ObamaCare Info

[daughtersrus]

:
And the same is true for self-employed construction tradesmen. They aren't on the clock for those free estimates they offer, and the majority of leads don't pan out. That's just part of being self employed - a lot of work on your own time, a lot of paperwork and clerical responsibilities, and a lot of unpaid efforts to build the paying business.

The examples that I gave were not for self employed mechanics. They are for journeymen at a car dealership.

As a matter of fact, my DH and I were talking about it yesterday. He had 2 salesmen that asked him to work on cars for their customers that he didn't get paid for. One was programming a key because the customer lost his as well as finding out what was causing a horrible smell inside the MKX. DH found a dead mouse and a nest in the pollen filter. The salesmen was not happy when DH told him that he was going to clean out the dead mouse/nest and replace the filter without getting paid. The customer didn't feel that he should pay for it so the car was still sitting at the dealership when DH went home.

The other was a customer that forgot what the code was for his key-less entry. DH had to retrieve the original that came from the factory.

Paperwork involves mostly after market warranty companies. Many require forms to be filled out and pictures to document the need for the repair before they will cover it as a claim. This usually requires diagnostic time as well as time to take something apart. If the warranty company refuses to pay they have to put the car back together with the broken part and they don't get paid for any of the time that they spent on the car.

 

[A_Princess'_Daddy]

The examples that I gave were not for self employed mechanics. They are for journeymen at a car dealership.

As a matter of fact, my DH and I were talking about it yesterday. He had 2 salesmen that asked him to work on cars for their customers that he didn't get paid for. One was programming a key because the customer lost his as well as finding out what was causing a horrible smell inside the MKX. DH found a dead mouse and a nest in the pollen filter. The salesmen was not happy when DH told him that he was going to clean out the dead mouse/nest and replace the filter without getting paid. The customer didn't feel that he should pay for it so the car was still sitting at the dealership when DH went home.

The other was a customer that forgot what the code was for his key-less entry. DH had to retrieve the original that came from the factory.

Paperwork involves mostly after market warranty companies. Many require forms to be filled out and pictures to document the need for the repair before they will cover it as a claim. This usually requires diagnostic time as well as time to take something apart. If the warranty company refuses to pay they have to put the car back together with the broken part and they don't get paid for any of the time that they spent on the car.

That absolutely stinks for your husband and completely shocks me, as well. I must confess that I always assumed the mechanics who worked on my car were paid for the hours in their shift and not on a "per case" basis! Is that the norm? It seems deeply unfair to me.

 

[robinb]

That absolutely stinks for your husband and completely shocks me, as well. I must confess that I always assumed the mechanics who worked on my car were paid for the hours in their shift and not on a "per case" basis! Is that the norm? It seems deeply unfair to me.

I too thought that mechanics were paid hourly and not per job. I have to say that I am shocked.

 

[MommyBryn]

My best friends husband is a mechanic paid by the job, too. They definitely feel the "slow" times during the year.

 

[daughtersrus]

That absolutely stinks for your husband and completely shocks me, as well. I must confess that I always assumed the mechanics who worked on my car were paid for the hours in their shift and not on a "per case" basis! Is that the norm? It seems deeply unfair to me.

I too thought that mechanics were paid hourly and not per job. I have to say that I am shocked.

My best friends husband is a mechanic paid by the job, too. They definitely feel the "slow" times during the year.

Journeymen are generally paid by the job. Quick lube, semi-skilled and apprentice are generally paid by the hour. The kicker is that manufacturers have set warranty times so low that the guys are lucky to even break even on the times. Generally speaking, warranty pays about 2/3 of what a customer would pay. Back in the day, if you were good at your job, it was not uncommon to be paid for more than 40 hours. Now, the same guys are only paid 34 (minimum per the contract) although they work 40+ a week.

DH didn't mind staying late to finish up work or get a start on the work for the next day but when you're only going to be paid 34, it stings to have to stay an extra hour to finish up a job.

Most people would also be surprised to know that DH has close to $80,000 of his own tools. So when the porter borrows his screwdriver to put the license plate on and never returns it, DH has to buy a new one. And then they wonder why he only lends out his tools to the other journeymen that he's work with 28+ years.

Hourly pay was one thing that they were really fighting for in their last contract but the dealers association wouldn't budge. This past August, they voted to turn down the contract and strike but the dealers came back with a slightly different offer. They turned down the second offer as well but when they voted to strike the second time, they fell short of the 66% that they needed so it reverted back to accepting the contract.

 

[danygirl]

Add in that mechanics have to spend a fortune on tools which they must constantly update...
And just for fun - DH always said doctors had to be "managed" when they were his customers in the shop - he claims they protested more than anyone about paying for checkout time. He had to remind them that just like they do, he had to run tests to diagnose underlying symptoms and treat the root cause rather than put a bandaid on symptoms.

 

[lauradis]

this is correct-the hospital we've used has specific wording on their billing statements that instructs individuals without insurance to call and if they will pay in full they can receive AT LEAST a 50% discount. when I receive my EOB from my insurance company it shows the billed rate and the contracted rate-it is not 50% lower. a family member with no insurance ran up a bill at his local e/r, they offered to charge him 30 cents on the dollar if he would pay in full (a smaller but still significant reduction if he made payments).

Maybe with the new higher deductibles it would make better $$ since to become cash customer and only use insurance for bigger emergency.

 

[Robbi]

Maybe with the new higher deductibles it would make better $$ since to become cash customer and only use insurance for bigger emergency.

This is what we're going to do.

 

[j's m]

Someone's still not telling the truth:

The White House has said that the cancellations apply only to the 5 percent of Americans who buy insurance on the individual market, not the 80 percent who are covered by their employers.


In NJ all BCBS small employer group plans (2-50 employees) were cancelled. Total individual and small group (all insurance companies) cancelled in NJ exceeds 800,000.

http://usnews.nbcnews.com/_news/201...-glitchy-obamacare-site?lite&ocid=msnhp&pos=1

 

[Eastern]

Not necessarily and not in all cases. In most states NPs can practice independently of doctors (within their permitted scope) and PAs can do many procedures independently as long as there is a physician in proximity, e.g. in the practice. Physicians would still be needed, per my point, but they could focus on more complex cases and the number of physicians focused on routine primary care could be dramatically cut, thereby reducing costs and, I suspect, dramatically increasing patient satisfaction.

This model is already in place in many places, by the way, and working quite well. I haven't seen my primary physician in probably two years and rather have had PAs and a NP handle a couple of sinus infections, an ear infection and a case of strep throat. My primary physician is still there, I have seen him and said hello in passing, but he's focusing on annual physicals, major cases, etc. where his training is needed. Of course this model, if expanded widely, would also impact the near monopoly that physicians seek to have over the medical care system, but if we are to fix the economics of health care, a critical first step is not having somebody with 7+ years of post-undergraduate training handle the most basic of care.

Here's an article that addresses liability issues.

http://www.medscape.com/viewarticle/775746

 

[Eastern]

I'm not surprised that doctors are making less but I bet they are making more than $30/ hour.

Sometimes yes, sometimes no.

It depends on what insurance the patient has, or if they have insurance.

My husband does A LOT of charity care. He treats everyone the same, regardless of ability to pay. Does your husband do that?

 

[Eastern]

This topic is about the ACA.

Yes, so why are people posting things like, "doctors are notoriously bad savers" and "doctors order tests so they can profit".

That type of commentary needs to stay out of this discussion, it's just inflammatory.

 

[Eastern]

Really? My DH has been a mechanic at the same Lincoln dealership for almost 30 years. His salary had decreased every year for the last 3 years. Just because the shop charges $128/ hour doesn't mean that is what the mechanic gets paid. It is FAR less than that. Warranty times have been cut by the manufacturer not to mention all the work that he does and isn't paid for because the service dept "good wills " it for the customer.

I'm not saying they make the same money; the point I am trying to make is that my husband is responsible for the diagnosis and treatment of a human being, and he is sometimes making the same money as a car dealership diagnosing and treating a car.

And I'm sure your DH doesn't get called in at 2am to see a broken down car. Or work on all the major holidays, or pay ridiculous malpractice, etc etc.

 

[A_Princess'_Daddy]

Here's an article that addresses liability issues. http://www.medscape.com/viewarticle/775746

The link isn't working for me (it's requiring me to log in to my account). Can you check the link or copy and paste the content?

 

[Eastern]

I posted earlier that friends of ours who are an electrician and a plumber are making as much money as our friends who are doctors.

All the doctors we know tell their kids to go into business. Our kids are not going into medicine. If it was so rosey for doctors, mine wouldn't be looking to retire early.

 

[Eastern]

Don't bet on it! By the time they pay for their overhead costs, they are grossing a lot less than you think!

Then take into account that they pay 100% of their Social Security tax because they are self-employed, as opposed to having an employer pay half.

And then, they also have to purchase health insurance, usually on the private market, without an employer paying part of their premiums.

And you're not taking into account all of the time spent maintaining the electronic records for patients. Time which is not spent focused on the patient, but time which must be spent either during the exam itself or shortly after the completion of the exam. There is no additional reimbursement for that time yet it takes away from the doctor's ability to see an additional patient or squeeze in that urgent visit that someone needs.

The doctor's situation is no different than any other self-employed person. The same could be said for electricians, plumbers, mechanics and carpenters who work for themselves. However, unlike those other trades, they physician's fees cannot be set by himself. The insurance industry dictates what he gets in exchange for his service.

Well said. Plus many physicians deal in life and death situations.

Thank you.

 

[Eastern]

The link isn't working for me (it's requiring me to log in to my account). Can you check the link or copy and paste the content?

Here's a part of it: "There are currently about 85,000 certified physician assistants across the country, an increase of more than 100% over the past 10 years, according to the American Academy of Physician Assistants (AAPA). PAs can prescribe in all 50 states but must work under the supervision of a doctor.[1]

There are about 155,000 NPs nationwide, up from 111,000 in 2003, according to the American Academy of Nurse Practitioners. The vast majority of NPs work in primary care practices or for clinics and hospitals under a physician's supervision. In 18 states and the District of Columbia, NPs can practice without a physician's direct involvement but may need a formal collaborative arrangement with a doctor.

These allied health professionals earn an average of almost $90,000 a year. State laws vary greatly on what they are permitted to do and the level of supervision required by physicians."

From your post, it seems like you are saying, 'who needs doctors? pas and nps are just as good!'

 

[A_Princess'_Daddy]

Sometimes yes, sometimes no. It depends on what insurance the patient has, or if they have insurance.

How does that jibe with the salary data? We've already established that both professions are doing unpaid labor, yet the median salaries are vastly far apart. I understand your frustration, but the numbers don't back up your thesis on an aggregated basis.

 

[Eastern]

How does that jibe with the salary data? We've already established that both professions are doing unpaid labor, yet the median salaries are vastly far apart. I understand your frustration, but the numbers don't back up your thesis on an aggregated basis.

They should be far apart. I'm not disagreeing with that.

 

[A_Princess'_Daddy]

Here's a part of it: "There are currently about 85,000 certified physician assistants across the country, an increase of more than 100% over the past 10 years, according to the American Academy of Physician Assistants (AAPA). PAs can prescribe in all 50 states but must work under the supervision of a doctor.[1] There are about 155,000 NPs nationwide, up from 111,000 in 2003, according to the American Academy of Nurse Practitioners. The vast majority of NPs work in primary care practices or for clinics and hospitals under a physician's supervision. In 18 states and the District of Columbia, NPs can practice without a physician's direct involvement but may need a formal collaborative arrangement with a doctor. These allied health professionals earn an average of almost $90,000 a year. State laws vary greatly on what they are permitted to do and the level of supervision required by physicians." From your post, it seems like you are saying, 'who needs doctors? pas and nps are just as good!'

That wasn't my premise, so please do not misrepresent what I suggested. In fact, that report seems to support my thesis 100%, as NPs and PAs can augment and compliment the care of physicians, thereby allowing physicians to focus on more complex cases. That may also require adjusting the rules limiting NPs ability to operate, but if rules are outdated they should evolve. If the problems exist, we need to evolve to fix the challenges, so if you disagree with my thesis, what is your proposed solution to control costs and increase quality?