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SK in CV.
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May 24, 2016 at 11:52 PM #798020May 25, 2016 at 12:16 AM #798018
ucodegen
Participant[quote=SK in CV][quote=bearishgurl]You don’t have to be insulting, SK. I didn’t see you post any links here to your “anecdotal `evidence.'”[/quote]
It wasn’t anecdotal. If it was anecdotal, I’d be you. I’m not. As of the latest year available, 41% of children 0-18 were on Medicaid and other public insurance. More than 50% are covered by private insurance.
You’re right. I don’t have to be insulting. And you don’t have to be a bigoted racist. So it goes.[/quote]BTW: Name calling is known as a logic fallacy (argumentum ad hominem). This whole ACA is kind of OT to the original thread; but adding a point here that should be considered, particularly due to your ‘links’ reference. When you make participation in the ACA mandatory to the point that fines are as significant as they are, it is not really valid to count the number of people who have signed up or are now on insurance as a validation of the success of the ACA. It might really be the success of the fine and NOT the ACA. (This stick might be more successful than the meager carrot here). Now anecdotally here; I have paid out more, just for mandated coverage in one year, than I paid out over the entire year when I was very sick and turning jaundiced (and I footed that entire bill myself).
What I have noticed, though not so anecdotally, is that a greater amount of the cost is now administrative. Some doctors have avoided doing insurance covered work because they don’t want the costs, but now with the ACA being mandatory, there really is no choice. They may feel that forgoing the entire business might be a better choice for them.
This also should bring into consideration the costs to the doctor of any software/computer systems required to keep records as well software and systems having to now be completely compliant with HIPAA (as well as all of the software support/maint costs). – I think the open source group might want to take a look at this area. It could drive the costs down for smaller offices.
It is better to keep the doctors, doctoring, than pushing paper.
May 25, 2016 at 12:35 AM #798023Participant[quote=bearishgurl]
Had you even bothered to read any of the links I carefully referenced for your information in the following thread OR the CA agent-facilitator-in-the-trenches blogs they came from, you would have known this.http://piggington.com/ot_predictions_2016_presidential_election?page=3
[/quote]I would suggest not using the ‘page number’ links, they don’t always end up at the same location. If you ‘hover’ over the title to your post, you will notice a link popping up. That would be better to copy-paste (has comment number in it).
Your ref to links did not show your post in my ‘view’ of the thread. Did you mean this one?
http://piggington.com/ot_predictions_2016_presidential_election#comment-264482Or maybe this one?
http://piggington.com/ot_predictions_2016_presidential_election#comment-264580
May 25, 2016 at 12:45 AM #798024bearishgurl
Participant[quote=ucodegen][quote=bearishgurl]
Had you even bothered to read any of the links I carefully referenced for your information in the following thread OR the CA agent-facilitator-in-the-trenches blogs they came from, you would have known this.http://piggington.com/ot_predictions_2016_presidential_election?page=3
[/quote]I would suggest not using the ‘page number’ links, they don’t always end up at the same location. If you ‘hover’ over the title to your post, you will notice a link popping up. That would be better to copy-paste (has comment number in it).
Your ref to links did not show your post in my ‘view’ of the thread. Did you mean this one?
http://piggington.com/ot_predictions_2016_presidential_election#comment-264482Or maybe this one?
http://piggington.com/ot_predictions_2016_presidential_election#comment-264580
[/quote]Well, uco, there were two posts by me with relevant ACA links (as it applies to CA) on that thread but the one I brought to SK’s attention was on page 4 or 17, depending on how the reader has his/her Pigg site set up. Hope that helps.When I did “hover” over the title to my post on that thread and click it, it gave me the link of page 1 only (or the latest page, as you posted here).
May 25, 2016 at 12:50 AM #798025Participant[quote=bearishgurl]Well, uco, I there were two posts by me with relevant ACA links (as it applies to CA) on this thread but the one I brought to SK’s attention was on page 4 or 17, depending on how the reader has his/her Pigg site set up. Hope that helps.
When I did “hover” over the title to my post on that thread and click it, it gave me the link of page 1 only (or the latest page, as you posted here).[/quote]
I noticed the ‘page 1’ behavior and was in the middle of fixing my post you replied to — which locked me out of fixing it… To me, the item was on page 5.. I don’t have anyone ignored.
—– snip — replacement post was going to be—–
[quote=bearishgurl]
Had you even bothered to read any of the links I carefully referenced for your information in the following thread OR the CA agent-facilitator-in-the-trenches blogs they came from, you would have known this.http://piggington.com/ot_predictions_2016_presidential_election?page=3
[/quote]I would suggest being careful of using the ‘page number’ links, they don’t always end up at the same location. (depends upon who ignored who, what has since been deleted etc). I it showed up on page 5, not page 3 for me.
http://piggington.com/ot_predictions_2016_presidential_election?page=5
Rich T;
It would be nice to be able to have ‘links’ to specific comments, but the ‘#’ target codes will not work across page boundaries. May want to add a cgi/asp/jsp key for comment number.. something along the line of ?comment=264580 to allow jumping to that portion of the thread and viewing from there… and have the links in the individual posts ref that instead of #html_target..
(ok.. engineer hat off – to bed).
—– end snip ——-now really off to bed..
May 25, 2016 at 12:59 AM #798019ParticipantBack to the original channel..
[quote=deadzone]This topic has been debated countless times already on this site. Bottom line is, yes, the idea of shortage of STEM graduates is propaganda and not backed up by factual data. The assumption is this purpose of this propaganda is corporate interests wanting to increase hiring of H1B visa workers.[/quote]
More Info:
As of April, all of the allotted 2017 H1B visa’s have been spoken for http://www.theindianpanorama.news/united-states-america/h-1b-cap-reached-majority-applications-indian-companies-250k-applications-5-days/ . The H1B visa lasts about 6 years (There are extensions https://www.usavisanow.com/h-1b-visa/h1b-visa-resources/h-1b-renewal-extension/ ), this years allotment was about 65,000. This would also mean that there may be about 390,000 people currently in the US under H1B visas. I would hazard that the number is actually significantly more due to use/abuse of extensions.
Considering that the income floor is $60,000 on getting a H1B visa approved, it is easy to game – particularly when Masters and PhD candidates are given preference. Remember that the suggested min wage of $15/hour comes to almost $30,000/year – so the floor requirement on H1Bs is just twice minimum wage. (NOTE: I need to track down the ref for the $60k and preferential treatment of advanced degrees – oh, just found it https://www.dol.gov/whd/regs/compliance/FactSheet62/whdfs62Q.pdf)
What I have been seeing are job reqs that are requiring a very large skill-set, but are for Associate/Junior Engineer categories. The skill-set required would not be found with a Associate or Junior engineer. Note that the $60k is just a little above what Bachelor of Science Engineering graduates currently make. http://www.payscale.com/research/US/Degree=Bachelor_of_Engineering_%28BEng_%2F_BE%29/Salary The high reqs make it hard for anyone of that job ‘category’ (ie: Associate/Junior Engineer) to have the required skills. The H1B rating for ‘Prevailing wage’ is match to job Category/Grade and NOT the actual required skills.
I suspect the whole thing is being played to reduce wages of US citizens who have taken the STEM route – to the benefit of companies (and their directors/CEOs), detriment of the US workers; increase supply of workers above demand to push down wages. Everything is supply/demand in a Capitalistic system.
Here are some:
Generic “Computer Programmer”, York PA at Cillium Corp, offering $54,059 for an H1B worker.
Java UI Developer, Worcester MA, AVCO Consulting @ $69,160
Cute one here: It seems they want to have any ‘checking’ think it is a grade I when it is a grade III? (what is a grade Iii???)
Computer Systems Engineers/Architects- Iii, Sunnyvale CA, HCL America Inc, $71,032.00 (This is not even a level 1 wage)Some of the H1B sponsor postings I saw looked valid, but a lot are fishy.
May 25, 2016 at 8:26 AM #798029SK in CV
Participant[quote=ucodegen]BTW: Name calling is known as a logic fallacy (argumentum ad hominem). [/quote]
Please review your logical fallacies. This wasn’t one. What I did was a straight out insult. There was no logical fallacy involved. Some insults are ad hominem. Some are not. Mine wasn’t. Her lousy opinions stand on their own. They don’t need personal insults to support them. The personal insults were just an extra bonus.
May 25, 2016 at 8:37 AM #798030Participant[quote=ucodegen] This whole ACA is kind of OT to the original thread; but adding a point here that should be considered, particularly due to your ‘links’ reference. When you make participation in the ACA mandatory to the point that fines are as significant as they are, it is not really valid to count the number of people who have signed up or are now on insurance as a validation of the success of the ACA. It might really be the success of the fine and NOT the ACA. (This stick might be more successful than the meager carrot here). Now anecdotally here; I have paid out more, just for mandated coverage in one year, than I paid out over the entire year when I was very sick and turning jaundiced (and I footed that entire bill myself).
What I have noticed, though not so anecdotally, is that a greater amount of the cost is now administrative. Some doctors have avoided doing insurance covered work because they don’t want the costs, but now with the ACA being mandatory, there really is no choice. They may feel that forgoing the entire business might be a better choice for them.
[/quote]
I’m not sure who you think used the number of people signed up as a measurement of success of the ACA in this thread. Certainly not me. I used the number of people (children specifically) on private insurance to counter the bullshit claim that most children are on government insurance.
But nonetheless, the number of people who signed up for insurance, whether through a federal or state exchange is a precise measurement of the success of the ACA. It’s primary goal was to get people insured. It worked. A higher percentage of the population is insured now than at any other time. Arguing that it’s the fine is just stupid. The fine IS an integral part of the ACA.
Administrative costs are not higher now. As a matter of law, they’re capped. As part of the law. If you’re referring to providers administrative costs going up, there is no evidence to support the claim. Most providers have been dealing almost exclusively with insurance, whether private or government, for decades. There was virtually no change with this as a result of the ACA. EMR’s changed. And every medical provider has had to adapt to the modern world. That’s not administrative. That’s actual provision of service. I’d prefer to keep doctors practicing modern medicine rather that medicine of the 1950’s.
May 25, 2016 at 8:41 AM #798031Participant[quote=bearishgurl]
This figure has to be at least 5% higher today.[/quote]Because of your made up facts? You have absolutely no evidence of that. Nobody has been forced into Medicaid plans unless they wanted subsidies. If you have newer data, please share it. Your observations that you see lots of Mexicans crossing the border isn’t really evidence.
May 25, 2016 at 9:05 AM #798032Anonymous
GuestI picture an old lady sitting in the desert on a lawn chair under a beach umbrella.
She’s watching the Mexicans pass across the border, collecting data for use in her next argument.
May 25, 2016 at 9:23 AM #798033scaredyclassic
ParticipantFrom the regular internist docs point of view, chasing down $ from insurance companies is more of a bureaucratic nightmare than I think even the most cynical among u can imagine
May 25, 2016 at 9:33 AM #798034Participant[quote=SK in CV][quote=bearishgurl]
This figure has to be at least 5% higher today.[/quote]Because of your made up facts? You have absolutely no evidence of that. Nobody has been forced into Medicaid plans unless they wanted subsidies. If you have newer data, please share it. Your observations that you see lots of Mexicans crossing the border isn’t really evidence.[/quote]The vast majority of people who sign up for coverage on the exchanges DO take a subsidy. Why would anyone go thru all those layers of BS just to have a healthplan if they weren’t going to get a subsidy?
As has been mentioned here, there are always the carrier websites themselves as well as online health insurance agents such a ehealthinsurance.com, where one can buy insurance during the fall open enrollments periods without entering their income details and having to constantly “prove” their income to keep their coverage. Why give the gubment all that access to your personal business if you can’t qualify for a subsidy?
SK, why don’t you leave “border crossing” and your other racist comments out of this discussion? The “border crossing” situation will either get fixed …. or it won’t, but we won’t know until after “We, the People” have spoken. They’re going to be speaking loud and clear in your border state (AZ) as well, so stay tuned.
May 25, 2016 at 10:24 AM #798039Participant[quote=bearishgurl]The vast majority of people who sign up for coverage on the exchanges DO take a subsidy. Why would anyone go thru all those layers of BS just to have a healthplan if they weren’t going to get a subsidy?
[/quote]
Because they want and need insurance. And believe it or not, in some markets, there are very decent choices at identical rates as are available outside the exchange. I bought insurance on the exchange with no subsidy for almost a year. My wife purchased insurance on a different state exchange for almost 2 years with no subsidy. Neither of us ever had to enter any income data.
I did the same thing for my daughter on the CA exchange last year for the 3 months she was without insurance between school and her job starting. No income entered. And guess what? with her return she got a premium tax credit. It’s possible that just looking at her tax return, the state of California would have liked to push her into medi-cal, but they never got the chance. And they would have been wrong in doing so. But I never had to fight the fight.
Not everyone who purchases insurance through state and federal exchange receive subsidies.
May 25, 2016 at 10:26 AM #798040Participant[quote=bearishgurl]
SK, why don’t you leave “border crossing” and your other racist comments out of this discussion? The “border crossing” situation will either get fixed …. or it won’t, but we won’t know until after “We, the People” have spoken. They’re going to be speaking loud and clear in your border state (AZ) as well, so stay tuned.[/quote]LOL! it’s going to get fixed? With a wall? By a president with a rodent on his head?
May 25, 2016 at 11:00 AM #798044Participant[quote=scaredyclassic]From the regular internist docs point of view, chasing down $ from insurance companies is more of a bureaucratic nightmare than I think even the most cynical among u can imagine[/quote]scaredy, I can imagine it because I have heard this from my providers, also. It’s especially hard for them now to know who to use for ancillary services such as lab and x-ray for each and every one of their patients. They’ve got to have competent people on staff who keep up with all these carrier nuances on where to send a particular patient (OR, in the absence of the patient, their “specimen”) to the “right” lab and the “right” radiology group. If they don’t (especially in the case of a patient specimen), the patient will get a “surprise” out-of-network bill that could be up to 10x the normal PPO reimbursement rate. If the patient has to report in person (in the case of a blood drawing or x-ray referral, for example) to the ancillary service, they can be stopped at the counter and told that that office no longer accepts their plan and then call their doctor and ask for a referral to a lab/radiology group which does accept their plan (a hassle but at least the patient won’t be gouged after the fact). But if their specimen is sent to a lab that their provider has always used (and the patient’s carrier has always covered in the past) and their carrier ends up rejecting the claim because they recently narrowed their network, (common these days) the huge OON bill is on the patient.
This actually happened to me last fall because one of my longtime doctors had shut down their practice a couple of days after my visit and was short-staffed in the days and weeks following (closing down the billing/books) and my “specimen” got shuttled to the lab it always went to before. However, my marketplace plan carrier had narrowed its network even further in 2015 and rejected the claim, leaving me with a $173 bill in which they paid $19 (and my pre-ACA carrier paid $34) for the same service in several past visits to the same provider (0 copay for me). On a small scale like this, I was able to negotiate a balance billing with the lab, which, if paid by a certain date, would not go on my credit report. It still cost me $125, which is nearly 4x the amount it should have cost. On a larger scale, this provider mistake could have been for lab work for a hugely expensive endoscopic ultrasound specimen which was sent “stat” to a lab while the patient was still anesthetized. What kind of OON bill would the patient be left with in this (common) scenario? The patient has no control over these provider back office mistakes and they sour the patient to ever using the provider again, because it cost them so much out-of-pocket unnecessarily, all due to their provider’s staff not paying attention to detail for each and every patient.
see: http://kff.org/private-insurance/issue-brief/surprise-medical-bills/
It didn’t used to be like this when the 6-8 major carriers’ PPOs were functioning side by side in SD. They ALL paid for ALL the major Radiology groups and labs in town. I do believe it is harder to run a medical office efficiently now due to the fickle carriers who lower their networks mid-year and eliminate providers without deleting them from their online provider lists and without sending member medical offices any notice that they have done so.
My marketplace PPO carrier reimbursements have also gone to sh!t in the past 12-18 months. My internist rec’d just $58.93 (0 copay) for my “intermediate established pt appt” (of 20-25 mins) last year but in years past, he rec’d $168 (0 copay) for the same type of appt, acc to my EOB’s. A sole practitioner, he has 2-3 FT front office personnel and 2 FT back office personnel in a leased office in a mid-rise bldg situated in a very convenient (and expensive) Hillcrest (SD) location.
How is an established and even renowned local provider with multiple hospital privileges going to survive on these tiny reimbursements? They would have to see 2-3 patients at once all day every day and run from room to room, while their support staff (and magazines) keep their patients (in dressing gowns) occupied while they wait for the doc to come back in from another patient’s room. It’s just crazy. I can completely understand why so few providers are willing to see Medi-Cal patients but the marketplace PPO reimbursements are now getting so low that I’m wondering what the actual current HMO and Medi-Cal reimbursements are for the same service :=0
And we’re not even taking into account how much (required) malpractice insurance costs these providers (varies wildly by specialty). The presence of the ACA has really screwed the providers in favor of paying the multi-layered bureaucracy to constantly mind everyone’s personal financial business who signed up for a plan (or Medi-Cal) on the federal and state exchanges.
Back to the STEM issue, I’m not sure if it’s worth incurring the crushing student debt to become an MD today. If one can go thru what it takes to become an MD without any student loans, then maybe it is worth it. But don’t expect to make what your predecessors (in your specialty) may have made in the past. A new MD has to love what they are doing and feel they are making a difference in their niche in society because I feel going forward that the “psychic rewards” (whatever they may be) are going to outnumber the monetary rewards of practicing medicine.
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