What does 4 more years of Obama/ long term Obamacare mean for the profession

[DrRock44]

I was just wondering what you all thought about what possible long term Obamacare means for podiatry. As a member of the class of 2017, I am very interested on the effects this will have on my career, scope of practice and earning potential

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[Shinobiz11]

As an undergrad student going into podiatry I am very interested in this too. I don't know anything about politics though; enlighten me.

 

[Feli]

Nothing happens overnight... that's for sure.

House and senate stayed pretty right. Obama's office can kinda stack the supreme court, though.

The bottom line is that you have (or will get/develop) skills ppl will always need. If you are out to make $, then go get a 2yr computer programming or maintenance degree or go to biz school to be a biz owner/manager... way less student debt and higher top end. However, if you want a high satisfaction career with challenge, integrity, and less required travel, then health care is pretty awesome.

Dems are all about more govt programs (and therefore more tax $ and more ppl depending on govt programs), but at least with Medicare you know what you'll get. Of all the health plans, their rules are fairly clear, consistent, and spelled out. The problem is the govt plans pay like relative crap, but people who care about their health care will supplement their Medicare or opt for a private plan in order to get more qualified and/or less busy docs for their care anyways.

 

[DrRock44]

Nothing happens overnight... that's for sure.

House and senate stayed pretty right. Obama's office can kinda stack the supreme court, though.

The bottom line is that you have (or will get/develop) skills ppl will always need. If you are out to make $, then go get a 2yr computer programming or maintenance degree or go to biz school to be a biz owner/manager... way less student debt and higher top end. However, if you want a high satisfaction career with challenge, integrity, and less required travel, then health care is pretty awesome.

Dems are all about more govt programs (and therefore more tax $ and more ppl depending on govt programs), but at least with Medicare you know what you'll get. Of all the health plans, their rules are fairly clear, consistent, and spelled out. The problem is the govt plans pay like relative crap, but people who care about their health care will supplement their Medicare or opt for a private plan in order to get more qualified and/or less busy docs for their care anyways.

Maybe I wasn't clear enough. I wasn't just wondering about money. I was wondering if it would have an effect on what type of procedures/surgeries we can perform and what type of freedom we will have in terms of determining treatment options/protocols under government plans do you see it changing a lot in the next 10-15 years? And if so, how, and much of that will be due the president's policies? This is obviously a solicitation for an opinion since there is no way to know for sure

 

[podo trest]

Honestly, some may speculate, but nobody really knows. Just come along for the ride.

 

[dyk343]

Honestly, some may speculate, but nobody really knows. Just come along for the ride.

 

[JonScholl]

All physicians, regardless of speciality, will see a decrease in reimbursement.

However, Obamacare adds a huge number of insured patients into the pool of potential patients. This is one positive outcome of reform because these individuals were previously uninsured and most likely never seeking healthcare.

 

[Pod Stud]

The podiatrist with whom I shadowed with before entering pod school told me Obama Care will harm the specialist physicians and benefit the primary care physicians (i.e. family practioners, internists, pediatricians, and general dentists) in terms of patient load, but harm ALL physicians in terms of excessive paper work and less reimbursement.

ObamaCare in theory is trying to fix the national economic debt by reducing excessive health care costs from specialty care (ex: bunion procedures, hammertoe procedures by podiatrists or CABG procedures performed by cardiologists). The theory on paper is that these excessive specialty medical/surgical treatments caused our excessive national debt in the economy.

So, Obamacare is focusing more on primary care with a preventive approach to eliminate epidemics like obesity, cancer, hypertension, peripheral neuropathy, and diabetes. So many specialists like podiatrists, endocrinologists, neurologists, orthopedists, cardiologists, rheumatologists, and oncologists have been busy as a result, billing for very expensive medical and surgical procedures that add to the national economic debt.

The primary care doctor (internists and family practioners and pediatricians and general dentists) will be busy with a bigger patient load than specialists (ex orthopedists, podiatrists, neurologists, oncologists, psychiatrists, etc)

Obama wants to focus more on prevention medicine to eliminate these expensive specialty medical and surgical prodecures. Also, a mandatorium to make EVERY US citizen have medical and dental insurance: because lack of medical and dental insurance leads to advanced diseases that lead to the expensive specialty medical and surgical procedures in the long run.

Looks good on paper and theory, but still doubtful if it will work in the real world. We only have to wait and see.

 

[diabeticfootdr]

First, most of Obamacare (the Affordable Care Act) hasn't been implemented. Many States and entities delayed enacting some of the rules until SCOTUS upheld the law and President Obama was re-elected, so there is no chance of a reversal before 2014, when most of the policies must be in place.

Secondly, it's important to understand that Obamacare is not an insurance program, like Medicare/Medicaid or a private insurer. Instead, it establishes a set of rules by which private insurers and citizens have to abide by. Citizens must obtain health insurance (the individual mandate) or face penalties. If you can't afford insurance and make less than 400% of the federal poverty line, you'll get a subsidy in the form of a tax credit to help you pay for it. If you can't afford that you should be covered by Medicaid. Medicaid will be expanded and for the first 2 years the federal government will reimburse the States 100% of the cost of expansion. Insurance companies can not exclude you for pre-existing conditions, cap your lifetime benefits, or cancel your policy if you become sick. They must cover certain preventative care, offer contraception, allow adult children to stay on their parents insurance until age 26, and they can't exclude minor children from policies.

The law is more about healthcare finance than it is about actual care. It is paid for by cutting some provider, hospital, and nursing home Medicare reimbursements 2%. It also establishes more efficiencies in Medicare and taxes medical devices 2.3%. That saves Medicare $716B over 10 years but does reduce senior benefits. That savings will be used to cover the uninsured and some is put back into Medicare by eliminating the prescription drug donut hole and waiving co-payments for preventative care.

The individual mandate tax that everyone is so concerned with, will only generate about $7 billion when it first starts in 2016. It is not designed to generate revenue as much as it is a tool to induce personal responsibility.

Note: the law does nothing to correct the Sustained Growth Rate (SGR) which is the formula that automatically calculates provider payments by Medicare and it is part of the fiscal cliff. The 2013 adjustment is -28%. If Congress doesn't act, providers will see that cut. I fully expect Congress to act, as they have every year enacting a 1 year "doc fix", but the point is that physician payments are tenuous every year.

The ACA isn't a perfect law, but it is a step in the right direction. Some improvements could make it better for patients and providers, and finally reign in the cost of healthcare which increases faster than inflation every year. I'll post my suggestions below ...

 

[diabeticfootdr]

Here are my suggestions to improve the ACA:

1. Give regulators the power to reject insurance rate hikes
The Affordable Care Act (ACA) provides federal oversight in 2014 to identify companies who have a pattern of excessive or unjustified rate increases, but they have no power to prevent the increase. The individual mandate incentivizes people to buy insurance or face a penalty, but there is no guarantee that the insurance will be affordable. Regulators should be allowed to reject excessive hikes for consumers much like our insurance commissioner does in California for other types of insurance.

2. Create National Insurance Exchange
Exchanges give individuals and small companies similar clout to large companies when purchasing health insurance. The ACA leaves the insurance exchanges to be created by each State. This does not allow the true competition of a larger national market. Residents in more than half of the states are subjected to a near monopoly by insurers. Opening up the market nationally will allow greater competition and keep prices lower.

3. Allow individuals and businesses to buy into Medicare
Patients deserve the choice of purchasing private insurance or public insurance. Individuals and businesses should be able to purchase into Medicare at cost. Medicare should be added as an option to the national insurance exchange.

4. Negotiate Drug Prices
The United States carries the pharmaceutical research and development burden for the entire world. We are essentially subsidizing the lower drug prices in wealthy countries like England, Germany, France, Canada, and Japan. Americans should not pay more for the same medication than they do in other developed nations. Medicare and Medicaid should be able to negotiate drug prices like the VA, DOD and other nations. I also understand it is costly to develop new medications. Patents should be extended a minimum number of years from the time the drug goes on the market and not start the clock while it is in development an unable to be sold.

5. Doctors Determine Medical Necessity
Insurance companies can determine what treatments are medically necessary for you. This is an obvious conflict of interest. Doctors should determine medical necessity for patients, not insurance companies.

6. Preempt the Provider Shortages
There is a shortage of physicians even without the addition of 33 million new Americans with health coverage. We need to make medical school more affordable and shorten pre-medical education. We need to make sure every doctor graduating medical school has a residency slot available. Telemedicine programs should be developed to bring specialists to areas of need virtually. We need to expand programs to train nurse practitioners and physician’s assistants. Nursing shortages pose a real patient safety problem and we should immediately offer visas to well-trained foreign nurses to fill shortages while we increase our domestic supply of nurses.