Thursday, August 22, 2013

Obamacare: Your doctor won't be seeing you...

"If you like your doctor, you can keep your doctor."  Barack Hussein Obama

Except you can't.

Just received a letter from my former physician who I was forced to abandon due to Medicare.  Back in 2004, he transitioned to an all-cash practice enabling him to practice real medicine.  Since the insurance we purchased privately was more along the lines of a catastrophic policy with deductibles of $2500.00 - $5000.00, it suited us just fine.  If a patient wanted something submitted to their insurance company, the coding information was sent to an independent company for filing.  Cost?  Two dollars.

A typical visit ranged between $60.00 - $100.00, depending on what services were provided.  It was not unusual for him to spend an hour with you.  On the advice of our insurance salesman, we never submitted a claim.  If, for some reason, our out-of-pocket expenses were to reach our deductible (they never even came close), we could submit all of our claims at one time.  The reasoning is that if you submit tons of claims, the insurance company could deem you a higher risk and raise your premiums. 

Well, this fine doctor is transitioning again (excerpts from letter):
 [...]"Despite a number of concerns with "Obamacare", Donna and I feel that the intent of the law, specifically to extend medical care to those who have been previously underserved, is to be commended. However, we feel that medical delivery in the United States will dramatically change.  First and foremost is the significant increase in the number of people who will seek medical care, consulting an already limited number of primary care physicians.  Despite the anticipated influx of mid-level practitioners (physician assistants and nurse practitioners) to help handle the increased volume, the predicted shortage of physicians coupled with increased insurance and other regulatory requirements is expected to compromise care by extending wait times and making visits more abbreviated.  Waiting rooms will become more crowded and patients will be more readily referred to a specialist, often due to lack of time for a thoughtful diagnosis and development of an appropriate treatment plan.  Medical care will become further fragmented, and the cost for services will undoubtedly increase".

His solution?  Glad you asked...
 "Our solution to these and other concerns with Obamacare is the establishment of a medical practice known by a variety on names, including Direct Primary Care (DPC), concierge medicine, direct access and retainer medicine.  In this model, a monthly, quarterly, semi-annual, or yearly membership fee is paid by the patient in exchange for increased and direct access to their personal physician.  Provider availability includes weekend and evening hours, and the membership fee covers all physician services.  These services include office and home visits as well as the broad array of office procedures a Board Certified Family Physician routinely provides.  Services are enhanced by portable electronic medical records, cell phone calls/texting and e-mail communication.  Physicians in this model of practice typically have a much smaller panel of patients (usually capped at between 400 and 600 members), so convenient appointment times are easier to obtain, wait times are much shorter, and time spent with the physician is increased.  In a sense, this model is an updated version of the old-fashioned country doctor."

His suggestion is to buy a high deductible policy for the big stuff, and sign up for his concierage service for everything else.  Problem is, with all the government mandates (can you say free birth control?), the price of a high deductible policy will be much higher than in the past.

 This physician is capping his enrollment at 400.  Not knowing how many patients he has now, I can't say with certainty how many people will be pushed onto an exchange, but I'm pretty sure it will be at least five hundred, if not more.

Let's break this down for the low-info voters who think they'll be getting "free" or very low-cost medical care under Obamacare.  You won't.  There is a difference between health insurance and health care.  Capisce?  You'll be lucky to get an appointment to see a Physician Assistant or Nurse Practitioner. 

A typical "bronze" plan under Obamacare for a person 55 years old will cost about $500.00 with a deductible of about $3,200.00.  After the deductible is met, you'll still be on the hook for 40% of every service provided.  What a deal.

What about the "caps" that Obamacare has placed on out-of-pocket expenses?  Obamacare requires that health plans cap the maximum out-of-pocket costs (including co-pays, co-insurance and deductibles) at $6,350 for individuals and $12,700 for families.  But wait!  That little mandate has been delayed for a year so there are no caps.

Another very hard to understand (for non-insurance professionals), is the matter of benefit managers who are essentially the middle men between you, your insurance company, and the provider.
The government published a FAQ in February saying some insurance plans offered by employers have separate policies or benefit managers for different parts of their coverage, such as medical care and drugs, and sometimes a third for children's dental services. Some employer plans have separate out-of-pocket caps for each of the coverage areas, according to Kaiser Health News.
So if plans use more than one company to administer their benefits — as many do — consumers may face separate caps next year. That means someone might have to pay $6,340 for doctor and hospital services and another $6,350 for prescription drugs. source
Essentially, not only will you face separate caps, you will also be left standing at the prescription counter unable to receive your medicine because the pharmacy will have no idea of whether you're covered or not.

Now we get to the truly outrageous part.  Spend some time at the subsidy calculator provided by Kaiser Health.  You see, if you are a couple with two children earning $92,000.00 per year and your employer doesn't offer insurance, you qualify for a subsidy of over $3500.00 to help pay your insurance premiums of approximately 12,000.00 dollars.  Just exactly who is paying for this?  Why you are.   

This monstrosity needs to be defunded and then repealed.  Why repealed?  Because the next Congress just may decide to fund it.  In the meantime, I'm rather looking forward to the chaos about to descend on the low-info Obama voters who think this is such a great idea.  May they suffer greatly...

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