It's a mixed bag. The Republicans should get credit for passing Medicare D (prescription drug coverage). This went far in prevention since it is much cheaper to provide a medication to control blood pressure than it is to treat a stroke or chronic renal disease secondary to hypertension.
The battle to shift from tertiary (acute) care to primary care (prevention) has been an uphill climb. The public's resistance has been an issue but unrealistic expectations are also a big part of the problem.
That latter is why I say that a $100 tax credit should be given for getting a physical. Maybe make it in just odd-numbered years, since many physicians say we don't need one every single year. It would move us toward preventive care and get people thinking in that direction.
For example, about 30% of Medicare expenses are incurred in the last year of a Medicare recipients life. Remember "death panels"? That was actually a clause proposed in ACA that would have reimbursed primary care practitioners for family discussions about living wills and end-of-life choices- a clause that was removed because of irrational blowback from the Tea Party and Republicans. Those discussions between physicians and patients about their end-of-life care choices might have gone a long way toward reducing a lot of unnecessary and fruitless care during the last year of life.
I'm happy that of the five people I know who've died in the past couple of years, all requested no "heroic measures" -- in fact two required that if doctors decided they were doomed, they would be returned home and be kept comfortable, nothing else.
Honestly, it depends on the specialty. The worst of the shortage is primary care practitioners and psychiatrists. There's going to be a shortage of surgeons because of impending retirements (about 1/3 of US surgeons are over age 55!) and low numbers of physicians choosing surgery specialties like orthopedics and vascular surgery.
We're not doing badly on medical specialties and most medical specialists are accepting new patients and are able to accommodate patients for appointments within a 2-4 week period.
Not my experience for myself, my sister or my mom. The only time any of us have gotten a quick specialist appointment is if the primary physician said it was life or death -- and even that took three days! (Though I give the specialist credit: the moment he saw my mom and scanned the monitors, he said to clear his schedule and the OR.)
Late December and January are horrible times for emergency rooms because of physician vacations, high numbers of flu cases, GI bleeds and indigent/homeless patients seeking care. But overall, ED wait times are down since the ACA was implemented BUT it depends on whether your state adopted the expanded Medicaid program.
Around here, June is pretty heavy for emergency rooms, too: kids get out of school and go ripping off to intense activities they're not in shape for and have serious accidents. Though if the scuttlebutt is right, the worst ER day here last year was July 4th.
What we think happened is that after the passage of the law, patients did use the emergency rooms more initially. A poll of emergency departments found that about 47% of departments reported a "slight" increase in volume. What happened after that depended upon what resources were available and whether the emergency department was able to refer the patient to a primary care provider.
That was reported to be the case here, including people who didn't understand how the law worked and showed up expecting free care without having signed up. It stayed higher, too, until the new clinic was finished.
Though I heard a comment at the clinic the other day, from a couple in their 80s: it's still not like it used to be, when you could go see your own doctor without an appointment! I think that's the standard we need to get back to; I've used immediate care and it's frustrating to sit there while the doc goes through my doc's records (when he has them!) to get a feel for my history.
The stats coming out of states like Kentucky that accepted Medicaid reported about $1 billion savings on unpaid emergency department visits. That's significant. Because Kentucky also put money into establishing a public clinic system and mobile van clinics, patients who were going to be emergency room for primary care problems was reduced significantly. In states that didn't accept the Medicaid expansion, we expect the patients volumes to either be flat or slightly higher.
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Yes. We were all paying for those costs anyway; now they're actually in the accounting in a plain way.
Most people don't realize that ACA removed the separation between medical and psychiatric care benefits. This means that your insurance company must treat your psychiatric care visits in the same way as any other medical expense.
There is a need for systemic reform of the mental health care system and the laws around involuntary custody and commitment. Instead, state legislatures and Congress seem to be focusing on issues on the social conservative agenda- like access to abortion and gender-bathroom issues.
I was aware of it, as was most of my family, as we either use mental health care or know people who do. The ministerial association in town got the word out, too. I remember it coming as a great relief to a number of people who were looking at the cap on benefits that was inevitably going to cut them off once they got elderly -- so just by making that change, the law improved mental health!
My proposal is to put reform of the mental health care system in a new Militia Act. Call the section "To provide for a competent militia", and have it make sure everyone gets screenings in middle school, high school, and regularly thereafter. Those determined to be a risk to themselves and/or others could by law be removed from the status of belonging to the militia (which we all do) and put on a warning list for the NICS.
In addition, every community should have a drop-in mental health center with facilities for voluntary overnight stays. That was available when I was at OSU, and it seriously reduced the incidence of injuries, self- and otherwise, among the mentally ill. The day center had lots of activities, volunteers to talk to and get help from, and a hot link to most of the counselor types in town. Everyone praised it, but getting money to keep it up? Didn't happen, and it should.
That's something I'm kind of intense about partly because of my bit of native American blood: many tribes had the equivalent of a community care facility, and if we can't live up to at least the standards of caring for one another of the people we as Europeans stole the continent from, we should just give it back.
