The Obamacare Bomb Explodes

[Panacea]

We do need to move away from payouts that are designed to increase unneeded treatments and procedures and tests because it's bogging the whole thing down and people are getting hurt or sicker as a result.

^-.-^

To do that, we need to move away from fee for service. Doctors won't like that; they like being able to charge what they want and be independent rather than salaried.

[Mytical]

Sadly a for-profit driven medical system is bass-akwards. See there is no profit in CURING people. Once they are well, they do not need the doctors/hospitals any more. So it is best to treat the symptoms, not the actual disease/problem. Do not get me wrong, I am sure doctors and nurses do everything they can to actually fix the problem, but the research just is not there for a lot of things. Because there is no profit in it, and the big companies which have the money to fund the research won't. Why shoot themselves in the foot?

Donations and government grants help a little, but only go so far. It would take a massive effort to get the best and brightest, pay them amazingly JUST to work on cures..and then not worry about actually making much money on the cure. Not going to happen anytime soon. Imagine the impact on an already staggering economy, also, if the billions for certain currently incurable diseases suddenly were able to be cured.

Factor in how it woudl affect the worlds population..and there are a lot of people out there who never want to see a cure. Ever. Sounds cold and cruel, but it is true. But I am just probably a conspiracy nutjob , so ignore the man behind the curtain

[Panacea]

Sadly a for-profit driven medical system is bass-akwards. See there is no profit in CURING people. Once they are well, they do not need the doctors/hospitals any more. So it is best to treat the symptoms, not the actual disease/problem. Do not get me wrong, I am sure doctors and nurses do everything they can to actually fix the problem, but the research just is not there for a lot of things. Because there is no profit in it, and the big companies which have the money to fund the research won't. Why shoot themselves in the foot?

I'm afraid you've got the problem a bit backwards.

Physicians really do want to give good care. The problem isn't that they don't want to give the best care. Many of the conditions that are the most expensive are chronic; there IS no cure, only new treatments. The vast majority of Medicare dollars spent per person are spent during that person's last six weeks of life delivering futile care in a direct effort to "cure" the patient.

The problem is the perverse incentive system. Doctors are paid by the tests they order and the procedures they perform. That's why cardiologists are a dime a dozen. They can make money hand over fist putting stents in patients with unstable angina (chest pain that is not a heart attack). They make next to nothing doing the CORRECT and safer treatment, which is beta blockers, statins and aspirin.

We have a surplus of specialists because that's where the money is. The result is we don't have enough family docs, pediatricians, and OBs and have to make up the shortfall with PAs, nurse practitioners and nurse midwives.

Physicians should be salaried. Then the system of perverse incentives would disappear and physicians would be free to treat based on the medical evidence rather than a need to make money to stay in business. Physicians would have time to actually TALK to their patients, and get complete histories so they can order the RIGHT tests and RIGHT treatments. Satisfaction would improve.

CMS (Centers for Medicare and Medicaid Services) has actually done trials where physicians were put on salary, and that's exactly what happened. This is how the Mayo Clinic and Kaiser Permanente are modeled. They control costs, and patients are satisfied.

[Skunkle]

I'm very, very glad that this is taking effect. I'm glad it has at least BEGUN before the Conservatives manage to kill it.

I'd bet money that THE reason - THE ONE AND ONLY reason - the Republicans are so against what they've termed Obamacare, throwing money, time, effort and nasty lies (like the outright insane "death panels" crap) at getting rid of it - yes, EVERY BIT of the mad rush to vilify it and, once shreds of the original plan squeaked through, to pull it back down - are entirely because of the loss of profit to people who contribute to them and put money in their pockets, and in their own pockets - croneyism is full swing.

I do not believe, personally, that there is the tiniest molecule of good, caring intent in their plan. In fact, their plan as far as I've been able to tell is, "Everything is golden just the way it is." Call me stupid, but I hear all these arguments that those who can't afford health care are just whiny, lazy bums, the whole fuckin' lot of 'em - and all I hear is, "I got mine. You can freeze, starve or rot and I won't care. Nobody should have to, or should want to, or should care about anyone but themselves. I got care, I got megabucks in my pocket, so go to hell and rot!!"