The Dismantling of ObamaCare - Ongoing Updates.

[nylife11023]

PCP's have been dropping for years. Many of their duties are replaced by PA's, NP's, etc.

The bigger issue is the number of providers that are being squeezed out by carriers that are forced to replace PPO's with HMO's in order to compete under Obamacare rules.

In some areas that contain a wealthy demographic many PCPs are going the 'boutique' route.

Those under 65 pay a flat fee in the area of $1500 a year per person age 45 and over. Often there is a 10% discount for an adult couple. You also have to have medical insurance (or Medicare) to cover labs, xray, hospital, surgery, etc. For the money you get same-day office appt., home visits, doc's cell number and email, longer visits, etc.

Those I know who have a boutique PCP really love it... but of course they can afford it.

 

[kgmom219]

In some areas that contain a wealthy demographic many PCPs are going the 'boutique' route.

Those under 65 pay a flat fee in the area of $1500 a year per person age 45 and over. Often there is a 10% discount for an adult couple. You also have to have medical insurance (or Medicare) to cover labs, xray, hospital, surgery, etc. For the money you get same-day office appt., home visits, doc's cell number and email, longer visits, etc.

Those I know who have a boutique PCP really love it... but of course they can afford it.

I have a bunch of clients who have their "concierge" doc (that's what we call it in DFW).

Here's my problem with it: they don't have privileges at the hospitals. So you get sick, who checks you in? Some doc you have never met? And the doc with all your records can't see you or your chart. That's dumb.

 

[Sherota1]

"Healthcare.gov should be shut down" Didn't we say this in 2013. Interesting read.

 

[junkman]

I have a bunch of clients who have their "concierge" doc (that's what we call it in DFW).

Here's my problem with it: they don't have privileges at the hospitals. So you get sick, who checks you in? Some doc you have never met? And the doc with all your records can't see you or your chart. That's dumb.

Those I've seen do have admitting privileges. The issue would be out of network charges of the hospital. Some of the docs run this fee part through a separate corporation and give preference to those patients. Most of the docs were in networks and simply stop taking new patients unless they come through the separate Corp. The well off all have some type of insurance and network. There are degrees of wealth and those with lots consider high price with service and badge of honor.

Docs that are mostly enhancement services join with their buddies and build clinics and charge what they want.

 

[bluemarlin08]

Prior to going on Medicare my wife and I and my parents used a concierge doctor and it was fantastic. We had his cell, could get in to see him anytime, no NP, he coordinated specialist visits and was able to get us appointments quickly.

 

[Yagents]

"Healthcare.gov should be shut down" Didn't we say this in 2013. Interesting read.

This is one of the primary reasons the law failed. Cut out private market and agents, and their marketing dollars. The comments section of the article show the ignorance of the public of what a broker does, and online quoting systems that were available pre-ACA.

Listening to EHTH conference call now. Change is comin'

 

[scagnt83]

I have a bunch of clients who have their "concierge" doc (that's what we call it in DFW).

Here's my problem with it: they don't have privileges at the hospitals. So you get sick, who checks you in? Some doc you have never met? And the doc with all your records can't see you or your chart. That's dumb.

Im sure there are different types and levels of this service. Some form or fashion of this has been in my area for the past 6 or 7 years now. But most that I know of certainly have privileges at the hospitals.

The Dr. I grew up with as a child retired due to health reasons, got healthy again, and went back to work as a Concierge MD. He is part of a larger group, but its a $1,800 per year retainer to be a patient (started at $1,200 5 or 6 years ago).

The service is a bit of overkill imo. Although the guarantee of being seen within an hour of calling them is a very nice benefit. If someone is at high risk of a serious disease then it would make a lot of sense to do. You get every scan/test/consultation you could want of over the course of a year. I think they now even have an implant you can have inserted so your vital signs can be monitored real time by an AI computer (ok, maybe thats an exaggeration).

 

[Ann H]

Rearranging the deck chairs is fun, but the root causes remain unchanged in everything Congress is doing right now. Medical costs rise far higher than the general economy. Until we face that issue head-on, we are just finding new ways of paying more money.

For this new reform, medical doctors are active - in Congress, HHS, and as advisers. If they are not willing to change the high costs, cost shifting, and non-transparent pricing, then we are just redecorating the deck with new insurance & tax techniques.

As an agent, I see disruption and opportunity. As an American, I care deeply, and as a consumer and taxpayer, this idea of cost-shifting an ever increasing amount of money is worrisome.

 

[VolAgent]

Rearranging the deck chairs is fun, but the root causes remain unchanged in everything Congress is doing right now. Medical costs rise far higher than the general economy. Until we face that issue head-on, we are just finding new ways of paying more money.

For this new reform, medical doctors are active - in Congress, HHS, and as advisers. If they are not willing to change the high costs, cost shifting, and non-transparent pricing, then we are just redecorating the deck with new insurance & tax techniques.

As an agent, I see disruption and opportunity. As an American, I care deeply, and as a consumer and taxpayer, this idea of cost-shifting an ever increasing amount of money is worrisome.

I agree with you about not addressing the underlying cause. However, I'm not sure doctors are the driver of high costs, unless you consider them enablers. Yes, doctors can make significant income, but it also does come at a high cost. College, med school, years of low pay as an intern and resident before they finally make a high income. Depending upon their field, they can work long hours and often not 9-5, Monday to Friday. Nights and weekends are not uncommon depending upon their specialty. Then there are huge liability risks.

The big driver is lifestyle, simply eliminating diabetes and heart disease caused by lack of activity and poor diet alone would be huge. And I do believe doctors, medical device manufacturers and the pharmaceutical industry are definitely enablers in this. Everyone is trying to invent the device or pill that will allow us to continue to make bad decisions but no repercussions. Also, doctors are afraid to tell their patients, they are killing themselves.

Once upon a time pilots were considered over paid. I recall a strike in the late 80s and thought, "No one cares about guys making 200k a year and saying they are underpaid." Then we ended up with guys on food stamps in the pilot seat of some regional jet. Now it is slowly going back the other way, were they are making a decent income. So going after the income of doctors can have undesired consequences.

 

[scagnt83]

The big driver is lifestyle, simply eliminating diabetes and heart disease caused by lack of activity and poor diet alone would be huge. And I do believe doctors, medical device manufacturers and the pharmaceutical industry are definitely enablers in this. Everyone is trying to invent the device or pill that will allow us to continue to make bad decisions but no repercussions. Also, doctors are afraid to tell their patients, they are killing themselves.

Here is some food for thought about the "enablers"... start taxing the hell out of the corn syrup and sugar industry. Thats whats really behind the rise in heart disease and diabetes, corn syrup and refined sugar.

Make it more expensive to make crap food than to make nutritious food. Its not a "now" fix, but it would be an effective part of a long term solution.

Or maybe give the same amount of subsidies to growers and importers of fresh fruits and vegetables, as they do the corn and sugar industries. It will drop the price of fresh nutritious food so that it is more accessible to lower income citizens.

Our government has used our tax dollars to make unhealthy food the cheapest option on the market. And it has screwed this nations health and its national debt.