in themselves and all the risk would be on them? I realize that many would not be willing to accept that risk which might make the venture unprofitable. But, what about just shipping the drugs to them? Seems like you would have immunity from US drug laws, but maybe only in a de jure sense, I guess. Just thoughts...
Also, to play devils advocate on the exit sign in your small building, isn't the rational for them in case of a fire where it is extremely smoky and people cannot see the exit, the lit exit sign would direct them? I am not defending it, just trying to anticipate rebuttals. Are there any highly flammable or explosive substances in the pharmacy. I would think a fire would be gradual enough to give one time to get out before it became life threatening, but if there were anything that were highly flammable or explosive (perhaps pressurized cans containing flammable gasses), I would guess that would be the argument for the exit sign, "This place could blow any minute given the right circumstances. Why not just spend the $40 for the exit sign?" they might proclaim, however poor that argument may be from a property rights perspective.
"Wow, that is insane that they ask for the patient's progress report. As if it wasn't bad enough that the government has any right to look at this (HIPAA apparently doesn't apply to the state), they then treat the patient like a middle schooler; a progress report?!?!?!?! Than, to top it all of, they ask the wrong guy for the information.
Question: when you say a retail pharmacy, does that mean you own a building that is simply a pharmacy and that is all? When you first said it, I pictured a CVS or something."
When I say retail pharmacy I mean an outpatient pharmacy that sells prescriptions to the public. I work for a large retail store that has a pharmacy inside with thousands of locations.
Let me clarify a few things in regards to Medicare and prescriptions. There are 2 plans, Medicare Part D that Bush enacted, and Medicare Part B. Part D is used when purchasing drugs and is actually carried out by private insurance companies that are subsidized by the government. Part B is used to pay for medical devices (diabetic testing strips, nebulizers, wheelchairs...). Part B is paid directly from the governement, not using private insurers as a middleman. The audits I am talking about are for Part B. Luckily, the majority of my business is Part D (even though that presents it's own set of problems).
Let me give another scenario though in regards to Part B. If you are a diabetic and require daily testing of your blood sugar, you are allowed to test 1 time per day if you are not on insulin, and 3 times per day if you are on insulin. Some people actually require testing of 6 or 8 times a day though, so then what? Don't worry, Medicare has an override for this...all you have to do is keep a daily testing log, and then every time you need a refill bring that log in and let me fax the results off to the Medicare gods for approval. Keep in mind, we are mostly dealing with elderly patients here. Can they accurately keep a log of their blood sugar if they are testing 6 times a day? It's not like they can't just make up numbers anyway, I don't know what the point of this even is.
As for the prescription itself, it has very strict criteria that must be on it. Dr. forgot to write the diagnosis code on the Rx? Sorry, go home, I will fax the Rx back to the Dr. so he can scribble a few numbers on it. No diagnosis code on your albuterol Rx, sorry, go home while I fax this to your Dr. Hopefully it's not Friday night or you may have to wait until Monday. Please don't have an asthma attack between now and then. And no, I can't just call the Dr. to get the diagnosis code, he physically has to write it on the Rx.
But what about inpatient pharmacy, what my wife does? As I said before, October 1st was a new deadline for some new rules under Obamacare. One of those regulations involves how often a patient is readmitted into a hospital over a 30 day period. If some patient gets discharged and has to return within 30 days, the Medicare reimbursement gets decreased to the hospital.
But how much of this does the hospital have control over? Heart failure patients, for example, are continuously in and out of the hospital. Because their heart is weak, they have fluid build-up on their lungs and they can't breath easily. Now a lot of this can be controlled by medications. But what if the patient doesn't take the meds? What if they choose not to follow dietary guidelines? The hospital can do everything within their power to prevent this, but at the end of the day we can't force the meds down the patient's throat. The hospital gets penalized for the lack of patient responsibility.
wow, please keep it coming. These little anecdotes are just awesome. I don't know if you saw this thread I started. If you read the first post, you'll find that I am currently compiling and editing all of the Mises articles I can find on the American healthcare system and the Universal Healthcare systems into one cohesive and organized whole. I have also been on the lookout for forum posts that I think are distinctly astute on this topic. That said, if you want to write more of these, I will happily include them in the "book" as a I'm calling it. There doesn't appear to be a whole Austrian perspective book dedicated to this topic, so I have taken it upon myself to make one.
Let me know if you are in, and if I have your permission to put these in the book which I will publish on these forums. Hopefully I can get the institute to publish at least an ebook version for free download. None of this would be possible if Mises.org were not so hateful on IP and so generous with their works.