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Author Topic: Doctors are revolting against ObamaCare  (Read 1234 times)
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« on: March 14, 2013, 07:05:06 AM »


The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care

Jim Epstein|Mar. 13, 2013 9:00 am


Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
 
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
 
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
 
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
 
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
 
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
 
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
 
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
 


Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
 
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
 
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
 
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
 
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
 
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
 
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
 
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
 
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
 
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
 
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
 
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
 
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
 
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
 
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
 
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
 
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
 
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
 
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.

http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print

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« Reply #1 on: March 14, 2013, 12:15:31 PM »

i know several revolting doctors.
that's why I dont use them.
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« Reply #2 on: March 14, 2013, 12:22:50 PM »

Other stances from Reason

Climate changeThe Reason Foundation for many years denied climate change was being caused by human beings. But in 2005, Reason magazine's science writer Ronald Bailey wrote a column declaring that climate change is both real and man-made. He wrote, "Anyone still holding onto the idea that there is no global warming ought to hang it up. All data sets—satellite, surface, and balloon—have been pointing to rising global temperatures."[26]

In 2006, Bailey wrote an article titled "Confessions of an Alleged ExxonMobil Whore: Actually no one paid me to be wrong about global warming. Or anything else."[27] In the article Bailey explains how and why he changed his mind on climate change.



War in IraqThe Reason Foundation has been critical of the cost of the war in Iraq. Reason magazine's May 2008 cover story "Trillion Dollar War"[28] discussed the dubious ways in which the war in Iraq and Afghanistan have been funded by Congress and the Bush administration. The majority of Reason magazine's staffers opposed the war, but a few—notably the Beirut-based contributing editor Michael Young—endorsed it.[29]

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« Reply #3 on: March 14, 2013, 12:25:44 PM »

This is a Doctor Owned Medical Group. Second biggest Medical Group in California

HealthCare Partners Medical Group to Participate as Medicare Pioneer Accountable Care Organization

Robert Klein  310.630.4126
Monday, December 19, 2011


Torrance, CA, December 19, 2011 – HealthCare Partners Medical Group today announced it has been selected to participate in the Pioneer Accountable Care Organization (ACO) Model, a transformative new initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.

Through the Pioneer ACO Model, HealthCare Partners Medical Group will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.

“We are pleased to be part of such an important initiative,” said Robert Margolis, MD, HealthCare Partners chairman and chief executive officer. “Since HealthCare Partners Medical Group was founded in 1992, we have been focused on supporting our physicians to provide coordinated healthcare for patients in Los Angeles and Orange counties to improve health outcomes while controlling costs. Coordinated care can improve patient health through intensive patient and family education and earlier treatment of chronic conditions to help prevent complications.  We have particularly strong experience in caring for older adults and patients with complex health conditions, and participating in the Pioneer ACO will allow us to partner with other like-minded healthcare organizations to demonstrate how a coordinated care approach allows physicians to help transform the way healthcare is delivered.”

The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other healthcare providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, HealthCare Partners Medical Group was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.

“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “HealthCare Partners Medical Group has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,” Tavenner said.

Under the Pioneer ACO Model, CMS will provide incentives for participating healthcare providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.

CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding HealthCare Partners Medical Group for reducing growth in Medicare expenditures for the same patient population.

Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.

Today’s announcement was the culmination of a competitive selection process that began in May with the national release of a Request for Applications from CMS. HealthCare Partners Medical Group was selected based on its demonstrated capabilities to offer high quality, coordinated care.

The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of health care delivery and payment.

About HealthCare Partners
HealthCare Partners Medical Group has been named a top-performer for eight years in a row by the Integrated Healthcare Association (IHA), and has been recognized by health plans and business groups for medical leadership, the high quality of medical care delivered, operational effectiveness, and high rates of patient satisfaction. The HealthCare Partners physician network cares for nearly 580,000 managed care patients and hundreds of thousands of fee-for-service and PPO patients in the areas of Los Angeles, Long Beach, South Bay, Pasadena/San Gabriel Valley, San Fernando and Santa Clarita Valleys, and Orange County, with more than 1,200 employed and affiliated primary care physicians and more than 3,000 employed and contracted specialists. In addition to primary care doctors’ offices, HealthCare Partners provides medical services through urgent care centers and ambulatory surgery centers.  For more information, please visit
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« Reply #4 on: March 14, 2013, 12:37:38 PM »

LOL at Option FAIL defending obamacare.   Fucking clown 
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« Reply #5 on: March 14, 2013, 12:59:09 PM »

LOL at Option FAIL defending obamacare.   Fucking clown 

HealthcarePartners Medical Group. Look it up

Its a Doctor Owned Medical group... they are for it... oh yeah.. did it mention... its doctor owned

See... thats real world.. real money... not bullshit actors posing for pictures with signs..

Cmon on 3333 i know you like to troll and sometimes i ignore it.. but today i just feel like destroying you... so.. thats where were at now
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« Reply #6 on: March 14, 2013, 01:03:49 PM »

HealthcarePartners Medical Group. Look it up

Its a Doctor Owned Medical group... they are for it... oh yeah.. did it mention... its doctor owned

See... thats real world.. real money... not bullshit actors posing for pictures with signs..

Cmon on 3333 i know you like to troll and sometimes i ignore it.. but today i just feel like destroying you... so.. thats where were at now


LOL.   Sad bro - sad - the clown you love so much destroyed your chosen profession and you still kneepad him.
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« Reply #7 on: March 14, 2013, 01:15:51 PM »


LOL.   Sad bro - sad - the clown you love so much destroyed your chosen profession and you still kneepad him.

LOL... just keep on ignoring it.. that should work out for you..
you keep spouting opinion and ill keep slapping you with facts.

HealthcarePartners is a medical group.. a very successful medical group. Rated as a top company to work for in California. And it is physican owned medical group...

Torrance, CA, December 19, 2011 – HealthCare Partners Medical Group today announced it has been selected to participate in the Pioneer Accountable Care Organization (ACO) Model, a transformative new initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.

Through the Pioneer ACO Model, HealthCare Partners Medical Group will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.

“We are pleased to be part of such an important initiative,” said Robert Margolis, MD, HealthCare Partners chairman and chief executive officer. “Since HealthCare Partners Medical Group was founded in 1992, we have been focused on supporting our physicians to provide coordinated healthcare for patients in Los Angeles and Orange counties to improve health outcomes while controlling costs. Coordinated care can improve patient health through intensive patient and family education and earlier treatment of chronic conditions to help prevent complications.  We have particularly strong experience in caring for older adults and patients with complex health conditions, and participating in the Pioneer ACO will allow us to partner with other like-minded healthcare organizations to demonstrate how a coordinated care approach allows physicians to help transform the way healthcare is delivered.”

The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other healthcare providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, HealthCare Partners Medical Group was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.

“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “HealthCare Partners Medical Group has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,” Tavenner said.

Under the Pioneer ACO Model, CMS will provide incentives for participating healthcare providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.

CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding HealthCare Partners Medical Group for reducing growth in Medicare expenditures for the same patient population.

Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.

Today’s announcement was the culmination of a competitive selection process that began in May with the national release of a Request for Applications from CMS. HealthCare Partners Medical Group was selected based on its demonstrated capabilities to offer high quality, coordinated care.

The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of health care delivery and payment.

About HealthCare Partners
HealthCare Partners Medical Group has been named a top-performer for eight years in a row by the Integrated Healthcare Association (IHA), and has been recognized by health plans and business groups for medical leadership, the high quality of medical care delivered, operational effectiveness, and high rates of patient satisfaction. The HealthCare Partners physician network cares for nearly 580,000 managed care patients and hundreds of thousands of fee-for-service and PPO patients in the areas of Los Angeles, Long Beach, South Bay, Pasadena/San Gabriel Valley, San Fernando and Santa Clarita Valleys, and Orange County, with more than 1,200 employed and affiliated primary care physicians and more than 3,000 employed and contracted specialists. In addition to primary care doctors’ offices, HealthCare Partners provides medical services through urgent care centers and ambulatory surgery centers.  For more information, please visit
www.healthcarepartners.c om


Helpful Links
For more information about the Pioneer ACO Model, visit the Pioneer ACO website at
www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco/
.
The Pioneer ACO Model is one of several initiatives underway at CMS designed to encourage the formation of ACOs. For more information, visit
www.cms.gov/aco
. For more information about the Innovation Center, visit innovations.cms.gov.

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« Reply #8 on: March 14, 2013, 01:26:33 PM »

LOL - O-SHITHEAD just announced today he is cutting medicare funding for that. 

Keep worshipping this asshole because he is black - makes you look like a complete idiot

http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements

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« Reply #9 on: March 14, 2013, 02:02:11 PM »

LOL - O-SHITHEAD just announced today he is cutting medicare funding for that. 

Keep worshipping this asshole because he is black - makes you look like a complete idiot

http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements



Soooooo... the Doctor owned Medical group, whose ceo makes insane amounts of money...and is also a doctor..... is wrong

33333 the internet guy is right.... Gotcha
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« Reply #10 on: March 14, 2013, 05:33:38 PM »

Soooooo... the Doctor owned Medical group, whose ceo makes insane amounts of money...and is also a doctor..... is wrong

33333 the internet guy is right.... Gotcha



After your revolution I'm gonna need to see you for some pain in my lower back.


In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?
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« Reply #11 on: March 14, 2013, 05:57:40 PM »



After your revolution I'm gonna need to see you for some pain in my lower back.


In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?

Of course not. In fact, he expects to triple his take home pay because Obama said it would. And if he doesn't, its because of Dick Cheney.

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« Reply #12 on: March 14, 2013, 08:23:18 PM »



After your revolution I'm gonna need to see you for some pain in my lower back.


In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?

It hasnt... but im new on the scene so i havent been able to compare it to anything...


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« Reply #13 on: March 14, 2013, 08:25:17 PM »

It hasnt... but im new on the scene so i havent been able to compare it to anything...




If Barry O'Malley were a white GOP politician who did this health law you would be livid. 
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« Reply #14 on: March 15, 2013, 07:41:27 AM »

The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care

Jim Epstein|Mar. 13, 2013 9:00 am


Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
 
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
 
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
 
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
 
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
 
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
 
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
 
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
 


Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
 
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
 
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
 
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
 
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
 
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
 
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
 
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
 
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
 
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
 
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
 
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
 
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
 
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
 
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
 
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
 
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
 
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
 
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.

http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print


Did you notice this part?

This is the healthcare that I have been touting all along.  No Insurance.  No Republican wants that.  No Democrat wants that.  I can only think of Bernie Sanders who wants that and that is it.

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« Reply #15 on: March 15, 2013, 07:42:50 AM »

Republicans should love ObamaCare.  Its the same thing Bob Dole proposed with Insurance Companies at the forefront. 

Can anyone tell me which Republican supports dismantling the Health Insurance Industry?   Huh    Huh    Huh
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« Reply #16 on: March 15, 2013, 07:45:59 AM »

The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care

Jim Epstein|Mar. 13, 2013 9:00 am


Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
 
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
 
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
 
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
 
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
 
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
 
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
 
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
 


Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
 
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
 
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
 
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
 
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
 
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
 
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
 
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
 
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
 
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
 
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
 
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
 
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
 
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
 
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
 
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
 
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
 
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
 
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.

http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print


This article demonstrates well why we need to do away with the Private Health Insurance Companies.  Take out the Middleman.

No Republican supports that.  They support the Dictator Market of Private Health Insurance companies.  This article is not an argument for Republican Policy whatsoever.

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« Reply #17 on: March 15, 2013, 07:52:38 AM »

Neuhofel strongly believes in continuity of care and believes his system will allow for a long-lasting doctor-patient relationship despite job, insurance or health conditions. That’s because he doesn’t accept any third party health plans.


Neuhofel said he has seen patients who had diabetes but hadn’t been to a doctor in five years because they changed jobs and lost insurance.

“That’s the silliest thing in the world,” he said. “It shouldn’t be expensive or difficult for people to do that.”


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« Reply #18 on: March 15, 2013, 07:54:00 AM »

Neuhofel knows his novel idea isn’t going to be an easy-sell.

“The big challenge in selling this idea is the concept of health insurance and health care have become synonymous. People don’t make a distinction,” he said. “People need to think about health care instead of health insurance to get health care.”
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« Reply #19 on: March 15, 2013, 07:55:01 AM »

This is from his Website-

<a href="http://www.youtube.com/watch?v=FlaNd8foIsI" target="_blank">http://www.youtube.com/watch?v=FlaNd8foIsI</a>
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« Reply #20 on: March 15, 2013, 07:56:22 AM »

I thuink most health insurance is a scam. 
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« Reply #21 on: March 15, 2013, 08:00:21 AM »

I thuink most health insurance is a scam. 
I agree, but you support the Private Health Insurance Industry as do all Republicans and Democrats.  This is the problem.  I don`t see any Republicans solution other than going right along with Obamacare or establishing something nearly the same.  Either way, Private Insurance stays at the dictatorial position, controlling the entire medical "industry".


Republicans don`t want to cut away the middleman any more than the Democrats.  Both are the problem and if you support either one on their effort, then you become part of the problem as well.


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« Reply #22 on: March 15, 2013, 08:03:19 AM »

I agree, but you support the Private Health Insurance Industry as do all Republicans and Democrats.  This is the problem.  I don`t see any Republicans solution other than going right along with Obamacare or establishing something nearly the same.  Either way, Private Insurance stays at the dictatorial position, controlling the entire medical "industry".


Republicans don`t want to cut away the middleman any more than the Democrats.  Both are the problem and if you support either one on their effort, then you become part of the problem as well.




The only type of insurance I would support is some type of catastrophic hospitalization or something like that.  Other than that - its a rip off.   
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« Reply #23 on: March 15, 2013, 08:05:11 AM »

The only type of insurance I would support is some type of catastrophic hospitalization or something like that.  Other than that - its a rip off.  
Agreed, but why is this not represented in Washington by anyone except Bernie Sanders and the former Congressman Anthony Wiener?
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« Reply #24 on: March 15, 2013, 08:07:19 AM »

Agreed, but why is this not represented in Washington by anyone except Bernie Sanders and the former Congressman Anthony Wiener?

Because they all get $$$$$ and control the way it is. 
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