Monday, September 10, 2012

Politics, 2

     I followed the Republican National Convention, then listened along with the rest of America to speeches by Clinton, Biden, Michelle Obama, and Barack Obama at the Democratic convention.
     At least--I think the rest of the country was watching.  No one I know seemed to care, nor had they listened to the speeches or the pundits' analyses of either candidate.
     Sometimes patients ask me what I think about the new healthcare act.  That's all they ask, though.  People don't see to know enough to ask more detailed questions, once I say what I have to say.  It's hard to blame them--how can anyone fathom 2,600 pages, or separate opinion from facts in the political crossfire about the contents of an obscure healthcare plan?  Politics seems to be of pressing interest to the majority of people only in countries where there's horrific corruption--and a revolution in the works.  We have enough to eat in America, and there's no revolution, so Americans are stuck in the heavy muck of apathy.
     I had just left the clinic when President Obama started his speech at the Democratic Convention.  Then I went to the grocery store.  At check-out I said:  "We're missing Obama's speech," and the clerk answered, "I make it a point never to talk about politics at work."
     "When do you talk about politics?"  I asked.
     "Pretty much, never," he admitted.
     "Why not?"  I asked.
     "I don't know anyone who wants to talk about politics."  The bagger nodded in agreement.
     I went home and watched Obama's speech on YouTube.

     Here's what I know about the Healthcare Act, and its ramifications for America.
     1.  Taxpayers are slated to pay for subsidized health insurance for everyone.  No one dares to guess how much, but it's probably in the half-trillion dollar range.
     2.  Medicare doctors are having their payments reduced by $716 billion.
     3.  Some experts think that a Medicare pay cut this big will induce 40% of physicians to stop seeing Medicare patients.
     4.  60 million new patients will soon need doctors.  There aren't enough doctors in practice, or in the works, to see them.  No one thinks nurse practitioners or physician assistants can fill the void.
     5.  Republicans would like to repeal the Healthcare Act, and put a Medicare voucher system in place.
     6.  Healthcare premiums for a family of four were $12,680 in 2008, and rose to $15,073 in 2011.
     7.  The healthcare act has closed the "donut hole" for Medicare patients who have been running out of coverage for medications before the end of each year. Donut hole coverage costs $4 billion per year.
     8.  Obama claims that the $716 billion in savings will extend the Medicare program--which was slated to go bankrupt in 2016, and now won't go bankrupt until 2024.  The Republicans say he's "double-counting" the $716 billion by saying he's saving it, and it will extend the Medicare program.
     9.  A big question is how to lure more medical students into family practice, since the healthcare act relies heavily on primary care doctors. 
    10.  Medicaid patients should have an easier time finding doctors starting January 2013, because the pay rates for services will be raised to equal those for Medicare.
    11.  Electronic health records are being required in all physician offices, despite more than 50% of physicians who believe that computers in exam rooms interfere with the doctor-patient relationship.  There are financial penalties for physicians who don't purchase and use electronic records.
    12.  159 new government programs and agencies will be needed to handle the administrative issues attached to ensuring every American has healthcare.
    13.  There is an individual mandate, and an employer mandate--terms that mean that individuals or employers will be forced to obtain health insurance coverage so that everyone has insurance.
    14.  Health care in America is big business:  it's estimated to represent one-sixth of our economy.
    15.  One problem remains:  Everyone needs health coverage, but the USA cannot afford unlimited healthcare for everyone.  No one seems to agree on what limitations should be placed on healthcare coverage, so that the country can afford it.
    16.  One-third of American doctors plan to leave medicine in the next ten years, according to a poll by the staffing company, Jackson Healthcare.  They site their reasons as the negative implications of healthcare reform, and the economic changes being forced on physicians.  Such a huge loss of doctors will represent a major healthcare access problem for everyone, especially aging and poor patients.

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