Obamacare

[Lamplighter]

It always devilishly amusing to read David Brooks in the NY Times.
He wants so badly to be a leader, a guru, or at least be on the winning team.
He's just not sure which team will win.
Today, he joined the Limbaugh team...

It's going to fail HOORAY ! YEA! YEA! ... I told you so


NY Times
DAVID BROOKS
April 25, 2013
Health Chaos Ahead

It was always going to be difficult to implement Obamacare,
but even fervent supporters of the law admit that things are going worse than expected.
<snip>
I’ve been talking with a bipartisan bunch of health care experts,
trying to get a sense of exactly how bad things are.
In my conversations with this extremely well-informed group
of providers, academics and former government officials, I’d say
there is a minority, including some supporters of the law,
who think the whole situation is a complete disaster. They predict
Obamacare will collapse and do serious damage to the underlying health system.

But wait a minute, David.
After showing us your width of knowledge... yada, yada, yada
You go on to say:

But the clear majority, including some of the law’s opponents,
believe that we’re probably in for a few years of shambolic messiness,
during which time everybody will scramble and adjust,
and eventually we will settle down to a new normal.
<snip>
Over all, it seems likely that in some form or another Obamacare is here to stay.
But the turmoil around it could dominate politics for another election cycle, and the changes after that
— to finally control costs, to fix the mind-boggling complexities and the unintended consequences
— will never end.

Regulatory regimes can be simple and dumb or complex and sprawling.
When you build complex, it takes a while to work through the consequences.

So which is it, David ... CHAOS ... or just take a while ?

Next month David will be telling us of all the benefits and success
that he predicted for Obamacare.

.

[richlevy]

We will all know when Obamacare has succeeded when the first Republicans go back to calling it it The Affordable Care Act. This of course will not work well, since they have spent years attaching Obama's name to it.

You know it's too late when wiki puts in a redirect ....

http://en.wikipedia.org/wiki/Obamacare

If they had tried this bullshit decades ago, Social Security would be called Roosevelt Security.

BTW, Brooks is right about one thing. Obamacare is a sea change. It is not a band-aid. For good or ill is an at least partial overhaul of an entire system. There will be adjustments. We will see the real result in 5-10 years. There will always be detractors, even if there is a consensus that it turns out to be an improvement. But then again, some of the people who disagree with Obamacare still think the Earth is only 10,000 years old.

[xoxoxoBruce]

I got an email today saying Obamacare should be run by walmart.

[richlevy]

Originally Posted by xoxoxoBruce

I got an email today saying Obamacare should be run by walmart.

One of the most efficient delivery systems of goods and services to consumers that exists today, with an almost across the board presence in the U.S. . I can see the pros and cons.

Add in Costco, Sam's Club, B.J.'s, and everyone in the US is probably 30 minutes from a store.

[xoxoxoBruce]

They're the worst thing to happen to the United States since the Vietnam war.

[Lamplighter]

They're the worst thing to happen to the United States since the Vietnam war.

Ummmm. My entry for the worst thing is in three words...

The next time you go to a doctor's office or a hospital or any kind of health center,
check the I.D. badge of the person interviewing you before (?) you are seen by your physician.
That person may then even give you a diagnosis and write a Rx for you,
and you may not ever meet "your" licensed physician (M.D., D.O, etc)
That person was a Certified Medical Assistant

Graduates of medical assisting programs accredited by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
or the Accrediting Bureau of Health Education Schools (ABHES)
are eligible to take the CMA (AAMA) Certification Exam.
<snip>
A greater number of employers are preferring (or even insisting)
that their medical assistants be CMAs (AAMA).<snip>

Sounds pretty innocuous, doesn't it ?
At least until you find out that your cute little 20-something's
education only amounted to what would otherwise be called an A.A.
(Community College) degree via an "accelerated program".
And, they are programs being heavily touted now by the
"for profit" colleges, universities, and on-line centers of "education"
Google "Medical Assistant certification" for more info.

OK, so doctors have had assistants and secretaries for years. So what ?
Well, aside from the competence of your CMA, the real rub is when it comes time for your billings.

The physician or hospital can charge for that CMA's time and service at the
same $ rate as "your" physician would have charged for their own
time and service as if they, he/she, had actually provided your service.

Thus, the physician or hospital can have "legal clones" of themselves
seeing patients and practicing medicine, and earning $ at any
number of different locations (offices/clinics) and times (24/7)
and the $-income is at the highest level commensurate with
that physicians "local and customary" charges,
and Medicare/Medicaid must reimburse these charges without question.

If these charges are higher than is covered by your own insurance,
you get the bill for your excess part of this scheme.

So, pay attention to who actually is treating your medical problems.
Maybe you would want to insist on seeing a doctor in person.

[Ocean's Edge]

these are the same doctors and hospitals that for decades have had a problem with the idea of 'nurse practitioners'?

*shakes*head*

[Lamplighter]

Originally Posted by Ocean's Edge

these are the same doctors and hospitals that for decades have had a problem with the idea of 'nurse practitioners'?

*shakes*head*

Yes, it's the same idea as was the original concept of a "licensed nurse practitioner",
but there the LNP was a graduate RN, so there was/is a great deal more education and experience.
L.P.N.'s now are setting up their own practices, billings, etc. with only
a modicum of physician medically relevant oversight.

The R.N. is something of an endangered species, particularly
those who graduated out of a 2-year post-graduate program.
The Schools of Nursing are in the process of eliminating the 2-yr programs,
and defining the RN as a 4-yr graduate degree and licensure.

The CMA is a financial gimmick to multiply (literally) the $ earnings of physicans.
This is not a result of a government requirement or Obamacare...
it is strictly the workings of capitalism and physicians efforts to
maintain and/or improve their standard of living.

[infinite monkey]

My friend got her LPN then went back for her RN and was told her credits wouldn't transfer so she basically had to start over.

Do you think that's why some stay at LPN and don't go further?

I'll see the NP for a cold or something. Not been real impressed with them. The PAs, I like, and will see them in a pinch. But if it's for my chronic illness I insist on seeing my D.O.

I may be talking out my...I didn't read EVERYTHING.

[Lamplighter]

Sorry, my senior-moment fingers typed on their own again.

In my post above, I was referring to Licensed Nurse Practitioners,
which should be abbreviated as L.N.P.
But then I typed L.P.N, which (to me) means Licensed Practical Nurse.

I'm not sure, but I think the L.P.N programs have been phased out.
They were also 2-year under-graduate programs, while R.N.'s
were 2- or 4-year post-graduate degrees/licensures.

But I do agree with business about non-transfer of credits.
My daughter has a 4-year R.N. + many years of experience + a Master's of Nursing degree.
She too was told by some Schools of Nursing that her Master's degree credits were not transferable.
To get her L.N.P. license she would essentially have to start over as if she were at the RN level.

She is just finishing her 4-semesters of full-time course work and 600 clinical training hours
... next is the State Boards Exam and she'll be a full-fledged L.N.P.

[infinite monkey]

I also meant by NP 'nurse practitioner' which really had nothing to do with my question about LPN vs RN. So my comment about NP, PA, and DO were actually irrelevant.

If they're phasing out LPN what will the proprietary schools do? Those credits don't transfer so certainly they shouldn't also offer RN.

I thought LPNs just did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

[Lamplighter]

Originally Posted by infinite monkey

<snip>
I thought LPNs just did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

Now, as opposed to years ago, the Licensed Nurse Practitioner, is/can be essentially equal to an M.D.
Legally, I think they still must have some sort of oversight connection to an M.D.,
but beyond that they see patients, make diagnoses, write perscriptions, etc., etc.

[infinite monkey]

Let me try again:

I thought Licensed Practical Nurses (not Nurse Practioners) did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

[Lamplighter]

Originally Posted by infinite monkey

Let me try again:

I thought Licensed Practical Nurses (not Nurse Practioners) did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

Yes, I agree with this.

Sorry, sometimes I can't read straight.

[ZenGum]

Shit, I hope you two aren't preparing MY medication!

Sometimes you just need to go to the doc to get a medical certificate saying, yep, you've got a cold, take a few days off work. DownUnda, a nurse in the Dr's practice can assess this, and sign the forms. They know to be on the lookout for more serious conditions - such as meningitis - but they bloody well better not be charging Doctors rates for it!