Sorry to hear about what happened to you AFB, but I'm a bit confused about your story. I'm an engineer turned physician who's worked thus far mostly in underserved areas first in Miami and now in the Bronx. I don't understand how Obamacare would negatively affect hospice jobs, as most of my patients who require hospice service is supported by Medicare, and Obamacare expanded such services greatly.
You have to realize also that you're paying for the welfare of many citizens one way or another. Many of my patients use the ED as their primary care clinic, and those expensive ED visits come out of taxpayers' pockets since an ED cannot deny care. Enrolling these patients in Medicaid, which Obamacare incentivizes by federal matching of state Medicaid fund and which the state of NY has taken great advantage of, actually reduces cost as the way Medicaid payment works incentivizes healthcare providers to treat these patients preventively with cheap clinic visits rather than expensive ED visits.
The result is the rise of CMOs which my current health system is adopting in earnest. We essentially become the healthcare guardians of our patients, setting up appointments for them, calling them to remind them to go to appointments, set up transportation, set up home visits, arrange paperwork for medicaid/medicare/etc. application, and all the other things that our poorly educated patients have trouble doing in order to access proper preventive care. All this keep them healthier and help reduce expensive ED visits and hospital admissions, which, again, are paid by tax dollars.
I think the greatest loophole still existing in our system is for people between rich and poor. Many of my patients also have too much assets for Medicaid and they're not willing to give up their house and all their savings in order to qualify, so they end up receiving less care than the bums who never worked a day in their life. This isn't anything specific to Obamacare, however, but it's a long running issue that really bothers a lot of practitioners.
I most certainly have great respect for Drs. and in my five years in Hospice, I have nothing but great respect for the many faithful and fearless medical professionals who serve tirelessly, (they really are tired) and they work very hard.
I worked for VNA/TIP Hospice of Bridgeton, Mo, it was a private hospice, but as you have alluded to most of our patients did receive medicare coverage...I started in Jan 2006 and received a raise before I even started,,, qualified Chaplains were a required part of Hospice Care,,, I was also Bereavement Co-ordinator and Volunteer Co-ordinator. I loved my job, loved my patients and was very well respected and loved by my Co-workers, Nurses, and CNA's who made the world go around.
I also served patients in East St. Louis and the Metro East, many who had nothing, but the Hospice did improve many of their circumstances greatly. Shortly after Obamcare was passed, Medicare guidelines for Hospice were rewritten, drastically cutting fee's paid for services, as I said, we were an NGO, and this gutted many of our services, as we provided our own transportation, supplies, etc, etc,.
Instead of a Chaplain the guidelines were re-written to provide a "spiritual counselor". I wasn't getting rich, but did make about 38,000 per year, so I was getting by.
After those guidelines were re-written our company fired 4 Chaplains in one year, my employer asked me to take a part time position, but as I had twin 13 year old daughter's still at home, I really couldn't do that. So they hired a part-time "Spiritual Counselor" without credentials and a part time Volunteer/Bereavement Coordinator, both of whom they also fired with-in the first month?? LOL
As you have noted, those who game the system and don't work are breaking the back of this country,,Mitt Romney's 47%, and that percentage is higher now, so NO a system with more "USERS" than Payors" as Obamacare still is today, its NOT been repealed as of yet?? is doomed to FAIL! and it is failing, and if Trump is unable to replace it, it will inevitable fail, just as people have been predicting since its inception.
So thank-you for your service as a Dr., I have a friend who was a Navy Pilot flying "Hoovers" off the carrier, but he went back to school and became a Dr., he was a Flight Surgeon on his last deployment during Desert Shield, actually got a little more flying time in the "Hoover"..
He is a "Week-end Warrior" in the ER's of several local hospitals, but very busy.
