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Pre-Med & Medical School Pre-Med Topics
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<p>The bill just passed. Several key components.</p>

<p>1.) A variety of cost-control pilot programs. "In the end, it contains a test of almost every approach that leading health-care experts have suggested. (The only one missing is malpractice reform. This is where the Republicans could be helpful.)"</p>

<p>2.) Vague cuts to Medicare. I'm not familiar yet with what these will be.</p>

<p>3.) Subsidies for those who can't afford insurance.</p>

<p>4.) The Insurance Exchange. Advertised to be basically a big comparison shopping site with a quality floor.</p>

<p>5.) Medicaid Expansions.</p>

<p>6.) Pressure for Employers to Buy Health Insurance.</p>

<p>7.) Higher taxes on so-called "Cadillac Plans."</p>

<p>8.) Higher taxes on certain procedures -- probably will end up being tanning salons.</p>

<p>9.) Banning insurers from discriminating based on preexisting conditions. In fact, insurers are prohibited from discriminating based on any factors except for a few. They have to charge everybody the same rate, no matter what their background health conditions are.</p>

<p>They are allowed to charge different rates for family vs. single plans and age and geography. Even within those, however, the maximum difference allowed is 3:1. If you charge an elderly cancer patient $75,000 a year in premiums, the least you're allowed to charge a young, healthy person is $25,000.</p>

<p>This is the most important part of the bill.</p>

<p>10.) A mandate. Everybody must have a health insurance plan.</p>

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<p>Do we know how these new measures will affect doctors and nurses?</p>

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<p>Yes, a lot of them are predictable based on the bill itself.</p>

<p>(1) is the big one, however, and that is extremely unpredictable. Because the bill imposes a variety of experiments, it’s hard to know which ones of those will ultimately stick.</p>

<p>However:</p>

<p>(2): Will reduce physician reimbursements in high-profile fields (cardiology, radiology, dermatology).</p>

<p>(3), (6), (9), (10): Will increase the rates of insureds – which will help reduce the number of patients who visit without paying.</p>

<p>(4): Unpredictable. May make insurers more or less powerful; either way can either help or harm physician autonomy and negotiations. The ostensible result is that it will increase competition in the insurance market, which will help physicians be in a better position to negotiate. Another possible result, however, is that it will push insurers into raw premium competition, which will bring the HMO era back. Physicians hated that.</p>

<p>(5): Similar to (4) and (9), except that you add the fact that Medicaid pays very poorly and more patients will be on it.</p>

<p>(7): Will decrease truly high-end insurance plans. Likely to harm physicians by removing high-reimbursement patients from the pool, which many offices use to “cost-shift” to cover money-losing patients (like Medicaid patients).</p>

<p>(8): Depends on what procedures are covered. Original gossip was that it would include plastic surgery, which would have obvious ramifications for that field.</p>

<p>(9): Oy, complicated. I don’t really want to think about this right now.</p>

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<p>And of course, I’m assuming a lot more paperwork. One thing I’m worried about is lawsuits. Physicians will do lots of extra things just to protect against lawsuits but this bill should help curb those but there’s nothing in the bill to compensate for that by restricting lawsuits against physicians. <em>sigh</em> And yet I still want to put myself through it. I wonder if the number of medschool applicants will be affected by this.</p>

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<p>Paperwork isn’t likely to change too much. Physicians offices might increase or decrease their paperwork, but that’s not the sort of thing physicians themselves deal with anyway.</p>

<p>Which is to say: paperwork, as frustrating and intolerable as it is now, probably won’t get any worse.</p>

<p>You’re correct about the lack of tort reform, however.</p>

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<p>Medicine seems like a less attractive field hahaha.</p>

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<p>Also, dependents will be covered under family’s health plan until age 26. </p>

<p>When are most of these points supposed to kick into noticeable effect?</p>

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<p>I disagree, bdm. Within a decade (or generation?), the paperwork will all coalesce into one standardized medicare form, a SUPER, superbill?</p>

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<p>[How</a> the health care bill could affect you - CNN.com](<a href=“http://www.cnn.com/2010/HEALTH/03/19/interactive.health.care.benefits/index.html]How”>How the health care bill could affect you - CNN.com)</p>

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<p>Thanks for the informative post BDM. A couple of my thoughts:

I don’t understand what they were thinking here. This defeats the very purpose of insurance.</p>

<p>Obviously, I think people with pre-existing conditions should receive care and coverage, but it should be from a separate fund and not from traditional insurance pools. Prohibiting insurers from doing this defeats the entire purpose of risk pooling and insurance.</p>

<p>Premiums go up, and healthier policyholders switch to less expensive plans. Of course, since the sick people/people with pre-existing conditions are paying higher premiums, they too switch to the same less expensive plans, and since those plans cannot discriminate based on PECs, the cycle repeats.</p>

<p>Insurers will be losing a lot of money and, as a result, will put the squeeze on their budgets; guess who’s among the first to get hit? Physician reimbursement will decline further.</p>

<p>Big issues that this bill doesn’t address that would have been nice (“nice,” here, is an understatement):
-Cutting down on monopoly and monopsony power of insurers by repealing some of the powers issued by the McCarran-Ferguson Act, which gives insurers free rein, to some extent, to participate in tacit collusion by exempting them from most federal antitrust laws.
-Giving doctors some more bargaining power (ie, unionization) to give them some leverage against the aforementioned antitrust-law-exempted insurers.
-Ending the mandatory enrollment in Medicare for seniors. There are many 65+ individuals with private or employer-sponsored insurance who do not need Medicare, but they don’t have a choice. I haven’t looked into the numbers so I don’t know how much Medicare spending this accounts for, but it seems like a waste to me.
-On that same note, the new bill mandates all Medicaid-eligible individuals to participate in Medicaid. I guess this has pros and cons too.</p>

<p>Ultimately, however, I feel like this whole “healthcare reform” thing is like putting a Band-Aid on a much bigger problem. What are some of the root causes of rising healthcare costs? Smoking and obesity, to name just two.</p>

<p>Why not target tobacco companies? Why not target companies that make junk food, soda, Cheetohs and Twinkies? Why is much of the healthcare industry forced to feel the squeeze? How about more focus on reining in spending on end-of-life care, which accounts for 10-12% of spending?</p>

<p>Also, who’s going to see these additional 32 million patients? Will ER docs see a decrease in the number of patients? If so, I assume primary care docs will see an increase, but many PCPs are overloaded as it is, are they not?</p>

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<p>What I don’t understand is how this health care bill will cut costs. Simple economic policy, says that any time a third party payer system exists, costs will always be high.</p>

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<p>Not necessarily, when you consider that the bill also requires almost everyone to purchase insurance. Currently, when an individual purchases insurance, they are billed based on their perceived risk. However, if they get insurance, through an employer or school, they pay the same as everyone else, regardless of any pre-existing conditions they might have. It’s all still risk pooling, just in different ways. (I can’t seem to remember the proper terms for the different types)</p>

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<p>For the same reason you shouldn’t target gun manufacturers when their product is used in a crime - because the companies are not forcing people to smoke/eat unhealthy foods/etc. When did personal responsibility go out the window?</p>

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<p>You’re looking for the terms “experience rating” and “community rating.”</p>

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<p>This isn’t necessarily true. And even if it were, the bill still represents a major difference, since cross-employer rates will no longer be permitted to vary very much.</p>

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I want to agree but, unfortunately, in the country (world?) we live in today, there is not much personal accountability. I don’t think health care should be punished as a result.</p>

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<p>So now that we will effectively see the reimbursement rates for the rad/derm/oncology screwed, which specialty will be the next big thing? </p>

<p>Plastic looks good because it isn’t touched by this bill.</p>

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<p>^^ I though BDM said that plastic surgery is also affected.</p>

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<p>Plastic is primarily a cash basis practice, so insurance is not a factor. </p>

<p>According to my Derm, approx. half of her practice is cash, so the insurance impact is lessened. (Botox is big in SoCal. :smiley: )</p>

<p>Oncologists got hammered last year, according to my wife’s onc. For now, he’s eating the cutbacks. </p>

<p>The good “news” for the latter two, of course, is that the boomers are aging, and are incurring more cancers, including skin ca.</p>

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<p>The original proposals had a massive surtax on plastic surgery, which would have impacted practices even when they were cash-only. (It would also have applied to Botox.)</p>

<p>I believe the final bill removed these provisions, however.</p>

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<p>yes, bdm, you are correct. But the tax (aka “botax”) was only 5%, so that would not have dissuaded many Botox injections or boob jobs.</p>

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<p>I wouldn’t necessarily pay attention to the rest of this guy’s post, but he makes an interesting point.</p>

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<p>[Health</a> Care: Arbitrage Obama And The Dems - The Market Ticker](<a href=“http://market-ticker.denninger.net/archives/2109-Health-Care-Arbitrage-Obama-And-The-Dems.html]Health”>http://market-ticker.denninger.net/archives/2109-Health-Care-Arbitrage-Obama-And-The-Dems.html)</p>