We Told You So: The New "Obamacare Sux" Thread

[Zevico]

Anything with "Reason" in it's name or title pretty much guarantees it's the opposite.

Like Democratic or Republican? Apply your cynicism consistently and nothing means what it is meant to anymore.

[Dr Strangelove]

Are the premiums rising because of the mechanics of AHC or are insurance companies trying to get in one last rate hike before the regulation begins?

[Sava]

He mortgaged your future and your children's future.

We've got Reagan and two Bushes to thank for that. Obama's just trying to pick up the pieces... with no help from House Republicans.

[Imran Siddiqui]

I think the bump of this thread is ONLY worth it due to Slow saying he'd **** himself.

[Kidlicious]

Anything with "Reason" in it's name or title pretty much guarantees it's the opposite. It's the same mindset that brought us Pravda ("Truth") or the Democratic People's Republic of Korea, which like MRE is three lies for the price of one.

Good reason.

[DinoDoc]

Reason magazine thinks Obama is ****ing everyone over by not being a libertarian so I'm not really surprised that they think he's screwing over the young by not being a libertarian.

Why does Buzzfeed (not a conservative site by any reasonable definition) think Obama is ****ing over the young to facilitate a wealth transfer to the old?

[DinoDoc]

Who's ready for a pharmacist to be your primary care provider?

State lacks doctors to meet demand of national healthcare law

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"

Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.

Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.

As the nation's earliest and most aggressive adopter of the healthcare overhaul, California faces more pressure than many states. Diana Dooley, secretary of the state Health and Human Services Agency, said in an interview that expanding some professionals' roles was among the options policymakers should explore to help meet the expected demand.

At a meeting of healthcare advocates in December, she had offered a more blunt assessment.

"We're going to have to provide care at lower levels," she told the group. "I think a lot of people are trained to do work that our licenses don't allow them to."

Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges.

Physician assistants, nurse practitioners, pharmacists and optometrists agree that they have more training than they are allowed to use.

"We don't have enough providers," said Beth Haney, president of the California Assn. for Nurse Practitioners, "...so we should increase access to the ones that we have."

Hernandez, who said he would introduce his legislation and hold a hearing on the issue next month, said his own experience as an optometrist shows the need to empower more practitioners. He said he often sees Medicaid patients who come to his La Puente practice because they have failed their vision test at the DMV. Many complain of constant thirst and frequent urination.

"I know it's diabetes," he said. But he is not allowed to diagnose or treat it and must refer those patients elsewhere. Many of them may face a months-long wait to see a doctor.

The California Medical Assn. says healthcare professionals should not exceed their training. Phinney, a pediatrician, said physician assistants and other mid-level professionals are best deployed in doctor-led teams. They can perform routine exams and prescribe medications in consultation with physicians on the premises or by teleconference.

Allowing certain health workers to set up independent practices would create voids in the clinics, hospitals and offices where they now work, he said. "It's more like moving the deck chairs around rather than solving the problem," Phinney said.

His group proposes a different solution: It wants more funding to expand participation in a loan repayment program for recent medical school graduates. Doctors can now receive up to $105,000 in return for practicing in underserved communities for three years.

Still, it typically takes a decade to train a physician. Health experts say the pool of graduates cannot keep pace.

"We're not going to produce thousands of additional doctors in any kind of short-term time frame," said Assemblyman Roger Dickinson (D-Sacramento). "It makes sense to look at changes that could relieve the pressure that we're going to undoubtedly encounter for access to care."

Administrators of community clinics and public hospitals say nurse practitioners and other non-physician providers already play key roles in caring for patients, a trend they predict will grow as more Californians become insured and enter the healthcare system.

At Kern Medical Center in Kern County, two clinical pharmacists have run the hospital's diabetes clinic, treating about 500 patients a year, since the specialist physician in charge retired. They are licensed to perform physicals, order lab tests, prescribe medicines and counsel patients on lifestyle changes.

"We're going to have to get a whole lot more creative about how care is provided," said Paul Hensler, Kern Medical Center's chief executive.

[PLATO]

This is not a problem of Obamacare, but rather a problem with the elitist nature of medical schools. Does a GP family doctor need the same level of med school as a brain surgeon? Perhaps we could look at educating more people to be primary care physicians and also train them when to refer someone to the decade long trained physician. If you can get a Doctorate in physics in 7 years, then surely you can learn to diagnose and treat most common illnesses in less.

[DaShi]

That's why much of primary care is being shifted to "midlevel" providers, such as nurse practitioners and physician's assistants.

reg is a moron.

[Tupac Shakur]

Why does Buzzfeed (not a conservative site by any reasonable definition) think Obama is ****ing over the young to facilitate a wealth transfer to the old?

It's pretty sad (but not surprising) that the ***** here decided to ***** about the producer of one of the articles I linked to rather than address the substance of either.

[DaShi]

Forget the issue. That guy is an *******!

[Guynemer]

This is not a problem of Obamacare, but rather a problem with the elitist nature of medical schools. Does a GP family doctor need the same level of med school as a brain surgeon? Perhaps we could look at educating more people to be primary care physicians and also train them when to refer someone to the decade long trained physician. If you can get a Doctorate in physics in 7 years, then surely you can learn to diagnose and treat most common illnesses in less.

Not sure if serious.

You really think general internists and brain surgeons receive the same amount of training?

[Dr Strangelove]

They need and get the same amount of medical school, but a general internist gets an additional 3 years of post-graduate training, while a neurosurgeon gets 7 to 8 years of post-graduate training.

[Guynemer]

Exactly.

If you want more primary care physicians, you'll either have to A) pay us more, or B) forgive our med school loans.

As it stands, I'll likely finish paying off my med school loan around the time I turn 60. Some people simply can not deal with that degree of debt.

[PLATO]

Not sure if serious.

You really think general internists and brain surgeons receive the same amount of training?

No, of course not. But I do think we need somebody that can diagnose and prescribe treatment for a common cold that doesn't have to go through 7 years of med school and intern training.

You are certainly more of an expert than I will ever be. Does it really take that level of training to diagnose and treat most common ailments? Could there not be some training for the "This is above my head...I have made you an appointment with a "Level 2" Doctor"?

Why can't we have different levels of competentcy? It seems that we do once you have the MD...hence specialist. Maybe we have a 5 year program for a "Generalist"?

I would be interested to know your thoughts and reasoning on this. I am just throwing ideas up against the wall.