Medicare doctors

Not every doctor accepts medicare patients.  Many doctors only accept a few.  The same is true of medicaid patients.  This is because government payments are less than the going rate for their services.  This could become a problem.

The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

via Doctors limit new Medicare patients – USATODAY.com.

We’ve got to cut medical expenses, we keep saying.  That means doctors will get less money.  But what if doctors won’t work for what we want to pay?  Shouldn’t doctors, like other economic players, be able to set the fees the market will allow?  Or should they be forced to serve anyone who comes into their offices?

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • http://RoseFremer@yahoo.com Rose

    Everything is going according to plan. The Left’s plan: Create a meltdown so the public will be desperate for national healthcare. Then ration that care to reduce benefits to the useless old people.
    Encourage trial lawyers in order to keep doctor’s expenses high.
    The game is actually half over already; doctors can’t set rates for the old.

  • http://RoseFremer@yahoo.com Rose

    Everything is going according to plan. The Left’s plan: Create a meltdown so the public will be desperate for national healthcare. Then ration that care to reduce benefits to the useless old people.
    Encourage trial lawyers in order to keep doctor’s expenses high.
    The game is actually half over already; doctors can’t set rates for the old.

  • Meredith Schultz

    Doctors spend 6-10 years (my father spent 11) in training *after* receiving their bachelors degree, racking up tremendous debt, which often exceeds 6 figures. They sacrifice freedom in their twenties and early thirties in order to acquire the mindblowing expertise necessary to coil aneurysms, repair cleft lips, and perform emergency c-sections. And they put their careers on the line every day, knowing that one false move or litigious patient could end their practice. (Malpractice insurance is another gigantic expense for medical practices.)

    In America, we typically reward careers that involve risk and investment. That’s why crab fishermen and entrepreneurs make more than janitors. Actually, come to think of it, pro-athletes and celebrities make more than even the most lucrative medical specialty! Most doctors are not in it for the money, but if we don’t reward their investments, I believe we’ll only end up with fewer well-trained doctors.

    Cuba, for instance, has a surplus of doctors. So much so that they’re sending them to other third world countries on outreach! But they frequently botch their procedures and leave their patients with infections! Good medical care costs money.

    My father’s practice handles medicare cases all the time. It’s awful. The reimbursement is so low, it only pays to keep the lights on at the office and the nurses happy–nothing for the doctor. The same goes for anything done for the local hospital. It’s all charity. The practice primarily pays the bills with elective, out-of-pocket surgeries. And when you look at the sum total on your medical bill, it’s not all going to the doctor. The practice has to make payroll first!

    There are plenty of occupations that make more than the medical profession, yet involve far less training, risk, and necessity to soceity. Let’s not sniff at paying the surgeon who spent 15 years learning how to replant your severed digit. I am the first to agree that there is plenty of waste in the medical profession, but let’s start by looking at the “medi-crats,” pharmaceutical companies, and trial lawyers who make malpractice insurance unaffordable–not the surgeon who just spent 7 straight days on call.

  • Meredith Schultz

    Doctors spend 6-10 years (my father spent 11) in training *after* receiving their bachelors degree, racking up tremendous debt, which often exceeds 6 figures. They sacrifice freedom in their twenties and early thirties in order to acquire the mindblowing expertise necessary to coil aneurysms, repair cleft lips, and perform emergency c-sections. And they put their careers on the line every day, knowing that one false move or litigious patient could end their practice. (Malpractice insurance is another gigantic expense for medical practices.)

    In America, we typically reward careers that involve risk and investment. That’s why crab fishermen and entrepreneurs make more than janitors. Actually, come to think of it, pro-athletes and celebrities make more than even the most lucrative medical specialty! Most doctors are not in it for the money, but if we don’t reward their investments, I believe we’ll only end up with fewer well-trained doctors.

    Cuba, for instance, has a surplus of doctors. So much so that they’re sending them to other third world countries on outreach! But they frequently botch their procedures and leave their patients with infections! Good medical care costs money.

    My father’s practice handles medicare cases all the time. It’s awful. The reimbursement is so low, it only pays to keep the lights on at the office and the nurses happy–nothing for the doctor. The same goes for anything done for the local hospital. It’s all charity. The practice primarily pays the bills with elective, out-of-pocket surgeries. And when you look at the sum total on your medical bill, it’s not all going to the doctor. The practice has to make payroll first!

    There are plenty of occupations that make more than the medical profession, yet involve far less training, risk, and necessity to soceity. Let’s not sniff at paying the surgeon who spent 15 years learning how to replant your severed digit. I am the first to agree that there is plenty of waste in the medical profession, but let’s start by looking at the “medi-crats,” pharmaceutical companies, and trial lawyers who make malpractice insurance unaffordable–not the surgeon who just spent 7 straight days on call.

  • Louis

    Hippocratic oath anyone?

  • Louis

    Hippocratic oath anyone?

  • E-Raj

    Why is health care considered a right? Why is it incumbent on someone else to help me when I’m sick? I’m thankful that there are many good doctors who care for us when we’re sick, but why do people think they have to? When people are forced to do what they don’t want to do, the quality of their work will plummet. Do you want doctors performing operations when they are angry that they have to do them? Not me!

  • E-Raj

    Why is health care considered a right? Why is it incumbent on someone else to help me when I’m sick? I’m thankful that there are many good doctors who care for us when we’re sick, but why do people think they have to? When people are forced to do what they don’t want to do, the quality of their work will plummet. Do you want doctors performing operations when they are angry that they have to do them? Not me!

  • Louis

    Again – Hippocratic Oath, anyone?

    It seems that the only right championed by some is the right to be a greedy bastard.

    This goes for PI lawyers too…..

  • Louis

    Again – Hippocratic Oath, anyone?

    It seems that the only right championed by some is the right to be a greedy bastard.

    This goes for PI lawyers too…..

  • Tom Hering

    Are the most expensive doctors the best doctors? Are the doctors who charge “whatever the market will bear” the best doctors? Acceptance of Medicare patients would be a pretty good standard by which to judge the actual caring involved in the “care” a particular doctor, clinic or hospital offers.

  • Tom Hering

    Are the most expensive doctors the best doctors? Are the doctors who charge “whatever the market will bear” the best doctors? Acceptance of Medicare patients would be a pretty good standard by which to judge the actual caring involved in the “care” a particular doctor, clinic or hospital offers.

  • Joe

    Tom – I really don’t know if that is a good standard or not. I can envision many find doctors who for many reasons don’t accept Medicare or Medicaid or insurance for that matter. There are a number of cash only practices and the imputation that the doctor is somehow less carrying is simply unsupportable as it assumes facts that you don’t know.

  • Joe

    Tom – I really don’t know if that is a good standard or not. I can envision many find doctors who for many reasons don’t accept Medicare or Medicaid or insurance for that matter. There are a number of cash only practices and the imputation that the doctor is somehow less carrying is simply unsupportable as it assumes facts that you don’t know.

  • Tom Hering

    Joe @ 6, it’s at least as good a standard as “I’ll get the best care from a doctor who charges as much he wants.”

  • Tom Hering

    Joe @ 6, it’s at least as good a standard as “I’ll get the best care from a doctor who charges as much he wants.”

  • kerner

    `
    The “market” is largely out of the health care system now. As long as the majority of people expect somebody (the government, their employers, insurance companies, ANYBODY) else to pay for their medical care, the market will not control costs.

    Here’s an idea. Outlaw health insurance for all but truly catastrophic medical care. Then doctors could charge “whatever they want”, but they would have to settle for whatever their patients would be willing and able to pay. The cost of health care would drop like a rock.

  • kerner

    `
    The “market” is largely out of the health care system now. As long as the majority of people expect somebody (the government, their employers, insurance companies, ANYBODY) else to pay for their medical care, the market will not control costs.

    Here’s an idea. Outlaw health insurance for all but truly catastrophic medical care. Then doctors could charge “whatever they want”, but they would have to settle for whatever their patients would be willing and able to pay. The cost of health care would drop like a rock.

  • J

    kerner @8
    What a stupid suggestion.

  • J

    kerner @8
    What a stupid suggestion.

  • Joe

    J @9

    what a stupid response.

  • Joe

    J @9

    what a stupid response.

  • kerner

    Excellent conclusory statement J, but humor me for a second. Why is it stupid? What would happen if the deductable on all health insurance policies were, say, $5,000.00 or more. And why would it be so bad.

  • kerner

    Excellent conclusory statement J, but humor me for a second. Why is it stupid? What would happen if the deductable on all health insurance policies were, say, $5,000.00 or more. And why would it be so bad.

  • MikeR

    I have a high school friend who is now a resident physician. She spent several years in school, is now working long hours for little pay, and when she’s finally done she’ll be hundreds of thousands of dollars in debt. But if she were to charge the going rate for her services, that would make her a “greedy bastard”? And how on earth is not treating someone a violation of the Hippocratic Oath? Should doctors be forced to work until all hours of the night, 7 days a week, for free, lest they violate the Hippocratic Oath by not treating someone?

  • MikeR

    I have a high school friend who is now a resident physician. She spent several years in school, is now working long hours for little pay, and when she’s finally done she’ll be hundreds of thousands of dollars in debt. But if she were to charge the going rate for her services, that would make her a “greedy bastard”? And how on earth is not treating someone a violation of the Hippocratic Oath? Should doctors be forced to work until all hours of the night, 7 days a week, for free, lest they violate the Hippocratic Oath by not treating someone?

  • Louis

    Mike R: There are circumstances, and there are circumstances. Here in SK, the government has had to import many doctors, because we loose our own to the lucrative US market, and to some other provinces in Canada, because of money (mainly). A dr in a major centre in SK (there are exceptions in some remote rural locations, and they have all my sympathy), work 32 hours per week. The average salary, according to a survey done in 2008, is CA$181000 for a GP, and $273500 for a specialist. At those salaries, we were bleeding doctors to the richer areas of this continent. Yes, your friend has a raw deal, because many Dr’s now specialise exclusively on the wealthy (or so it seems, from this article).

    I post here the modern and original forms of the Hippocratic Oath (fromo Wikipedia), and all can ask themselves how far we have strayed from the Spirit of this oath. Remember, medicine is a calling, first and foremost.

    Modern:

    I swear to fulfill, to the best of my ability and judgment, this covenant:
    I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

    I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

    I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

    I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

    I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

    I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

    I will prevent disease whenever I can, for prevention is preferable to cure.

    I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

    If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

    Original:

    I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
    To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

    I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

    I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

    But I will preserve the purity of my life and my arts.

    I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

    In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

    All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

    If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

  • Louis

    Mike R: There are circumstances, and there are circumstances. Here in SK, the government has had to import many doctors, because we loose our own to the lucrative US market, and to some other provinces in Canada, because of money (mainly). A dr in a major centre in SK (there are exceptions in some remote rural locations, and they have all my sympathy), work 32 hours per week. The average salary, according to a survey done in 2008, is CA$181000 for a GP, and $273500 for a specialist. At those salaries, we were bleeding doctors to the richer areas of this continent. Yes, your friend has a raw deal, because many Dr’s now specialise exclusively on the wealthy (or so it seems, from this article).

    I post here the modern and original forms of the Hippocratic Oath (fromo Wikipedia), and all can ask themselves how far we have strayed from the Spirit of this oath. Remember, medicine is a calling, first and foremost.

    Modern:

    I swear to fulfill, to the best of my ability and judgment, this covenant:
    I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

    I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

    I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

    I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

    I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

    I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

    I will prevent disease whenever I can, for prevention is preferable to cure.

    I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

    If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

    Original:

    I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
    To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

    I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

    I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

    But I will preserve the purity of my life and my arts.

    I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

    In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

    All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

    If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

  • Louis

    My last post dissapreared, but here’s the gist:

    IN SK, we’ve had to import a large number of dr’s because we cannot compete with the lucrative markets elsewhere, ESPECIALLY the US. But lets put that into perspective:

    In 2008, the average GP income for SK was CA$181000, and average income for a specialist was CA$273500. What does this say for incomes elsewhere?? And Mike’s friend might be in that position because so many dr’s choose the money above the calling (medicine used to be a calling, right?). Maybe our host should post something about the vocation of a Healer.

    In the meantime, look at the Hippocratic oath, both original and modern (see http://en.wikipedia.org/wiki/Hippocratic_Oath). People love to point out that the original prohibited abortion, and that’s good. But what about the marked antithesis to the mercantile spirit so common today?

  • Louis

    My last post dissapreared, but here’s the gist:

    IN SK, we’ve had to import a large number of dr’s because we cannot compete with the lucrative markets elsewhere, ESPECIALLY the US. But lets put that into perspective:

    In 2008, the average GP income for SK was CA$181000, and average income for a specialist was CA$273500. What does this say for incomes elsewhere?? And Mike’s friend might be in that position because so many dr’s choose the money above the calling (medicine used to be a calling, right?). Maybe our host should post something about the vocation of a Healer.

    In the meantime, look at the Hippocratic oath, both original and modern (see http://en.wikipedia.org/wiki/Hippocratic_Oath). People love to point out that the original prohibited abortion, and that’s good. But what about the marked antithesis to the mercantile spirit so common today?

  • Louis

    And suddenly both appear – apologies!

  • Louis

    And suddenly both appear – apologies!

  • Tom Hering

    No need to apologize, Louis. It happens all the time here. I see comments, that weren’t there before, suddenly show up way back in line – throwing off everyone’s references to comment #s. There’s some very strange software at work.

  • Tom Hering

    No need to apologize, Louis. It happens all the time here. I see comments, that weren’t there before, suddenly show up way back in line – throwing off everyone’s references to comment #s. There’s some very strange software at work.

  • http://lutherama.blogspot.com Dr. Luther in 21st Century

    The other thing that has not been covered is dealing with the Medicare/aid bureaucracy is a major headache. I know many doctors who have a person on staff who’s sole job is to work through the paperwork and bureaucratic fiefdoms or they outsource to an advocacy agency. Either way it is costing them money just to be reimbursed.

    Something hospitals don’t advertise is that they negotiate prices, particularly when dealing with predictable stays say delivering a child. They would rather have somebody pay them cash than have to deal with insurance companies or the government.

  • http://lutherama.blogspot.com Dr. Luther in 21st Century

    The other thing that has not been covered is dealing with the Medicare/aid bureaucracy is a major headache. I know many doctors who have a person on staff who’s sole job is to work through the paperwork and bureaucratic fiefdoms or they outsource to an advocacy agency. Either way it is costing them money just to be reimbursed.

    Something hospitals don’t advertise is that they negotiate prices, particularly when dealing with predictable stays say delivering a child. They would rather have somebody pay them cash than have to deal with insurance companies or the government.

  • http://www.bikebubba.blogspot.com Bike Bubba

    It’s worth noting that in many areas, it’s flat out impossible to find specialists in some areas who will take medicare and Medicaid–and examples I have seen are in Indiana and Michigan, not Kansas or Utah or somewhere where you see “next gasoline 140 miles” and such.

    I’m not quite with Kerner, but I’d suggest that we might do well to equalize the taxation between employer paid insurance and other, as well as creating incentives for major medical insurance instead of comprehensive. You want to drive costs down? Make sure that they watch as nickel and dime issues eat up their deductibles.

  • http://www.bikebubba.blogspot.com Bike Bubba

    It’s worth noting that in many areas, it’s flat out impossible to find specialists in some areas who will take medicare and Medicaid–and examples I have seen are in Indiana and Michigan, not Kansas or Utah or somewhere where you see “next gasoline 140 miles” and such.

    I’m not quite with Kerner, but I’d suggest that we might do well to equalize the taxation between employer paid insurance and other, as well as creating incentives for major medical insurance instead of comprehensive. You want to drive costs down? Make sure that they watch as nickel and dime issues eat up their deductibles.

  • Kandyce

    I was thinking a little about this last night, and I came to the conclusion that I don’t believe healthcare is a right. I believe it is a great privilege of wealth and technology. Do I believe that doctors should withhold the benefits of their privilege of education and technology? No, I don’t, but I also don’t believe that they should be forced to share the benefits of said privilege.
    Of course, I also believe that people should stop treating healthcare like some sort of day spa or consumable. I’m not real big on government or legislation, but I might find favor for restricting advertising privileges for pharmaceuticals.

  • Kandyce

    I was thinking a little about this last night, and I came to the conclusion that I don’t believe healthcare is a right. I believe it is a great privilege of wealth and technology. Do I believe that doctors should withhold the benefits of their privilege of education and technology? No, I don’t, but I also don’t believe that they should be forced to share the benefits of said privilege.
    Of course, I also believe that people should stop treating healthcare like some sort of day spa or consumable. I’m not real big on government or legislation, but I might find favor for restricting advertising privileges for pharmaceuticals.

  • Peter Leavitt

    Kerner is right. The best solution is to allow insurance companies on a national scale to provide catastrophic insurance and for those who so wish to pay for ordinary care directly. This would cause a more competitive market-place along with an incentive for people to live a healthily.

    Obama and those who wish to establish socialized medicine lack the wit to understand that medicine is a service that thrives best with competition. Why else do we find Canadians flocking to doctors and hospitals along the U.S. border.

    Those who view medicine romantically as a public good in the long run find themselves fleeced in the wallet and unable to secure basic health.

    J asserts but hardly proves that Kerner is “stupid” for his view.

  • Peter Leavitt

    Kerner is right. The best solution is to allow insurance companies on a national scale to provide catastrophic insurance and for those who so wish to pay for ordinary care directly. This would cause a more competitive market-place along with an incentive for people to live a healthily.

    Obama and those who wish to establish socialized medicine lack the wit to understand that medicine is a service that thrives best with competition. Why else do we find Canadians flocking to doctors and hospitals along the U.S. border.

    Those who view medicine romantically as a public good in the long run find themselves fleeced in the wallet and unable to secure basic health.

    J asserts but hardly proves that Kerner is “stupid” for his view.

  • Louis

    PL: “Why else do we find Canadians flocking to doctors and hospitals along the U.S. border”

    I have often heard this stated. But I have yet to see any concrete proof. I do know however, that Americans flock across to buy cheap medicine. So maybe it is a mutually beneficial relationship :)

    PS: Please do not quote the case of Premier Danny Williams to me. It has been shown that the surgery could have been dealt with here, easily. DW is, to be as polite as possible, a “colourfull” character…

  • Louis

    PL: “Why else do we find Canadians flocking to doctors and hospitals along the U.S. border”

    I have often heard this stated. But I have yet to see any concrete proof. I do know however, that Americans flock across to buy cheap medicine. So maybe it is a mutually beneficial relationship :)

    PS: Please do not quote the case of Premier Danny Williams to me. It has been shown that the surgery could have been dealt with here, easily. DW is, to be as polite as possible, a “colourfull” character…

  • fws

    “Shouldn’t doctors, like other economic players, be able to set the fees the market will allow? Or should they be forced to serve anyone who comes into their offices?”

    are you saying dr veith that doctors are going to be forced to accept medicare patients?

    this would be news.

  • fws

    “Shouldn’t doctors, like other economic players, be able to set the fees the market will allow? Or should they be forced to serve anyone who comes into their offices?”

    are you saying dr veith that doctors are going to be forced to accept medicare patients?

    this would be news.

  • Paul of Alexandria

    Louise: “Again – Hippocratic Oath, anyone?”
    Again – Oaths don’t pay the office bills. Most doctors treat charity patients who cannot pay, but having the government force them to treat patients and then not reimbursing them properly is unacceptable.

  • Paul of Alexandria

    Louise: “Again – Hippocratic Oath, anyone?”
    Again – Oaths don’t pay the office bills. Most doctors treat charity patients who cannot pay, but having the government force them to treat patients and then not reimbursing them properly is unacceptable.

  • Paul of Alexandria

    kerner: Here’s an idea.
    Actually, that is the only way to fix the system. Health care for the rest of us is more costly precisely because of health insurance and the government programs – somebody has to cover the difference. As several people – including Rush Limbaugh – have noted, most doctors and hospitals offer significant discounts for self-insured patients because of the lack of paperwork load.
    See Professional Dystopia: The ObamaDoc
    The Deadly Tax on Medical Innovation
    The Big Lie of Health Care Reform
    Manufactured Healthcare Crisis
    The Big Problem with Health Care Is Cost, Not Access
    Is the Individual Mandate ‘Severable’ from the Rest of ObamaCare?

  • Paul of Alexandria

    kerner: Here’s an idea.
    Actually, that is the only way to fix the system. Health care for the rest of us is more costly precisely because of health insurance and the government programs – somebody has to cover the difference. As several people – including Rush Limbaugh – have noted, most doctors and hospitals offer significant discounts for self-insured patients because of the lack of paperwork load.
    See Professional Dystopia: The ObamaDoc
    The Deadly Tax on Medical Innovation
    The Big Lie of Health Care Reform
    Manufactured Healthcare Crisis
    The Big Problem with Health Care Is Cost, Not Access
    Is the Individual Mandate ‘Severable’ from the Rest of ObamaCare?

  • Paul of Alexandria

    Louise:
    U.S. hospitals become a magnet
    for Canadian nurses

    Canadians Flee South for Health Care Treatment
    Billboards lure patients south
    Canadians go to U.S. hospitals for care
    Canadians visit U.S. to get health care

    Yes, some of this is paid for via the Canadian health care system, but there’s still the issue of why Canada doesn’t have enough physicians of its own.

  • Paul of Alexandria

    Louise:
    U.S. hospitals become a magnet
    for Canadian nurses

    Canadians Flee South for Health Care Treatment
    Billboards lure patients south
    Canadians go to U.S. hospitals for care
    Canadians visit U.S. to get health care

    Yes, some of this is paid for via the Canadian health care system, but there’s still the issue of why Canada doesn’t have enough physicians of its own.

  • kerner

    At last, a response that was the product of some thought. Thanks, Peter @ 19, for the kind words.

    But I repeat, J, tell me what is wrong with the basic idea.

    If most health care insurance plans had high, or catastrophic, deductables, and we coupled this with tort reform, I believe a number of things would take place.

    First, there would be market forces applied to most ordinary health care for the first time in decades. Non-emergency services would be subject to supply and demand. Tests, like MRI’s, etc, would become competitive, and thus cost less, much like lasik eye surgery and cosmetic surgery and orthodontia. People could still set aside money in a health care savings account, and maybe employers could still help create these. Perhaps accident insurance could still be in use.

    (did you know that medical expense insurance is available through your auto insurance policy for very reasonable rates? Back in the 90′s, when I was between health care insurances, I boosted my med-pay auto insurance to $50k per person per accident, and it only cost about $15.00/month)

    Long ago, the first providers of catastrophic insurance were “fraternal” organizations like Aid Association for Lutherans. People pretty much paid their own ordinary health care expenses, which were largely within their means, and if little Gretchen got run over by the combine or something AAL was there to raise the money for her reconstructive surgery. Hospitals were largely non-profit operations too. That’s why so many hospitals are affiliated with a religion (or even quasi religions, like Shriners’ Hospital in Chicago). Organiations like these could make a comeback.

    And, as Peter says, people would start to pick and choose their health care carefully. There would be no question of “rationing care”, because people would not demand care they didn’t need, because they would have to pay for it.

    50 years ago, when I was a little boy, if I got sick the doctor came to my house to see me. Then he sent my father a bill that my dad could, and did, pay from his pocket. I have read that in small towns at least, it was not unusual for family doctors to have their offices in their homes until the 1960′s. House calls may be impractical today, because much of the equipment necessary to practice modern medicine may be too big to carry around, and because it is probably a waste of the doctor’s time to have to travel from patient to patient. Home offices may no longer be practical because diagnostic labs are now associated with most medical practices.

    But I am convinced that we should try to make the economics of health care resemble the economics which existed 50 years ago as much as we can. I believe the existence of big corporate, or big government, payors is what has driven the costs of health care through roof.

  • kerner

    At last, a response that was the product of some thought. Thanks, Peter @ 19, for the kind words.

    But I repeat, J, tell me what is wrong with the basic idea.

    If most health care insurance plans had high, or catastrophic, deductables, and we coupled this with tort reform, I believe a number of things would take place.

    First, there would be market forces applied to most ordinary health care for the first time in decades. Non-emergency services would be subject to supply and demand. Tests, like MRI’s, etc, would become competitive, and thus cost less, much like lasik eye surgery and cosmetic surgery and orthodontia. People could still set aside money in a health care savings account, and maybe employers could still help create these. Perhaps accident insurance could still be in use.

    (did you know that medical expense insurance is available through your auto insurance policy for very reasonable rates? Back in the 90′s, when I was between health care insurances, I boosted my med-pay auto insurance to $50k per person per accident, and it only cost about $15.00/month)

    Long ago, the first providers of catastrophic insurance were “fraternal” organizations like Aid Association for Lutherans. People pretty much paid their own ordinary health care expenses, which were largely within their means, and if little Gretchen got run over by the combine or something AAL was there to raise the money for her reconstructive surgery. Hospitals were largely non-profit operations too. That’s why so many hospitals are affiliated with a religion (or even quasi religions, like Shriners’ Hospital in Chicago). Organiations like these could make a comeback.

    And, as Peter says, people would start to pick and choose their health care carefully. There would be no question of “rationing care”, because people would not demand care they didn’t need, because they would have to pay for it.

    50 years ago, when I was a little boy, if I got sick the doctor came to my house to see me. Then he sent my father a bill that my dad could, and did, pay from his pocket. I have read that in small towns at least, it was not unusual for family doctors to have their offices in their homes until the 1960′s. House calls may be impractical today, because much of the equipment necessary to practice modern medicine may be too big to carry around, and because it is probably a waste of the doctor’s time to have to travel from patient to patient. Home offices may no longer be practical because diagnostic labs are now associated with most medical practices.

    But I am convinced that we should try to make the economics of health care resemble the economics which existed 50 years ago as much as we can. I believe the existence of big corporate, or big government, payors is what has driven the costs of health care through roof.

  • Paul of Alexandria

    I think that the main point we want to keep in mind is that publicly funded health care always results in rationing. It must, since 1) government medical boards are funded by bureaucrats who set their budgets according to political realities, not medical ones; and 2) people have an essentially infinite appetite for health care services. When people pay for their own, they’re much more careful with what they ask than if they can charge the government (or an insurance company) for it. (Which, BTW, is why insurance companies charge co-pays; not to regain any money, but to encourage people to think a bit about whether they really need the service or not).

  • Paul of Alexandria

    I think that the main point we want to keep in mind is that publicly funded health care always results in rationing. It must, since 1) government medical boards are funded by bureaucrats who set their budgets according to political realities, not medical ones; and 2) people have an essentially infinite appetite for health care services. When people pay for their own, they’re much more careful with what they ask than if they can charge the government (or an insurance company) for it. (Which, BTW, is why insurance companies charge co-pays; not to regain any money, but to encourage people to think a bit about whether they really need the service or not).

  • http://www.toddstadler.com/ tODD

    You know, I don’t understand people who feel compelled to point out that “publicly funded health care always results in rationing”, but seem equally compelled to ignore that privately funded health care also results in rationing, that being because health care is not an infinite resource, and is going to be rationed no matter what idyllic scenario you dream up. Health care is rationed right now, largely based on whether or not you have a good job (either with good benefits and/or that pays you enough to pay the bills). Not everyone has one of those, of course.

  • http://www.toddstadler.com/ tODD

    You know, I don’t understand people who feel compelled to point out that “publicly funded health care always results in rationing”, but seem equally compelled to ignore that privately funded health care also results in rationing, that being because health care is not an infinite resource, and is going to be rationed no matter what idyllic scenario you dream up. Health care is rationed right now, largely based on whether or not you have a good job (either with good benefits and/or that pays you enough to pay the bills). Not everyone has one of those, of course.

  • http://www.scyldingsinthemeadhall.blogspot.com Louis

    Paul, eh, did you read my earlier (repeated too!) comment? It is the $$!

    And todd is quite right. I must also add that in this discussion it is the subtext that is the most interesting. At least Kandyce was quite honest in saying that she finds neither options acceptable (government coercion / dr refusal).

    Btw Paul, it is Louis, not Louise. Major gender difference there.

  • http://www.scyldingsinthemeadhall.blogspot.com Louis

    Paul, eh, did you read my earlier (repeated too!) comment? It is the $$!

    And todd is quite right. I must also add that in this discussion it is the subtext that is the most interesting. At least Kandyce was quite honest in saying that she finds neither options acceptable (government coercion / dr refusal).

    Btw Paul, it is Louis, not Louise. Major gender difference there.

  • MikeR

    Kandyce @20 had some good thoughts. The basic issue, for me, is that health care is the fruit of someone else’s labor, and I don’t think you can ever say that everyone has a “right” to the fruit of the labor of others (see: the tenth commandment).

    Certainly doctors are capable of being greedy, but they “deserve their wages”, just like anyone else. I think it’s wonderful that many, many doctors treat those who cannot pay or for whom the doctor will be poorly reimbursed, but it’s not inherently wrong for a doctor to decide not to treat non-paying patients, or to treat a limited number.

  • MikeR

    Kandyce @20 had some good thoughts. The basic issue, for me, is that health care is the fruit of someone else’s labor, and I don’t think you can ever say that everyone has a “right” to the fruit of the labor of others (see: the tenth commandment).

    Certainly doctors are capable of being greedy, but they “deserve their wages”, just like anyone else. I think it’s wonderful that many, many doctors treat those who cannot pay or for whom the doctor will be poorly reimbursed, but it’s not inherently wrong for a doctor to decide not to treat non-paying patients, or to treat a limited number.

  • MikeR

    Todd @29, Paul said, “when people pay for their own [insurance], they’re much more careful with what they ask.” Sounds to me like he is directly addressing the fact that “privately funded health care also results in rationing.” The point is that individuals rationing their own health care based on what they can afford (the same as for any other good or service) is a much more rational and just basis than rationing by some uninvolved bureaucrat based on God knows what.

  • MikeR

    Todd @29, Paul said, “when people pay for their own [insurance], they’re much more careful with what they ask.” Sounds to me like he is directly addressing the fact that “privately funded health care also results in rationing.” The point is that individuals rationing their own health care based on what they can afford (the same as for any other good or service) is a much more rational and just basis than rationing by some uninvolved bureaucrat based on God knows what.

  • http://facebook.com/mesamike Mike Westfall

    Maybe doctors should unionize, and join the SEIU.

    But then what? Wouldn’t that be like “crossing the beams?” What do you do with a group that is simultaneously downtrodden union worker, AND greedy-bastard health care professional?

  • http://facebook.com/mesamike Mike Westfall

    Maybe doctors should unionize, and join the SEIU.

    But then what? Wouldn’t that be like “crossing the beams?” What do you do with a group that is simultaneously downtrodden union worker, AND greedy-bastard health care professional?

  • kerner

    tODD @ 29:

    You are of course correct to observe that any health care system involves making decisions that can be accurately called rationing. There are three broad catagories I can think of for doing this.

    1. A government provided health care system under which the treatment available to me is determined by government bureaucrat hundreds of miles away,

    2. A private insurance based health care system underwhich the treatment available to me is determined by a profit driven corporate official hundreds of miles away, or

    3. A market based system, under which most non-emergent or non-catastrophic health care is affordable to most people, and the treatment I receive is primarily chosen by me.

    I like option 3 the best because I get to decide what treatments my health care resources are spent on; not some government bureaucrat nor some profit driven corporate official. But such a system would only work if the corporate and government middlemen are largely purged from the system.

    Of course, the indigent would not be able to afford health care at all. In former times the indigent were served by charity hospitals and county hospitals for the poor, and the care they received may have been pretty bare bones service. But I think that putting everyone into government health care brings the majority down more than it raised the indigent up.

  • kerner

    tODD @ 29:

    You are of course correct to observe that any health care system involves making decisions that can be accurately called rationing. There are three broad catagories I can think of for doing this.

    1. A government provided health care system under which the treatment available to me is determined by government bureaucrat hundreds of miles away,

    2. A private insurance based health care system underwhich the treatment available to me is determined by a profit driven corporate official hundreds of miles away, or

    3. A market based system, under which most non-emergent or non-catastrophic health care is affordable to most people, and the treatment I receive is primarily chosen by me.

    I like option 3 the best because I get to decide what treatments my health care resources are spent on; not some government bureaucrat nor some profit driven corporate official. But such a system would only work if the corporate and government middlemen are largely purged from the system.

    Of course, the indigent would not be able to afford health care at all. In former times the indigent were served by charity hospitals and county hospitals for the poor, and the care they received may have been pretty bare bones service. But I think that putting everyone into government health care brings the majority down more than it raised the indigent up.

  • Paul of Alexandria

    MikeR

    Todd @29, Paul said, “when people pay for their own [insurance], they’re much more careful with what they ask.” Sounds to me like he is directly addressing the fact that “privately funded health care also results in rationing.”

    Yes, thank you. Given that human health-care desires (not necessarily needs) are essentially unlimited, and that there is a finite supply of physicians, medicine, and money available, a patient will always need to choose the level of care desired for any particular ailment. This is obviously true no matter who pays for it. Anyone who assumes that just because a health-care maintenance program (a better term, since “insurance” by definition covers only unexpected catastrophic events) is provided by the government that it must therefore cover all desired medical services is only fooling themselves.

    Private medical coverage plans operate according to a contract that specifies what is covered and under what conditions. They must obviously adhere to that contract or else be subject to a lawsuit. While there are good plans and weasels as with any human organization, most of the cases of “rejection” by private plans are actually due to patients asking for coverage that is not included in the contract. Remember, it is also not in the company’s interest to gain a reputation for screwing customers! Of course, with a private plan you can – and should – maintain a separate emergency fund (health-savings-account) in case you run into an eventuality that the plan doesn’t cover.

    With government plans, on the other hand, the bureaucrats make budgetary decisions solely for political purposes and with relatively little care for the medical realities. I’ve read story after story about the English system, with women delivering babies in hallways, people dieing because lifesaving surgeries were backlogged for years, and doctors shutting their offices in patients faces because they are only paid for X patients per day and no more. In most European countries, any sensible citizen who can afford it purchases supplemental coverage on top of their government-provided health care so that he/she can go to a private doctor when the national system is inadequate.

  • Paul of Alexandria

    MikeR

    Todd @29, Paul said, “when people pay for their own [insurance], they’re much more careful with what they ask.” Sounds to me like he is directly addressing the fact that “privately funded health care also results in rationing.”

    Yes, thank you. Given that human health-care desires (not necessarily needs) are essentially unlimited, and that there is a finite supply of physicians, medicine, and money available, a patient will always need to choose the level of care desired for any particular ailment. This is obviously true no matter who pays for it. Anyone who assumes that just because a health-care maintenance program (a better term, since “insurance” by definition covers only unexpected catastrophic events) is provided by the government that it must therefore cover all desired medical services is only fooling themselves.

    Private medical coverage plans operate according to a contract that specifies what is covered and under what conditions. They must obviously adhere to that contract or else be subject to a lawsuit. While there are good plans and weasels as with any human organization, most of the cases of “rejection” by private plans are actually due to patients asking for coverage that is not included in the contract. Remember, it is also not in the company’s interest to gain a reputation for screwing customers! Of course, with a private plan you can – and should – maintain a separate emergency fund (health-savings-account) in case you run into an eventuality that the plan doesn’t cover.

    With government plans, on the other hand, the bureaucrats make budgetary decisions solely for political purposes and with relatively little care for the medical realities. I’ve read story after story about the English system, with women delivering babies in hallways, people dieing because lifesaving surgeries were backlogged for years, and doctors shutting their offices in patients faces because they are only paid for X patients per day and no more. In most European countries, any sensible citizen who can afford it purchases supplemental coverage on top of their government-provided health care so that he/she can go to a private doctor when the national system is inadequate.

  • Paul of Alexandria

    kerner:
    I like option 3 the best because I get to decide what treatments my health care resources are spent on; not some government bureaucrat nor some profit driven corporate official.

    Yes, but be careful here: First, make the differentiation between “medical coverage plans” and “health insurance”. True health insurance, like auto, life, and homeowners, covers only unlikely catastrophic events such as long-term hospitalization or cancer treatments. Medical coverage plans cover all medical costs and actually just spread your health-care costs over your own salary over time. Most “health insurance” in the US is really medical coverage. I would recommend catastrophic health insurance for everybody simply because the costs for high-end medical treatment can be so high. On the other hand, you are correct with what you say about medical coverage; I would rather cover my own costs, preferably with the help of a tax-free or tax deferred medical savings plan which could be carried over year-to-year.

  • Paul of Alexandria

    kerner:
    I like option 3 the best because I get to decide what treatments my health care resources are spent on; not some government bureaucrat nor some profit driven corporate official.

    Yes, but be careful here: First, make the differentiation between “medical coverage plans” and “health insurance”. True health insurance, like auto, life, and homeowners, covers only unlikely catastrophic events such as long-term hospitalization or cancer treatments. Medical coverage plans cover all medical costs and actually just spread your health-care costs over your own salary over time. Most “health insurance” in the US is really medical coverage. I would recommend catastrophic health insurance for everybody simply because the costs for high-end medical treatment can be so high. On the other hand, you are correct with what you say about medical coverage; I would rather cover my own costs, preferably with the help of a tax-free or tax deferred medical savings plan which could be carried over year-to-year.

  • Paul of Alexandria

    There’s actually another aspect to this which most people miss. The current US medical insurance scheme – where coverage is primarily provided through employers and is not transferable – was intentionally designed in the 1930′s to keep workers tied to their jobs. Many “uninsured” people are actually that way because they lost or left one job and its associated coverage and either haven’t yet or couldn’t qualify for coverage at their new employer (this is where most of the “preexisting conditions” problems stem from).

    We could solve a rather large number of problems in this country by simply removing health coverage from the realm of the employer, having people pay for it directly, and allowing the coverage providers to operate across all states in the same way as any other insurance provider.

  • Paul of Alexandria

    There’s actually another aspect to this which most people miss. The current US medical insurance scheme – where coverage is primarily provided through employers and is not transferable – was intentionally designed in the 1930′s to keep workers tied to their jobs. Many “uninsured” people are actually that way because they lost or left one job and its associated coverage and either haven’t yet or couldn’t qualify for coverage at their new employer (this is where most of the “preexisting conditions” problems stem from).

    We could solve a rather large number of problems in this country by simply removing health coverage from the realm of the employer, having people pay for it directly, and allowing the coverage providers to operate across all states in the same way as any other insurance provider.

  • Paul of Alexandria

    MikeR
    I think it’s wonderful that many, many doctors treat those who cannot pay or for whom the doctor will be poorly reimbursed, but it’s not inherently wrong for a doctor to decide not to treat non-paying patients, or to treat a limited number.

    Just about every doctor I know of takes charity patients, most hospitals will also (not to mention the hospitals like the Shriner’s that are specifically charity hospitals), and most large drug companies will provide cancer or other expensive treatments at little or no charge to needy cases. Now doctors can afford to do this because the other patients pay their proper fees. When Medicare/Medicaid stiffs a doctor and only pays for the office lights (as mentioned above) it not only hurts the doctor, it cuts into the charity work that he/she can afford to give!

  • Paul of Alexandria

    MikeR
    I think it’s wonderful that many, many doctors treat those who cannot pay or for whom the doctor will be poorly reimbursed, but it’s not inherently wrong for a doctor to decide not to treat non-paying patients, or to treat a limited number.

    Just about every doctor I know of takes charity patients, most hospitals will also (not to mention the hospitals like the Shriner’s that are specifically charity hospitals), and most large drug companies will provide cancer or other expensive treatments at little or no charge to needy cases. Now doctors can afford to do this because the other patients pay their proper fees. When Medicare/Medicaid stiffs a doctor and only pays for the office lights (as mentioned above) it not only hurts the doctor, it cuts into the charity work that he/she can afford to give!


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