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NYT article about Medicaid

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8 years 3 months ago #80521 by residentmom
My main issue with insurance is exactly what tr pointed out... the companies only make money by denying care. Ergo, I get to spend my life on the phone justifying the studies I want to some idiot with (at best) an undergrad degree in telephone answering who can read protocols. Meanwhile, the CEOs of the insurance companies are some of the best-reimubursed people on the planet, in the multi multi million dollar range. If a CEO took just a measly 1 million dollar paycut (less than 10% for most of them!) imagine how many more people we could insure. So yes, I agree that the insurance industry is broken. I just don't think the government is capable of doing any better... considering their awesome track record and all. :)
The problem with entitlements is that they create entitled people, who feel they "deserve" everything given to them. I do believe that medicaid patients should receive quality healthcare, but it really irritates me to have a medicaid patient roll in carrying a Coach purse, with a brand new manicure, and carrying a smart phone on which they are complaining about their premium cable and the cost of cigarettes. That is insanity. As a group, medicaid patients take more time and more resources than an age-matched privately insured population, in my experience, and I do think it is mainly due to the entitlement issue. (Certainly I realize this is not EVERYONE, but it is a group characteristic.)

ResidentMom<br /><br />"If you bungle raising your children, I don't think whatever else you do well matters very much." --Jackie O.

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8 years 3 months ago #80522 by Doc201X
So does this indignation apply to Medicare patients too? Because if it doesn't that's grossly hypocritical.

We could also get some reimbursement of the Medicare program for those Docs who didn't or are no longer practicing for any good reason. :cool:

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

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8 years 3 months ago #80525 by southernmd
The reimbursements are different for Medicare and Medicaid, but both are way below actual cost to the physician.

Second, I don't have a problem treating those who need the care. I think we should. I have a problem with someone like the government telling me what I have to do, though. I think physicians should reserve the right to decide who to treat. We should have some say in that decision-making. It would be our practice, after all. Our business.

It's a principle of the thing - not necessarily how I'd act.

I'd see the Medicaid/Medicare populations if it were me, but I'd do like many do and limit the percentage so I'd be able to pay my staff etc. If we are going to keep government programs, the government has to pay what the visits are worth.

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8 years 3 months ago #80529 by residentmom
Medicare payments in most states are much better than medicaid. Also Medicare patients have at least a partial responsibility for their own costs, which I think even in small amounts will contributes to personal responsibility. (I used to see this one family every. single. week. For trivial things, just because "it's free!") TriCare is between the 2, although I feel a moral obligation exists to provide healthcare to our military who are willing to risk their lives for their country. Realistically, none of that matters, since I have no control over what programs are or are not accepted by my employer. :)

ResidentMom<br /><br />"If you bungle raising your children, I don't think whatever else you do well matters very much." --Jackie O.

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8 years 3 months ago #80540 by SW to MD
I truly place a lot of blame for our current health care system on insurance companies.
(What? Your daughter's physician *witnessed* her severe sleep apnea? I'm sorry (in snotty, half-laughing voice) but we have ten business days by contract to review the prior auth for home CPAP before making a decision.

Oh, wait. You say you will take her to the ER every time you are concerned about her breathing? (Confusion in voice, deep breath, pause.) Hold, please.

Ma'am? You can go pick up that CPAP immediately, no copay.)

Personally, I do not think any health insurance company should be allowed to be for-profit. If you look up the profit margins for the insurance companies, it is sickening- if companies took 1% of their profits and put it towards care for our poor/disabled, things would look much different.

I know there are Medicaid patients out there who fit the stereotypes, but there are also those who, say, lost their jobs and had that smart phone/Coach purse prior. Then there are those who have a legitimate disability and are covered by Medicaid/Medicare.

Totally agree that there should be copays, no matter how small, to reinforce the idea that there is a cost for medical care, whether the patient sees it or not. As a side note, I know that at least in the state we are in, no EOBs are ever sent to patients- they have to be requested (!), so unless extremely proactive, patients have no idea how much the services they are using actually cost.

The ultimate measure of a man is not where he stands in moments of comfort but where he stands at times of challenge and controversy - MLKJ

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8 years 3 months ago - 8 years 3 months ago #80562 by megboo

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 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.


Hooray for libertarians! I consider myself a conservative libertarian, because I'm fiscally conservative, and socially moderate, so that puts me more on the conservative side.

But I definitely identify more with the Libertarian party than the Republican party, especially once I became a small business owner.

And another problem I see, besides what you listed about gov't, is that the more a gov't regulates a business, the more the business will be creative, for better or worse, about their business. With respect to insurance companies, most are for-profit and have to cut as many corners as possible to meet the bottom line.

I'm a free-market gal, so I don't besmirch CEO salaries in the face of a good business. But when the business is shady with exorbitant CEO salaries, that tells me the business is either not on the up and up, or in bed with the gov't. Or both (see Goldman-Sachs, AIG, GM, etc). More regulations limit competition, and competition keeps prices lower and customer service better. Government, as we've seen time and time and time again, does not make a better product than the private sector, health insurance included.

"Some of it's magic and some of it's tragic but I had a good life all the way."<br />- He Went to Paris by Jimmy Buffett
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