Socialized medicine

[ERCougar]

I can see a lot of the benefits of socialized medicine. My chief concern is selfish but real--doctors will lose any sort of bargaining position. Pres Bush is about to veto a bill passed to temporarily fix a funding glitch in Medicare that cuts payments by 10%. We have to fight this every year, it comes down to the wire every year, and the only reason Congress listens is that doctors threaten to stop taking Medicare patients. Most doctors can threaten to do this because they have plenty of privately insured patients. If we switch to a one-payer system, doctors no longer have any leverage to prevent this kind of cut. Realize that once overhead is taken into account, a 10% cut in payment leads to about a 20% cut in income. Couple that with a 20% absolute tax raise (50% relative raise) that I've already discussed, and I'm not really excited about a one-payer system.

[MikeWaters]

Originally Posted by ERCougar

I can see a lot of the benefits of socialized medicine. My chief concern is selfish but real--doctors will lose any sort of bargaining position. Pres Bush is about to veto a bill passed to temporarily fix a funding glitch in Medicare that cuts payments by 10%. We have to fight this every year, it comes down to the wire every year, and the only reason Congress listens is that doctors threaten to stop taking Medicare patients. Most doctors can threaten to do this because they have plenty of privately insured patients. If we switch to a one-payer system, doctors no longer have any leverage to prevent this kind of cut. Realize that once overhead is taken into account, a 10% cut in payment leads to about a 20% cut in income. Couple that with a 20% absolute tax raise (50% relative raise) that I've already discussed, and I'm not really excited about a one-payer system.

again: all my friends who are psychiatrists only take cash, no insurance.

won't affect them at all. In fact, everyone having mental healthcare coverage would be a boon to psychiatry. It would be huge.

[SeattleUte]

Originally Posted by MikeWaters

again: all my friends who are psychiatrists only take cash, no insurance.

won't affect them at all. In fact, everyone having mental healthcare coverage would be a boon to psychiatry. It would be huge.

This tells me that much like cosmetic plastic surgery only the very rich see shrinks and shrinks are rolling in money. Physicians who deign to work for insurance companies get paid less because their fees are steeply discounted and partly becuase they have to accept medicare and medicaid patients as part of the deal.

[MikeWaters]

Originally Posted by SeattleUte

This tells me that much like cosmetic plastic surgery only the very rich see shrinks and shrinks are rolling in money. Physicians who deign to work for insurance companies get paid less because their fees are steeply discounted and partly becuase they have to accept medicare and medicaid patients as part of the deal.

shrinks are definitely not rolling in money. it is one of the lowest paid specialties. It's probably slightly above family medicine and pediatrics. Maybe even with them as the lowest.

[ERCougar]

Originally Posted by MikeWaters

again: all my friends who are psychiatrists only take cash, no insurance.

won't affect them at all. In fact, everyone having mental healthcare coverage would be a boon to psychiatry. It would be huge.

It would probably help my field as well, as we have to see about the highest number of uninsured (and unpaying) patients of any of the specialties. However, specialty coverage will be even worse. If people think it's hard to get into a specialist now, wait until you cut their payments (and raise their taxes). Call coverage is going to be really bad, particularly if there is no accompanying malpractice reform--orthopedic surgeons and neurosurgeons already won't take call because of the liability from trauma victims. There was a front page article in the ACEP (American College of Emergency Physicians) newsletter about ERs in Canada having to shut their doors for two days out of each week because of lack of coverage. This has never happened before and presents a real danger to public safety.

I wouldn't necessarily count on mental healthcare being adequately covered either. I wouldn't be suprised at all if psychiatry remains cash only if you're not reimbursed adequately.

[CardiacCoug]

Originally Posted by ERCougar

I can see a lot of the benefits of socialized medicine. My chief concern is selfish but real--doctors will lose any sort of bargaining position. Pres Bush is about to veto a bill passed to temporarily fix a funding glitch in Medicare that cuts payments by 10%. We have to fight this every year, it comes down to the wire every year, and the only reason Congress listens is that doctors threaten to stop taking Medicare patients. Most doctors can threaten to do this because they have plenty of privately insured patients. If we switch to a one-payer system, doctors no longer have any leverage to prevent this kind of cut. Realize that once overhead is taken into account, a 10% cut in payment leads to about a 20% cut in income. Couple that with a 20% absolute tax raise (50% relative raise) that I've already discussed, and I'm not really excited about a one-payer system.

One of the largest multi-specialty clinics in Houston recently stopped taking Medicare patients. I think it's going to become more and more common to not accept Medicare patients or at least to limit your patient panel to no more than a certain percentage of Medicare patients.

I've said this before, but doctors are the only profession that lets other people decide how much they will pay them for their services (at least with regard to insured patients). Given that, it's no surprise if physician reimbursement continues to decline even in the setting of inflation in the rest of the economy. If we could decide ourselves how much to pay our auto mechanics for their services, we would be paying them less, too.

[MikeWaters]

Originally Posted by CardiacCoug

I've said this before, but doctors are the only profession that lets other people decide how much they will pay them for their services (at least with regard to insured patients). Given that, it's no surprise if physician reimbursement continues to decline even in the setting of inflation in the rest of the economy. If we could decide ourselves how much to pay our auto mechanics for their services, we would be paying them less, too.

that's just plain false.

[CardiacCoug]

Originally Posted by MikeWaters

that's just plain false.

Explain, please. CMS and insurance companies decide how much they are willing to pay for physician services. Most doctors get paid mainly by CMS and insurance companies.

What other profession has a similar arrangement with their "customers"? I would love to know since I will be able to decide how much to pay them when I need their services and/or expertise. Are there any lawyers that do business that way?

By the way, looks like the Bush veto was overridden.

[MikeWaters]

Originally Posted by CardiacCoug

Explain, please. CMS and insurance companies decide how much they are willing to pay for physician services. Most doctors get paid mainly by CMS and insurance companies.

What other profession has a similar arrangement with their "customers"? I would love to know since I will be able to decide how much to pay them when I need their services and/or expertise. Are there any lawyers that do business that way?

By the way, looks like the Bush veto was overridden.

your group can refuse to be impaneled with an insurance company because you can't negotiate satisfactory rates.

Specialty groups that have a geographic monopoly can charge huge amounts.

[CardiacCoug]

Originally Posted by MikeWaters

your group can refuse to be impaneled with an insurance company because you can't negotiate satisfactory rates.

Specialty groups that have a geographic monopoly can charge huge amounts.

True, there is some semblance of a free market in that regard and doctors will continue to refuse Medicare patients and those with bad insurance.

I think we're eventually headed toward a formal two-tiered health care system in this country. Maybe 30-40% of people will pay for private insurance while everybody else stands in line for the few remaining doctors in major metropolitan areas (like university programs with residents) that will still accept government insurance.