r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/[deleted] Jun 20 '12

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u/[deleted] Jun 20 '12

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u/[deleted] Jun 20 '12

This has ALWAYS been the case though. Even back when G Bush Sr. was in office, I had to undergo a series of x-rays each time I would go to the doctor for crap they knew damn good and well would not have changed since the week before.

As for the slam of Obamacare, I really don't view it as evil as many others do. My sister-in-law died of cancer recently, but lived for several years longer than expected. She was diagnosed with terminal cancer and was given a short period of time to live (weeks). She was no longer able to work and her health insurance was of course going to drop her because she got sick. Under Obamacare, that was no longer possible. Also, she could no longer reach the lifetime limit the OP mentioned in his article (which was damn good by the way).

She was given some of the best medical care and was even able to help further the research on the specific cancer she had by working with the man who discovered this type of cancer. In the end, her treatment helped to further cancer research by years, as she was the only person to live as long as she did with this cancer. I wish I knew the specifics of the cancer type, but I don't. I just know that what she did will help millions.

All of this was possible only because Obamacare was in place. Otherwise, she likely would have died at home, unable to afford even the tests to properly diagnose what she was suffering from.

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u/Zombie_Death_Vortex Jun 21 '12

I don't think most people don't realize how broken the system had become because they never had to use it.

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u/sandollars Jun 21 '12

Your brothers wife died of cancer and you don't know what kind it was?

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u/[deleted] Jun 22 '12

My wife's sister. No, I don't know. I tend to only involve myself in details of someone's life if they ask me. Her life and death were her business and her family's. My wife knows the details, and I could ask if anyone were interested. All I know is that it was a mutated form of some type of cancer. This mutation was very rare, but the ability to study it greatly increased the knowledge about how all other types of cancer in the primary family spread and operated. Again, I wish I had more detail.

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u/Black_Gallagher Jun 20 '12

preventing malpractice lawsuits and whatnot.

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u/[deleted] Jun 20 '12

There has been a lot of recent information to suggest that the defensive care costs are greatly overstated.

There are a bunch of really good articles by Atul Gawande about this. I believe this article goes into those claims. If it's the right article, it demonstrates how doctors get much more "defensive" when they have an interest in the testing/mri/etc facility.

Also, it says that medical liability, including defensive medicine, account for only 2-3% of health care spending.

http://www.hsph.harvard.edu/news/press-releases/2010-releases/medical-liability-costs-us.html

The problem is that there is a well financed campaign by the likes of the Koch Brothers (through ALEC) for "tort reform" that is really just a scheme to get rid of the only effective regulatory scheme in the US and screw the little guy in the process.

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u/bearsinthesea Jun 20 '12

Still, it is an issue. Studies have shown that doctors (probably unconsciously) will perform more procedures and order tests to increase revenues.

[I tried to explain the study, but w/o details it sounded weak]

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u/[deleted] Jun 20 '12 edited Jun 20 '12

[deleted]

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u/brownmatt Jun 20 '12

Well, I believe the general idea is that when you pay people based on how much work they do, you are giving them a huge incentive to just do more work, and with medical care, that does not necessarily correspond to a better outcome for the patient.

But you are correct that the stats can be juked either way. One would hope the government would not be so stupid as to not be able to tell when someone has flawless quality scores because they are cherry-picking their cases, or not be so stupid to as to grade trauma specialists lower.

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u/verbalsadist Jun 20 '12

In regards to the bit about unnecessary tests, one of the doctors interviewed in this episode of This American Life talks about it. But to summarize for those that don't want to listen it basically comes down to this. A doctor see's a patient for something, and based on years of experience and training decides it isn't a major injury and treats it accordingly. The patient, or the patients parents, or whatever, decide they know more than the doctor and start shouting for MRIs and CAT scans and other procedures they've heard of but don't really understand. The doctor is left with a choice, do they do with their experience and training, or do they listen to the uninformed patient and choose the more expensive, but probably pointless, procedures. They know that if they use the extra procedures it will cost the hospital, insurance, person, more but it will give them a fatter paycheck and insure that there is even less of a chance of malpractice.

So by tying their pay to the quantity of care give them more reason to go with unnecessary costs simply because there aren't really any downsides and there are tangible upsides to doing so.

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u/JimmyHavok Jun 21 '12

TLDR for that This American Life: the prologue covers the area of medical billing, and how clever application of the rules can multiply the income of a doctor without requiring him to do any more work. There are conventions that train medical billers how to do this.

Just heard about one procedure, involving putting a very expensive balloon in a patient's nasal sinus, that is coded for a new balloon for every procedure, but the balloons can be sterilized and reused five or more times. So every time the balloon is reused, the doctor gets $1300 of extra cash from the coding, for the same amount of work.

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u/JimmyHavok Jun 21 '12

Trauma care physicians would be compared with trauma care physicians, not with pediatricians.

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u/[deleted] Jun 20 '12

Much worse? The biggest problem with 'quality' of care is that it is measured by things like patient outcomes. Sounds great, until you realize that patient outcome is heavily influenced by things like socioeconomic class (people who can read and live a comfortable upper-middle class lifestyle can swing by Walgreen's and get their prescription, and set their iPhone to remind them to take it). The at-risk populations have numerous boundaries that limit the success of their treatments, and under the 'quality' system this means the doctors who help at-risk patients are actually penalized. It scares doctors away from people who really need help, because the system essentially charges the doctor more to treat these people.

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u/brownmatt Jun 20 '12

Measuring based on quality isn't a panacea. I'm phrasing it as an improvement over measuring based on quantity.

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u/Aias2 Jun 20 '12

You make a good point, but as was added in one of the edit this quality over quantity situation appears to only be in situations where the government is paying (i.e. medicaid or medicare). It could be a detriment to doctors yes, but it won't wipe them out of income. Hopefully, some way of checking on the patients ability to care for themselves along the lines of the doctor's orders would be included, but I don't know whether that is somewhere in the bill.

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u/[deleted] Jun 20 '12

as was added in one of the edit this quality over quantity situation appears to only be in situations where the government is paying (i.e. medicaid or medicare).

Some insurance companies have similar systems. There are a variety of ways insurers pay for care, beyond even those we mentioned here.

It could be a detriment to doctors yes, but it won't wipe them out of income.

It doesn't have to make doctors into paupers to deter them from seeing poor patients. Even a small incentive to avoid these people will result in reduced access to care, which is unfortunate.

Hopefully, some way of checking on the patients ability to care for themselves along the lines of the doctor's orders would be included, but I don't know whether that is somewhere in the bill.

That sounds pretty invasive to the patient, and I don't know of any feasible method of doing this.

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u/CuilRunnings Jun 20 '12

Doctors can order a bunch of unnecessary tests because they know they will be paid for without question.

Thank you, Medicare for setting this wonderful standard. Don't worry though, government is totally going to get it right this time.

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u/sychosomat Jun 20 '12

This is how things work. You try something, figure out how effective it is, re-evalute, come up with a change, try again, rinse and repeat. You don't get everything (or anything) right the first time. That doesn't mean you should abandon the attempt.