November 24, 2012

A Doctor’s “new normal” under ObamaCare: “Free” has its price. [Darleen Click]

Each time you are now in the examining room, Obama is looking over your doctor’s shoulder.

Obamacare is awful. Forget all the “free stuff” it provides. Children covered on their parents’ plan until 26 years of age? A scam, making young adults — excuse me, children — pay for complete, comprehensive health insurance when all they need and should pay for is major catastrophe insurance. Then there is the “annual ” or “preventative” exam, which according to Obamacare is “free.”

You gotta love this stuff. I wish I had the chutzpah of the people who wrote Obamacare. What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum.

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code — insurance will not cover any new ailment under that code.

If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud. […]

I can hear the complaints from you guys already — I become the bad guy. “Why don’t you just take care of the problem, and not bill out any different code? You’re a rich doctor, and we are entitled to free stuff.”

It doesn’t work that way. First, doctors are not rich and, like most of you, actually work terribly hard for a living. Second, Obamacare is the law — and as I said earlier, we are audited all the time now.

Also — I don’t ask for free gas when I go to the gas station, or ask for free food from the supermarket. Additionally, Obamacare has a 23% cut in Medicare reimbursement to doctors and hospitals.

These lower payments won’t cover the cost of staying in practice to take care of the patient. […]

On top of all of that, doctors will be obligated — that’s right, obligated — to talk to you about things you may have no interest or need to talk about.

You may just want to have a pap smear or check your cholesterol. However, I am now mandated by the government to talk to you about your weight, exercise, family life, smoking, sexual abuse(!), and even to ask if you wear seat belts. And I am mandated to record your answers.

I am a physician. But I need to tell you to wear a seat belt and then record your answer.

Doctors as agents of The State.

Isn’t that special?

Posted by Darleen @ 10:06am

Tags: , ,

Comments (37)

  1. Obamacare was made so awful intentionally. It is intended to fail spectacularly, so that it in very short order, a majority of people, even nominal conservatives, would be clamoring for a Single Payer / NHS-style system.

    We will all soon be slaves of the State.

  2. I’m hoping the trend to cash doctor practices continues.

  3. Greetings:

    I spent most of my work life in the printing industry. One of that industry’s traditions is the provision of “free” estimates. A customer would tell us what they wanted printed and we would respond with the cost we would want to charge them. One time, and thankfully it was the only time, I came across a customer who didn’t really understand the tradition and was requesting a very large number of estimates for a not very complex job. In trying to explain the situation to her, I provoked the response, “I thought that estimates were free.”

    “They are, ma’am,” I replied, “but they’re not without cost.”

  4. I’m hoping the trend to cash doctor practices continues.

    I’m one who takes advantage of it, but I also expect it to be banned altogether, and fairly soon.

  5. BTW, My old high-deductible PPO policy will not be allowed under Obamacare, because the insurer’s medical-loss ratio (MLR) will be too low, literally because of the high deductible.

  6. I also expect it to be banned altogether

    They (yeah, them) can ban this practice, but it won’t stop it.

  7. OT: I’m sorta watching a show on Food Network that is dealing with food waste in the restaurant industry and among vendors. Four celebrity chefs are cooking with a bunch of discarded ingredients that are either imperfect or out of date, according to the FDA.

    One baker is throwing away over $15,000 a month in prime ingredients.

    I may have to revise my opinion of Freegans.

  8. Leigh

    It’s not waste, its the law (which can be an ass)

    There are a lot of restaurants out there that would be happy to donate their discardables to shelters, food kitchens, etc.

    They can’t.

  9. I had the nurse at my last check-up ask me about family abuse. I, of course, being the fully cooperative drone I am, told her ” none of your fucking business”.

    “WHAT? Quoth she.

    “NOYFB” I clarified. “Write it down.”

  10. I know, Darleen. They were talking about food that is discarded because it is blemished or otherwise imperfect and it is costed out as waste.

    Mojo: I told a nurse the same thing. *cyber fistbump*

  11. People will eventually come to understand, no one needs to be a Doctor. Especially given the cost to just become one, let alone try to run a practice.

    I met a person studying to be a Dr. on a missions trip to Cuba, I asked him what sort of benefits he would get above and beyond a regular citizen. After thinking for a few beats, he responded “Well, I’ll get a pair of underwear and shoes every year as opposed to every other year”.

  12. I think maybe nobody needs to be a community organizer either.

  13. I can’t wait to tell a doctor that I have a secret airbase with a whole wing of B2 stealth bombers hidden in a guitar case under my bed, but don’t let anybody know about it okay? It’s supposed to be a surprise. As for abuse other than all that S &M stuff we do around the holidays, and those broken bottle fights we get into, we all get along pretty well. Unless you count soldering burns.

  14. Do I wear seat belts? Wear ’em, masturbate with ’em, beat spotted owls and bald eagles to death with ’em, snap a hobo’s neck with ’em in an impromptu alley wrasslin’ match…what CAN’T you do with them? And they smell SO GOOD when you toss one on the camp fire.

  15. I don’t believe about the hobo

  16. Well, if I’m wrong then I’m sorry. I don’t actually snap hobo necks at all. I just leave hobos alone. I don’t use them to pleasure myself either. I leave them in the car and wear them when I drive. Nor do I kill protected birds of prey with them.

  17. There is nothing better in this life than wearing a hobo (that you left in your car) as you drive.

  18. I don’t think snapping their necks would work. But you could definitely choke a hobo with it.

    A friend told me.

  19. Fraternity brother of mine is a general practitioner for 10 + years. He’s non-political. And he was begging people on Facebook to vote against Obama because of Obama care. His main refrain was that people have no idea how much things will change for the worst, especially with his type of practice. He said doctors find themselves reducing non essential staff bc of the Obamacare requirements, at the very time they’ll need more personnel to comply w all the paperwork requirements.

  20. A bit about the new normal in Chicago, the agitation of which was the ONE’s (you didn’t bend that spoon!) first “real” job. (As seen on INSTY)

    “I didn’t want to point out that it was public pensions that were putting financial duress on us all. Nor did I want to point out that EPA‘s reluctance to allow the oil companies to find new sources of oil and gas were hurting the supply chain for energy, artificially driving up prices. I didn’t want to mention that coal plants all over the US were being shut down because of the regulations coming out of Washington.

    The checkout clerk said many of her friends were leaving the state. Interesting, I have heard that from a lot of the wealthy citizens too. Microeconomics theories work. Math eventually catches up with the chattering class.”

  21. I’ve been having lots of fun pointing out to crest-fallen libs that math is a harsh mistress.

    If only they had listened before it was too late.

  22. I will expect additional questions to be added and for the Sec of HHS to issue some small changes to go with it.

    The questions will be something along the lines of…

    “Are there any firearms in your home?” “Do you or your spouse/life partner own any firearms?” “If yes what firearms are they specifically.”

    The small changes will be…

    “All persons must take an annual examination.”


    “For the purposes of asking these questions, the doctor shall be considered a Federal Officer.”

  23. I raised hell when the nurse wanted to ask my minor child questions without me present.

    They don’t try that shit anymore.

  24. I imagine Peter Sellers as the questioning doctor:

    So, just how many human skulls do you have in your possession? That many? Alright. Of these skulls how many have tooth marks on them? Okay, I’ll just put ‘none’ then. And how many of these skulls were boiled? Right. And one last question, just a formality really? Are you killing people and making tamales out of their heads? Only occasionally. Alright then. No it’s not a problem. We have a special waiver form for this, that I’ll need you to fill out…if you could just…yes just leave it with the receptionist. Oh yes! I really hadn’t noticed. He does sort of have a nice fat face doesn’t he? Heh heh.

  25. scalloped tomatoes and corn bread, these are gifts from the Lord

    Praise HIM!

  26. “Give the people what they want…”

    and let them get everything they deserve.

  27. Family abuse? The government abuses my family quite satisfactorily, thank you. I’ll let you know if our needs require seeking additional vendors for it though.

  28. So doctors will be asking all sorts of government-required intrusive questions, and who exactly will have access to our responses that they dutifully note in our electronic medical records? And for what purpose(s)?

  29. Well, any employee of HHS and your state health insurance exchange, for openers.

  30. “For the purposes of asking these questions, the doctor shall be considered a Federal Officer.”

    “I respectfully decline to answer pursuant to my Fifth Amendment rights against self-incrimination.”

  31. Leigh, the problems with libs and math are these: at some point, libs are certain 2+2=5, because libs feel 2+2=5. Not only that, but, as far as libs are concerned, the only reason 2+2≠5 is because the math hasn’t been done the right way yet.

  32. Nature is more merciful than math sometimes. In the short term. Or God. Or physics. Or Dharma. Or “the dice”.

    As the VM team re-emerged from the post-Thanksgiving tryptophan-induced haze, we found yet another thing to be thankful for: the world did not end in 1883. A new paper reinterpreting old astronomical data argues that a massive comet disintegrated near Earth and its fragments passed as close as 600km from us in August of that year. Technology Review summarizes just what this could have meant:
    Manterola and co end their paper by spelling out just how close Earth may have come to catastrophe that day. They point out that Bonilla observed these objects for about three and a half hours over two days. This implies an average of 131 objects per hour and a total of 3275 objects in the time between observations.
    Each fragment was at least as big as the one thought to have hit Tunguska. Manterola and co end with this: “So if they had collided with Earth we would have had 3275 Tunguska events in two days, probably an extinction event.”

  33. Well, you know what they say:

    If it works, it’s math.
    If it stinks it’s chemistry.
    If it doesn’t work, it’s physics.

    No offense, BBH. ; )

  34. “For the purposes of asking these questions, the doctor shall be considered a Federal Officer.”

    Actually, they already are. Look up the various corrupt practices acts around the world, and doctors in government run health care are considered subject to the acts.

    That’s probably how they will break the “cash only” / concierge medical practices: your payments constitute an attempt to influence the government official’s decision. Also, most / all of these don’t require the “bribe” to be successful, there is no mens rea, and both the briber and bribee are guilty.

  35. Libby, In addition to the usual suspects, if you were ever involved in litigation, anyone with a subpoena will have full access to your medical records. I spend an absurd amount of time digging through plaintiffs records when defending lawsuits. It’s eye opening. For example, I’m blown away by the sheer number of plaintiffs who have herpes. I sure as hell wouldn’t want my records out there under the new requirements and my medical history is boring.

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