Some observers think this is how Obamacare will die: a critical mass of physicians will exit the system -- at the same time the number of insured persons surges -- so that the system collapses when these two freight trains collide.

That also applies to private clinics and hospitals. The dynamic is already well in place; numerous facilities have closed their emergency rooms because uninsured walk-ins (especially illegals) were treating emerg like their family doctor, and the facilities were prevented by law from turning them away.

Here's a good discussion of some of the background.

http://www.wsj.com/articles/SB10001424127887323971204578626151017241898

Providing the federal government will not put you in jail or fine you for seeing this doctor, you may find out that paying out-of-pocket is what you should have done in the first place! The majority of routine medical practices are far less costly than most deductibles.

The code cited is simple confirmation of something I have maintained for over six years: if you are not the one paying, you are a commodity, not a customer, and you do not have a choice as to your treatment plan. In my case, the government's own website shows me that I would pay over $12,000 before I receive a bandage under "Obamacare" if I was not tied to my employment.

Incredibly, there are Facebook groups – and I suppose other groups not on Facebook – who support "Obamacare", and even lie about its effects.

As before, I have the solution…

Good for her. For anything but catastrophically expensive care, I would rather have a physician I pay directly for treatment. Going through the bureaucracy is more trouble that it is worth. I'd keep her as my doctor.

I have to wonder at any set of medical codes that includes something like "Orca strike". Diagnostic codes are supposed to define the disease or injury that requires treatment. An "Orca strike" is not an injury - the codes uses should refer to the lacerations, broken bones, or whatever. Also, the whole purpose of these codes is to standardize and simplify medical coding. With 140,000 codes, the system is far too specific, and is simply a failure.

Anyway, I do have to wonder just where the federal government thinks it has Constitutional authority to mandate how doctor's write bills.

While the "Grandma got run over by a reindeer" is hyperbole (the text really should read "Pedestrian on foot injured in collision with other non-motor vehicle in non-traffic accident, initial encounter"); the gist of what this doctor is saying is true.

The ICD-10 codes are way too much. The examples she has given are NOT for diagnosis; so, what purpose do they serve? Why does the government need that information if some of these codes are not used for dealing with medical care?

Those are, of course, rhetorical questions. The government doesn't need this information; but, the buttinsky bureaucrats think they do. And, you will be penalized if you don't hand over the information.

at the same time the number of insured persons surges

I don't see that happening. The large increases in premiums will cause an ever increasing number of people to head for the exits, and people not currently insured to hesitate before leaping.

Remember, the IRS can not extract any penalties unless you have a refund due to you after you file your taxes. Smart people will simply jigger their withholdings such that they'll owe money.

Radwaste, paying out of pocket while being forced by the government to pay for insurance that covers everything is not something most people will do.

While the "Grandma got run over by a reindeer" is hyperbole

Uh, about that, probably not. Remember, this is the World Health Organization's code list. And in places such as, oh, I dunno, Lapland it is entirely possible to be hit by a reindeer who is not employed as a vehicle.

Such as grandma was out feeding the reindeer when they got spooked and ran her ass over.

I will guess about why ICD-10's are being introduced. There is a utopian idea that very specific codes sill support retrospective studies. Giant computers will compare everything to everything, finding all correlations.

However, when we look for corellations, we find them:
( www dot buzzfeed.com/kjh2110/the-10-most-bizarre-correlations )

And, the resistance has begun.

( http://www.kevinmd.com/blog/2014/08/m-worried-icd-10-heres.html )
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[edited] I am not worrying about ICD-10. Here’s why.. I suspect I will have to memorize a different set of 20 codes. When I see a patient who got injured in a spacecraft explosion, you better believe I am going to use M79.609, “pain in unspecified limb”, unless my bills stop getting paid. And if they do, I will learn incrementally more codes to barely get by. You will never find me looking up one of 68,000 codes, 50 times a day.

I’m pretty sure that most providers out there are going to do the same. Doctors who specialize in rotator cuff surgery will have their most common 20 rotator cuff codes memorized, and will look up other codes occasionally as needed. And the epidemiologists and policymakers who count these things will be left with similar quality data to what they have now: nonspecific-in gives nonspecific-out.
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You're correct, Amy. Most people won't pay out of pocket while paying several thousands of dollars for insurance.

Until they figure out that there is no downside for dropping the insurance and all kinds of upside for paying out of pocket because even with insurance they're essentially paying out of pocket until they hit the magic number that makes the insurance kick in.

And since you can't be denied coverage, if you come up with a catastrophic condition you can always buy insurance.

Obamacare: paying rates similar or greater than your old style coverage and getting catastrophic coverage instead.

You've stated you now have coverage you can't afford to use. What if, instead of paying your premiums, you kept that money and used it for your routine medical care? net gain? net loss? or break even?

Amy,

You are right that people will not pay out of pocket and pay for expensive insurance at the same time. So pay the penalty. A $500 or less annual tax is way less than $12,000 per year with a $6,000 deductible. And as IRA pointed out, if you don't have a refund you don't even have to pay the $500.

As for these codes, it isn't about health care. It is about generating statistics and micromanaging people. This is also part of trying to force doctors to work for hospitals. The government would prefer to manage just a few hospitals than have thousands of individual doctors doing their own thing.

"The examples she has given are NOT for diagnosis; so, what purpose do they serve?"

Insurance companies. Remember, insurance policies pay out based not only on what happened, but on why it happened. Look at the exclusions in your insurance policies sometime. Insurance wants the codes to capture not only the injury but the cause of the injury, so they can use it as an entry filter for whether or not they will pay the claim.

The thing about that is, doctors are perfectly happy to game the systesm. Under ICD-9, every doctor and medical bill processor in the country learned which codes usually got claims paid and which didn't. Most of the time, the distinctions were completely arbitrary from the medical standpoint -- they depended on arcane interpretations of policy wording by insurance lawyers. So doctors didn't have any qualms about stretching any diagnosis to get it to fit in a known "good" code if at all possible. After all, if the insurance companies are going to behave arbitrarily, why should the doctors not do the same? Unlike the insurance companies, doctors have an ethics code that says that, in general, they should not refuse service to anyone who needs it. But, y'know, they like to get paid for their work, same as everyone else. So we have the ICD game. Ultimately it wastes a lot of time and money and serves no purpose.

I would be happy to have just a catastrophic-care policy, and pay for everything else out of my pocket -- it would probably save me money *and* the doctor would make more. But don't forget what Obamacare is actually intended to be -- as the people who thought it up have since said, it was never intended to be anything other than another welfare program. Add in the quasi-welfare cost of all of the new government employees needed to administer it, and the costs of subsidizing the companies who demand it in exchange for their political support for the program, and you face the problem of paying for everything. How to do that? Easy. Capture the system and milk everyone else who isn't of one of the intended benificary classes.

Most people don't know 140,000 WORDS never mind being able to learn that many codes. I doubt if looking them up will help you either. It is insane. It is also clever of the insurance companies--instead of their staff having to figure out what written descriptions mean, they force the doctors/hospitals to do that work.

"It is also clever of the insurance companies--instead of their staff having to figure out what written descriptions mean, they force the doctors/hospitals to do that work."

The funny thing is, while it does create a bunch more work for the doctors and hospitals, the insurance companies will still call the doctors back and ask for additional justification. That's what happened with ICD-9 after the doctors figured out what codes got claims paid, and then the insurance companies figured out what the doctors were doing. I don't see anything about ICD-10 that will make it any different, just even more burdensome.

"Radwaste, paying out of pocket while being forced by the government to pay for insurance that covers everything is not something most people will do."

Sure they will.

It will be the only way they can get treatment - because what they are getting is only a policy.

You'll hear this: "Sick? The clerk is not sick. Fill out this form. Is the form filled out? Then the system is working perfectly. We will call you when it is your turn. No, ma'am, you are not being denied treatment - it's just not available right now..."