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NYT article about Medicaid

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8 years 3 months ago - 8 years 3 months ago #80512 by southernmd
No - in my opinion that encourages what is already a problem - low reimbursements. I don't think anyone should have to see any percentage. I'm not a huge fan of socialism. I think if people aren't able to see them due to cost - then reimbursements should be higher. Physicians' time needs to be valued. It isn't right now. Plus, I've heard physicians on the phone arguing with Medicaid insurance for their patients to get certain treatment courses, because they hardly approve anything. Medicaid costs way more than just an office visit.

There was a professor who decided one day to teach his class a lesson. He said that everyone would get the average grade of the class for a test. So the first test, the A students brought everyone up, and the F brought everyone down. Everyone got a C. The A students were pissed and said they weren't going to work so hard if they got something so average for all their work. The F students said - well, this isn't bad, I got a C for doing nothing. So the second test, the grades went down to a D. The F students said, well this is still better than nothing, so I'll continue to do nothing. The A students were even angrier, and they did even less next time, because no matter what they did - they didn't get a return on their investment. So the next test - everyone got an F.

Socialism doesn't work. I don't think you can just say - everyone let's just see 20% Medcaid for the good of the people. If you want people to invest in this population, just pay them what it is worth. What's the harm in actually reimbursing someone fairly for their time and effort?

I'm also a libertarian, and apparently we are a minority in this country. Actually, I really should say I'm a Republican that is developing a libertarian problem. LOL.

PS - there are several physicians in the rural town I'm precepting in right now that have gone without a salary this past year, because they see too many Medicaid patients, and they decided to pay their office staff and had to forego paying themselves this year bc they didn't earn enough money.
Last Edit: 8 years 3 months ago by .

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8 years 3 months ago #80514 by Doc201X

southernmd wrote: No - in my opinion that encourages what is already a problem - low reimbursements. I don't think anyone should have to see any percentage. I'm not a huge fan of socialism.


I'm not a fan of socialism either, but I am a huge fan of humanity.

Leaving the poorest/least insured of our population to medically fend for themselves is not only inhumane IMHO, it causes long term financial problems for ALL of us who eventually pick up the tab for people whose relatively small medical problem is now more costly than it would have been to provide adequate care in the first place.

IMHO the biggest problem with medicare/medicaid are NOT the poor people who use it, but the rich folks who sell everything at age 65 to qualify for it. It's the people who can afford their own medical care, yet get all these free services. But no one seems to want to talk about this because it involves folks with money.

I also think along very tough lines (No surprise) when it comes to who should be able to receive medicare/medicaid benefits and insurance benefits in general.

Smokers, those who are significantly overweight, and people with medical issues related to behavior, should either NOT qualify for free or reduced heath care at ALL, at least not until some effort has been made to address their behavior!! They should also have to pay higher insurance premiums, but where is the outcry for folks taking personal responsibility for their own health?

Obviously, somewhere between the Big Mac and the filet mignon from Ruth Chris.

AndI seriously doubt having 20% medicaid/medicare patients adversely affect ANY Physicians bottom line.

My Scientist/Physician Journey
www.Doc201X.blogspot.com

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8 years 3 months ago #80515 by Doc201X
The problem with medicine today as I see is that Docs from earlier generations (perhaps parents/grandparents of many of you) sold out medicine years ago to get to the point where we are today.

Trying to "fix it" now is d*mn near impossible since the cow has long since left the barn.

My Scientist/Physician Journey
www.Doc201X.blogspot.com

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8 years 3 months ago #80517 by tr_
Actually part of the reason reimbursements are so low is *because* there are not enough low-risk people enrolled. Healthy, wealthy people who are unlikely to need much in the way of health care are fattening the rolls of private insurance - and 30+% of their premiums are going to pay the bureaucrat actuaries to figure out ever more sophisticated ways to get more of this type of patient on their rolls, and fewer of the ones who actually need care. This cost would be completely eliminated if we got rid of private insurance.

I'm not sure if the gutted health care plan is going to do much, but I do know that universal enrollment would rather improve Medicare's finances than the reverse.

Note for the libertarians: Private insurance for health care is one of the only enterprises in which the company actually makes *more* money by providing *less* product. The more the company actually reimburses for health care (the service it is supposedly contracted to provide), the *less* well it does as a business. The more it can figure out how to avoid reimbursing, the better it will do (hence the 30% paid to their actuaries).

Free-market principles cannot improve the provision of care under this arrangement.

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8 years 3 months ago #80518 by Doc201X

tr_ wrote: This cost would be completely eliminated if we got rid of private insurance.


Personally, I think "insurance" in general is the biggest farce in the history of history. And the only people I despise more than Attorneys are folks in the insurance "industry". :mad:


My Scientist/Physician Journey
www.Doc201X.blogspot.com

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8 years 3 months ago #80519 by AmmaMD
This is an interesting thread. Obviously a subject that none of us can avoid thinking about in very practical terms, at least eventually. I appreciate hearing the hard numbers from those in their own practice now.

I read "Deadly Spin" the other day - the book by the former insurance exec who decided to resign and oppose the current strategies of the industry. It was fascinating, and I would definitely recommend it to those the medical business who wonder about these issues. For me, at least, it was a different side of the issues than I had had much exposure to.

Finally, to expand briefly on the issue of depression in the ER: while even acute suicidality can sometimes be handled on an outpatient basis by a physician who knows the patient well (and generally who has training in psychiatry), outside this situation there are a lot of good reasons for an acutely depressed patient to go to the ED. The general assessment in such a circumstance would include assessing immediate risk of harm (which, in the ED, can include a more thorough assessment of others' concerns than is often even legal outside an ED setting, since you generally seek to speak to at least a couple other people in the person's life, such as a partner, parent, etc), engaging in safety planning as indicated (which can even include making concrete plans to have X person get Y dangerous materials from someone's living place before they even return home from the ED), and making follow up arrangements (which can include getting people faster follow up appointments than they are able to get not coming from the ED - this of course being an example of a wasteful aspect of the system, but...). Just, you know, as long as the subject came up =).

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