ObamaCare Info

[A_Princess'_Daddy]

From A_Princess'_Daddy: "Another solution is to increase the usage of NPs and PAs for routine care, which would allow the more highly trained physicians to focus on specialty care, where their training is needed, but that would require doctors to allow a reduction in their monopoly on patient care."

You still need a doctor to supervise the NPs and PAs.

Not necessarily and not in all cases. In most states NPs can practice independently of doctors (within their permitted scope) and PAs can do many procedures independently as long as there is a physician in proximity, e.g. in the practice. Physicians would still be needed, per my point, but they could focus on more complex cases and the number of physicians focused on routine primary care could be dramatically cut, thereby reducing costs and, I suspect, dramatically increasing patient satisfaction.

This model is already in place in many places, by the way, and working quite well. I haven't seen my primary physician in probably two years and rather have had PAs and a NP handle a couple of sinus infections, an ear infection and a case of strep throat. My primary physician is still there, I have seen him and said hello in passing, but he's focusing on annual physicals, major cases, etc. where his training is needed. Of course this model, if expanded widely, would also impact the near monopoly that physicians seek to have over the medical care system, but if we are to fix the economics of health care, a critical first step is not having somebody with 7+ years of post-undergraduate training handle the most basic of care.

 

[chobie]

Really? My DH has been a mechanic at the same Lincoln dealership for almost 30 years. His salary had decreased every year for the last 3 years. Just because the shop charges $128/ hour doesn't mean that is what the mechanic gets paid. It is FAR less than that. Warranty times have been cut by the manufacturer not to mention all the work that he does and isn't paid for because the service dept "good wills " it for the customer.

Pretty much everyone has been making less money than they used to in the last several years. Why should anyone be surprised this includes doctors?

 

[AndyLL]

Are you a doctor? I don't think so, or you wouldn't be saying this.

My husband is a doctor. Every year he gets less money for doing the same procedures. Our car mechanic literally makes more money per hour than he did doing several procedures today. Good thing he is nearing retirement age.

This topic is about the ACA.

When someone buys a policy from the exchange the payments works the same as insurance policies have always worked. There is nothing the the law that mandates what the doctors are paid through policies bought on the exchange.

For decades doctors have been squeezed by the insurance companies to take less. Welcome to the club... patients have been also.

The insurance companies squeezing both doctors and patients has been going on long before the ACA was passed.

 

[AndyLL]

Pretty much everyone has been making less money than they used to in the last several years. Why should anyone be surprised this includes doctors?

Yeah... I'm in IT. Our company has outsourced over 90% of our IT jobs overseas.

 

[daughtersrus]

Pretty much everyone has been making less money than they used to in the last several years. Why should anyone be surprised this includes doctors?

I'm not surprised that doctors are making less but I bet they are making more than $30/ hour.

 

[Marionnette]

I'm not surprised that doctors are making less but I bet they are making more than $30/ hour.

Don't bet on it! By the time they pay for their overhead costs, they are grossing a lot less than you think!

Then take into account that they pay 100% of their Social Security tax because they are self-employed, as opposed to having an employer pay half.

And then, they also have to purchase health insurance, usually on the private market, without an employer paying part of their premiums.

And you're not taking into account all of the time spent maintaining the electronic records for patients. Time which is not spent focused on the patient, but time which must be spent either during the exam itself or shortly after the completion of the exam. There is no additional reimbursement for that time yet it takes away from the doctor's ability to see an additional patient or squeeze in that urgent visit that someone needs.

The doctor's situation is no different than any other self-employed person. The same could be said for electricians, plumbers, mechanics and carpenters who work for themselves. However, unlike those other trades, they physician's fees cannot be set by himself. The insurance industry dictates what he gets in exchange for his service.

 

[mhsjax]

Don't bet on it! By the time they pay for their overhead costs, they are grossing a lot less than you think!

Then take into account that they pay 100% of their Social Security tax because they are self-employed, as opposed to having an employer pay half.

And then, they also have to purchase health insurance, usually on the private market, without an employer paying part of their premiums.

And you're not taking into account all of the time spent maintaining the electronic records for patients. Time which is not spent focused on the patient, but time which must be spent either during the exam itself or shortly after the completion of the exam. There is no additional reimbursement for that time yet it takes away from the doctor's ability to see an additional patient or squeeze in that urgent visit that someone needs.

The doctor's situation is no different than any other self-employed person. The same could be said for electricians, plumbers, mechanics and carpenters who work for themselves. However, unlike those other trades, they physician's fees cannot be set by himself. The insurance industry dictates what he gets in exchange for his service.

Well said. Plus many physicians deal in life and death situations.

 

[Colleen27]

Funny how people can see the same thread in different ways. I was thinking yesterday that out of all the posts here only very few were postive.

I think there are two very good reasons for that. First of all, few on the DIS are in the demographic most likely to be helped by this (between 100% and 400% FPL with no access to employer-provided insurance. Some of those that are probably aren't especially comfortable admitting to it, given the attitudes on this board towards finances as a whole and government subsidies specifically. Admitting to being lower middle/working class, not being able to afford insurance, etc. invites getting posts about future trips/spending picked apart by those with long memories.

And second, those of us who have posted positives are mostly being drowned out/buried by those who hold a more negative view. Which is, really, just human nature... go over to the Theme Parks board and you'll see the same thing at play about MagicBands/FP+, people are just more apt to be vocal with complaints than with praise.

Actually, there's probably a third factor in there as well - with the website issues the subject leading news stories every day for almost a month so far and the policies not going into effect until January 1, I think many people are waiting until the bugs start getting worked out before jumping in. I'm in no great hurry for just that reason - why fight a glitchy site unnecessarily now, months before the policies go into effect?

 

[mom2rtk]

And second, those of us who have posted positives are mostly being drowned out/buried by those who hold a more negative view. Which is, really, just human nature... go over to the Theme Parks board and you'll see the same thing at play about MagicBands/FP+, people are just more apt to be vocal with complaints than with praise.

Well, it's not entirely impossible that both Obamacare and MB/FP+ are both really just lousy programs.

 

[robinb]

I think there are two very good reasons for that. First of all, few on the DIS are in the demographic most likely to be helped by this (between 100% and 400% FPL with no access to employer-provided insurance. Some of those that are probably aren't especially comfortable admitting to it, given the attitudes on this board towards finances as a whole and government subsidies specifically. Admitting to being lower middle/working class, not being able to afford insurance, etc. invites getting posts about future trips/spending picked apart by those with long memories.

This is very true. I remember (with my long memory ) when a very popular poster who was beloved for her fabulous trip reports (LYMI) was raked over the coals because she couldn't afford health insurance for her teen DD. I was shocked at how mean people were to someone who they encouraged and applauded just the year before.

 

[mistysue]

Well, it's not entirely impossible that both Obamacare and MB/FP+ are both really just lousy programs.

You totally just proved her point.

I've posted positive things a few times and for if you post positive you are either ignored or get a reply like this. If you post negative, the same exact people who contradict the positive post will copy you to agree. It's the same few posters multiplying their own negative posts.

 

[Marionnette]

Well, it's not entirely impossible that both Obamacare and MB/FP+ are both really just lousy programs.

The difference being that Disney is still testing MB/FP+ and is willing to make changes to improve the program.

 

[daughtersrus]

Don't bet on it! By the time they pay for their overhead costs, they are grossing a lot less than you think!

Then take into account that they pay 100% of their Social Security tax because they are self-employed, as opposed to having an employer pay half.

And then, they also have to purchase health insurance, usually on the private market, without an employer paying part of their premiums.

And you're not taking into account all of the time spent maintaining the electronic records for patients. Time which is not spent focused on the patient, but time which must be spent either during the exam itself or shortly after the completion of the exam. There is no additional reimbursement for that time yet it takes away from the doctor's ability to see an additional patient or squeeze in that urgent visit that someone needs.

The doctor's situation is no different than any other self-employed person. The same could be said for electricians, plumbers, mechanics and carpenters who work for themselves. However, unlike those other trades, they physician's fees cannot be set by himself. The insurance industry dictates what he gets in exchange for his service.

I can tell you that mechanics spend a lot of time not getting paid as well. For example, the time they spend talking to a customer, going for test drives with the customer, writing up paperwork, repairing the car and then not getting paid because the service manager "good-willed it", repairing the car and then taking it apart and putting the old part back in because the customer refuses to pay for the repairs...

The majority of the work done in a car dealership is warranty. The mechanic doesn't set the fee, the manufacturer does. For example, a big recall right now pays 2.4 hours (set by Ford not the mechanic or dealership) but it's impossible to get the job done that quickly. Every minute the mechanic spends beyond the 2.4 hours is unpaid. That is why the unions have negotiated a "guarantee" rate into most of their contracts. If they work 40 hours, they are guaranteed to be paid a minimum of 34. Basically taking a 20% pay cut.

Self employed mechanics have the same overhead, pay 100% of their SS, spend unpaid hours filing claims and maintaining customer files...

The point is that it's a bit disingenuous to say that mechanics make more money than doctors do.

 

[robinb]

You totally just proved her point.

I've posted positive things a few times and for if you post positive you are either ignored or get a reply like this. If you post negative, the same exact people who contradict the positive post will copy you to agree. It's the same few posters multiplying their own negative posts.

That was my feeling as well. I was curious about this, so I did a bit of post analysis. The top-10 posters on this thread have written 53% of the total number of posts. Of those posts, 82% are from people who are Obamacare "negative" and 18% are Obamacare "postivie".

Here are the numbers:
793 total posts
421 posts from top-10 posters
344 posts from "negative" ACA posters
77 posts from "positive" ACA posters

 

[A_Princess'_Daddy]

Don't bet on it! By the time they pay for their overhead costs, they are grossing a lot less than you think!

Then take into account that they pay 100% of their Social Security tax because they are self-employed, as opposed to having an employer pay half.

And then, they also have to purchase health insurance, usually on the private market, without an employer paying part of their premiums.

And you're not taking into account all of the time spent maintaining the electronic records for patients. Time which is not spent focused on the patient, but time which must be spent either during the exam itself or shortly after the completion of the exam. There is no additional reimbursement for that time yet it takes away from the doctor's ability to see an additional patient or squeeze in that urgent visit that someone needs.

The doctor's situation is no different than any other self-employed person. The same could be said for electricians, plumbers, mechanics and carpenters who work for themselves. However, unlike those other trades, they physician's fees cannot be set by himself. The insurance industry dictates what he gets in exchange for his service.

It is disingenuous to say that physicians make the same salaries on average as mechanics, electricians, plumbers, etc.

A comprehensive survey of physician salaries in 2012 found that the lowest average salary (for AIDS/HIV doctors) is $170,000 and that, on average, salaries are increasing. You can see the comprehensive report here: http://www.medscape.com/features/slideshow/compensation/2013/public

Meanwhile, per http://www1.salary.com/Automotive-Mechanic-I-Salary.html, "...the median expected salary for a typical Automotive Mechanic I in the United States is $34,925. This basic market pricing report was prepared using our Certified Compensation Professionals' analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies."

There are no doubt outliers in both professions, and people in both professions will see their salaries increase as they gain experience (although annual percentage increases would benefit those with the higher starting salary), but the medians are $135,000 apart so they are not comparable.

 

[A_Princess'_Daddy]

You totally just proved her point.

I've posted positive things a few times and for if you post positive you are either ignored or get a reply like this. If you post negative, the same exact people who contradict the positive post will copy you to agree. It's the same few posters multiplying their own negative posts.

Exactly. This is why I referred to it as a form of self-reporting poll, which are useful to reinforce one's own perspective, but are statistically irrelevant.

 

[Robbi]

Well, it's not entirely impossible that both Obamacare and MB/FP+ are both really just lousy programs.

Amen

The difference being that Disney is still testing MB/FP+ and is willing to make changes to improve the program.

It is disingenuous to say that physicians make the same salaries on average as mechanics, electricians, plumbers, etc.

A comprehensive survey of physician salaries in 2012 found that the lowest average salary (for AIDS/HIV doctors) is $170,000 and that, on average, salaries are increasing. You can see the comprehensive report here: http://www.medscape.com/features/slideshow/compensation/2013/public

Meanwhile, per http://www1.salary.com/Automotive-Mechanic-I-Salary.html, "...the median expected salary for a typical Automotive Mechanic I in the United States is $34,925. This basic market pricing report was prepared using our Certified Compensation Professionals' analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies."

There are no doubt outliers in both professions, and people in both professions will see their salaries increase as they gain experience (although annual percentage increases would benefit those with the higher starting salary), but the medians are $135,000 apart so they are not comparable.

I don't know about mechanics but I do know about these particular electricians and plumbers.

Exactly. This is why I referred to it as a form of self-reporting poll, which are useful to reinforce one's own perspective, but are statistically irrelevant.

As are most of the posts on the DIS on any topic.

 

[Colleen27]

You totally just proved her point.

I've posted positive things a few times and for if you post positive you are either ignored or get a reply like this. If you post negative, the same exact people who contradict the positive post will copy you to agree. It's the same few posters multiplying their own negative posts.

And it is absolutely impossible to overstate the bias inherent in having this conversation here, in a much more educated and affluent group than the population as a whole. Pop over to any forum geared towards freelance professionals and you'll see just the opposite - if I were to base my opinion of the ACA on the response from my writers' group, where very few have coverage through an employer, I'd have to say it is 80+% positive. Here, where most people have employer based coverage, it skews much more negative. Neither is a representative sample.

I can tell you that mechanics spend a lot of time not getting paid as well. For example, the time they spend talking to a customer, going for test drives with the customer, writing up paperwork, repairing the car and then not getting paid because the service manager "good-willed it", repairing the car and then taking it apart and putting the old part back in because the customer refuses to pay for the repairs...

And the same is true for self-employed construction tradesmen. They aren't on the clock for those free estimates they offer, and the majority of leads don't pan out. That's just part of being self employed - a lot of work on your own time, a lot of paperwork and clerical responsibilities, and a lot of unpaid efforts to build the paying business.

 

[johde]

And it is absolutely impossible to overstate the bias inherent in having this conversation here, in a much more educated and affluent group than the population as a whole. Pop over to any forum geared towards freelance professionals and you'll see just the opposite - if I were to base my opinion of the ACA on the response from my writers' group, where very few have coverage through an employer, I'd have to say it is 80+% positive. Here, where most people have employer based coverage, it skews much more negative. Neither is a representative sample.

I've been recently following an Insurance Salesman's Forum. Another biased sample, but in general has provided some of the best information I've found on the net. In general, they tend to be negative. At least partly because they see navigators as undertrained competition. We've talked about it early in one of these threads. They are also the ones on the "front lines" of things both good and bad.

 

[daughtersrus]

It is disingenuous to say that physicians make the same salaries on average as mechanics, electricians, plumbers, etc.

A comprehensive survey of physician salaries in 2012 found that the lowest average salary (for AIDS/HIV doctors) is $170,000 and that, on average, salaries are increasing. You can see the comprehensive report here: http://www.medscape.com/features/slideshow/compensation/2013/public

Meanwhile, per http://www1.salary.com/Automotive-Mechanic-I-Salary.html, "...the median expected salary for a typical Automotive Mechanic I in the United States is $34,925. This basic market pricing report was prepared using our Certified Compensation Professionals' analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies."

There are no doubt outliers in both professions, and people in both professions will see their salaries increase as they gain experience (although annual percentage increases would benefit those with the higher starting salary), but the medians are $135,000 apart so they are not comparable.