Obamacare by Decree

Obamacare. A word that is 100% guaranteed to be polarizing in almost any discussion about heatlh care. In the 2 years since a 2700 page law dubbed Obamacare has come in to being, the HHS Department and specificalyl the Secretary have issued some 12,000 pages of regulations and edicts, all in the name of making health care, and health insurance, more accessible and affordable.

So far, we have yet to see either.

That hasn’t stopped them from pressing forward, alienating large segments of the public, turning health care providers (and the Supreme Court) in to adversary’s and generally making a mess of things, all due to Obamacare provisions.

But wait, there’s more!

Some 85,000 or so physicians will play a crucial role in Obamacare, including the 16+ million new enrollee’s in Medicaid. So how will this impact the doctors?

The Hudson Institute has some insight in to the future of Obamacare from a physician’s perspective.

This $800+ billion (a low estimate in our view) will be funded by new taxes on everyone who uses health care (including the poor and middle class) as well as significant reductions in Medicare funding plus increased cost shifting for out of pocket expenses to seniors and the disabled on Medicare. This is part of Obamacare that no one wants to discuss.

Beyond the complexity of Obamacare (which no one admittedly read before voting on it) the one individual given almost total control over health care rests with a non-elected official that holds the title of HHS Secretary. Given virtual czarist powers, we have already seen the way the current Secretary has bludgeoned her way through almost every aspect of the health care system with complete disregard for the outcome.

The most recent public battle, which is still being waged in the form of a lawsuit due to Obamacare and HHS directives, involves the issue of mandated “free” contraceptive devices for everyone, including those who oppose such on the basis of religious views.

How did the HHS Secretary gain such control?

HHS Mentioned 3,000 Times in 2700 Pages of Obamacare

References to the HHS Secretary appear over 3,000 times in the 2700 page Obamacare legislation.

Former HHS Secretary Leavitt said “It puts more power than is prudent in the hands of one person, and it is not an answer to our current health care crisis”.

Also from the Hudson report comes this tidbit about Obamacare.

Incredibly, the bill’s powers are not limited to the broad macroeconomic issues described above. They also regulate a wide range of medical areas in minute detail, extending their reach even to one of the most personal arenas: the dentist’s chair. Section 4102 of the ACA, for example, states: “The secretary shall develop oral healthcare components that shall include tooth-level surveillance.” As Secretary Leavitt describes it, the mandate for tooth-level surveillance would  require “a clinical examination in which an examiner looks at each dental surface, on each tooth in the mouth.”

In the real world we call this micro-managing.

In DC world of Obamacare, this is just business as usual.

Doctors Believe Obamacare is Negative for Patients

A recent survey indicated that 60% of physicians surveyed said Obamacare would have a NEGATIVE impact on patient health care . . . and these are the folks on the front line of health care delivery. Another survey of new physicians found 57% were pessimistic about the future of health care and 34% feel that way specifically because of Obamacare.

And then there is the concern about the economic impact of Obamacare.

From the economic perspective, doctors’ top concern raised by the Obama health care law is in the area of reimbursement rates. The reimbursement question usually centers on the Sustainable Growth Rate (SGR). The proposed cut in reimbursements would hit doctors hard, imposing initial cuts of over twenty percent

I wonder how many in the general population would be willing to take a 20% pay cut in order to advance the noble cause of “health care for everyone”?

While the Obama health law will cover an additional 32 million Americans, 16 million of those newly covered Americans will get their coverage through Medicaid, according to the

Congressional Budget Office. Doctors are well aware that Medicaid reimbursement rates are lower than those they get from privately insured patients. In fact, according to Moffitt,

“physicians in Medicaid are paid 56 percent of private payment.” This reduced reimbursement rate is the reason that Medicaid patients often have difficulty finding a doctor. Imposing these lower reimbursement rates on a growing number of patients will likely have the impact of exacerbating access issues in the future

And even this fails to take in to account funding at the state level for Medicaid expansion.

Where will the money come from?

Funding Obamacare

How high will taxes have to go at the state level and how many services will be cut back to fund Medicaid expansion under Obamacare? At what point will we, as a society have to say, enough is enough. It is time for the poor to bear the cost of their own care rather than relying on the taxpayer to provide their every need from womb to tomb.

The proverb that says “Give a man a fish and he can eat for a day, but teach a man to fish and he can eat for a lifetime” needs to be considered in this regard.

Beyond economic issues, physicians worry that the new law will interfere with their practice of medicine, and in a variety of ways. To begin with, there is a generalized concern about decision making being taken from doctors and having medical decisions made instead by government officials. Doctors worry about the imposition of “uniformity of practice,” the establishment of strict guidelines that fail to permit individual doctors to make decisions based on their in-person interactions with patients. As Dr. Saul Greenfield writes in the Wall Street Journal, “every physician must, at some point in the patient-care process, make decisions and take responsibility for them. And unless the doctor does so, the outcomes will be compromised.”

Does the government REALLY know what is best? Mayor Bloomberg wants to tell New Yorker’s what size sugary drink they can and cannot consume within the confines of “his” city.

Isn’t all this going a bit too far? And where will it end?

If doctors cannot practice as they wish, it raises the question of whether they will practice. As Dr. Mark Siegel has noted, because of the anticipated changes in health care, “To stay in business under ObamaCare, doctors will have to adjust. Some will see fewer patients themselves and hire nurse practitioners to help carry the load; others will work part-time and supplement their income elsewhere. Many will join groups or become salaried employees of hospitals or clinics.”

Will Obamacare be the primary cause of killing the goose that laid the golden eggs? Was the real goal of Obamacare to make health care, and health insurance, more affordable or was it more a legislative Mt. Rushmore designed to feed an ego?

The further Obamacare goes, the more one has to wonder if this is really what we, as a country, need or want. And in particular, how much control will those who hold the office of HHS Secretary in the future want, and what kind of whims and ego-driven, power hungry schemes await us?

In addition to the cost of Obamacare, which may single-handedly bankrupt the country, there is the issue of will there be enough medical personnel to service the needs of 30+ million newly insured people coming on board in 2014?

Obamacare is the iceberg and the United States is the Titanic, speeding right toward a disaster.


Medicare Secrets They Don’t Want You to Know

Medicare will pay for a kidney transplant then expects you to die in 3 years. Bet you didn’t know that. According to the WSJ Health Blog, Medicare could save lives and money by making beneficial changes to the way they approve treatment but they choose not to.

Medicare’s three-year limit on payment for anti-organ-rejection drugs led to a woman needing a second kidney transplant, because she couldn’t afford to the medicine that would have allowed her to keep her first transplanted kidney in healthy, working condition. The cost of anti-rejection drugs for the patient? $1,000 to $3,000 a month. Cost of the second transplant? $125,000. The average Medicare expenditure per kidney transplant patient care is $17,000 yearly, while it’s $71,000 a year for dialysis patients and $106,000 for a transplant, according to the Times.

According to the NY Times, Melissa Whitaker found herself in a Medicare conundrum.

Ms. Whitaker, 31, who describes herself as “kind of a nerd,” has Alport syndrome, a genetic disorder that caused kidney failure and significant hearing loss by the time she was 14. In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease. By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again. “If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker

So rather than paying $1000 – $3000 per month for anti-rejection meds beyond the arbitrary 36 month limit, Medicare in their infinite wisdom put her back on dialysis, approved a second transplant, and started her on a new 36 month plan.

The most recent report from the United States Renal Data System found that Medicare spends an average of $17,000 a year on care for kidney transplant recipients, most of it for anti-rejection drugs. That compares with $71,000 a year for dialysis patients and $106,000 for a transplant (including the first year of monitoring).

This reminds me of Jay Leno’s question to Hugh Grant following Hugh’s incident with a transvestite hooker. “What were they thinking?”

Are Scooters Sinking Medicare?

Medicare will spend almost $1 billion on scooters for Medicare beneficiaries but more than half those dollars are wasted on people who don’t need a motorized chair. According to a report by the OIG (Office of Inspector General for Health and Human Services), many who got the scooters didn’t need one over 60% of the time Medicare paid too much.

What about eliminating waste, fraud and abuse?

According to the report, 61% of power wheelchairs purchased by Medicare in 2007 were either unnecessary or lacked sufficient documentation to justify claim . . . yet Medicare approved them any way!

In the first half of 2007 Medicare approved and spent $189 million on power wheelchairs. Of that, $95 million were either not considered medically necessary or lacked sufficient documentation to justify the claim.

A whopping 78% of claims submitted by Medicare DME (durable medical equipment) providers had records that did not match physician records for medical necessity.

In other words, records submitted by DME suppliers indicated the motorized wheelchair was medically necessary but the doctor records did not agree with that assessment.

In most of those cases physician notes had less documentation than what was provided by the medical supplier but in some cases the doctor records contradicted those provided with the Medicare claim.

Medicare covers over 650 types of powered scooters. Medicare requires medical providers to use one of 42 different codes when submitting the claim.

Prior to January of 2011 Medicare beneficiaries were allowed to rent or buy a chair. Almost all chose to buy rather than rent the chair.

Power wheelchairs are referred to as MAE (Mobility Assistive Equipment).

To qualify for MAE (mobility assistive equipment), also known as a scooter, you must meet the following.

Have a health condition where you need help with activities of daily living like bathing, dressing, getting in or out of the bed or chair, moving around, or using the bathroom

Be able to safely operate and get on and off the wheelchair or scooter

Have good vision

Be mentally able to safely use a scooter, or have someone with you who can make sure the device is used correctly and safely

The equipment also must be useful within the physical layout of your home (it must not be too big for your home or blocked by things in its path).

If you qualify for a scooter, it will be paid for under Medicare Part B. Your Medicare supplement insurance plan will pay the contractual balance after Medicare approves the claim and pays their portion.

You can read more in this article about motorized wheelchairs written and published by Georgia Medicare Plans.

Compare Georgia Medicare supplement rates and plans and view instant Medigap quotes.



Compare Medigap Rates

Compare Medigap rates. Compare your Georgia Medicare supplement insurance plan premiums to the lowest Medigap rates in Georgia. Get the best rates from Blue Cross GA, Gerber, Mutual of Omaha and more. Never pay too much!

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When you pay more you don’t get more, you simply paid too much. In these tough times can you afford to pay more than is necessary for Medicare supplement insurance?

Does the BEST Medigap plan in Georgia really have to cost more?

The answer is no.

All Medicare supplement insurance plans are standardized by the government.

Medigap plan F from Aetna is the exact same plan as plan F from Blue Cross.

Which Carriers Offer Medicare Supplement Plans in Georgia?

Most Georgia Medigap plans are written by Blue Cross followed by AARP (United HealthCare). Other companies that offer Medicare supplement plans in Georgia include Aetna, Humana, Assured Life (Woodmen of the World), Conseco, Forethought, Gerber, Loyal American, Medico, Mutual of Omaha (United of Omaha, United World) New Era, RNA (Royal Neighbors of America).

Sometimes you will also see Medigap plans from Bankers Life and Casualty or Combined Insurance. Agents from these carriers can only tell you about their plans and are required to make in home visits to sell their plans.

An agent that comes in your home has one goal in mind.

They are instructed to get you to buy from them while they are in your home and will sell you something by any means necessary.

You should never feel pressured to buy on the spot from an agent. Plans and rates available today will be there tomorrow. There is no need to rush and pay more than you can afford.

How do you know if you are paying too much for Medigap coverage?

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