× Debates, Issues & Talk

NYT article about Medicaid

More
8 years 2 months ago #80607 by tr_

Government, as we've seen time and time and time again, does not make a better product than the private sector, health insurance included.


Gosh, it's difficult to imagine a worse product than the current private insurance system (wasted resources, nonprovision of care, nonpayment for care, care decisions delegated to bureaucrats over physicians, etc.). Almost anything would be better. I'd for sure take any of the major nationalized health systems over what we have.

Maybe if we went completely free-market, fee-for-service for health care then market forces could improve the product. But not with the insurance model. Insurance has to go hand-in-hand with universal enrollment. Otherwise you just have a mess, which is what we have now.

Please Log in or Create an account to join the conversation.

More
8 years 2 months ago - 8 years 2 months ago #80610 by megboo

tr_ wrote:
Gosh, it's difficult to imagine a worse product than the current medicare/medicaid[/u] system (wasted resources, nonprovision of care, nonpayment for care, care decisions delegated to bureaucrats over physicians, etc.). Almost anything would be better.


See how such awful systems are interchangeable? Yet the medicare/medicaid system predates our current insurance debacles thanks to Johnson. It wasn't until a decade later that HMOs really caught on and another decade later until we started seeing what you're complaining about.

Maybe if we went completely free-market, fee-for-service for health care then market forces could improve the product. But not with the insurance model. Insurance has to go hand-in-hand with universal enrollment. Otherwise you just have a mess, which is what we have now.


There's really no "maybe" about it. The insurance business sucks on our end mostly because of the massive regulations that keep good competition from lowering prices and providing better product.

Not to mention, I believe it's unethical to force other people pay for my healthcare.

"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
Last Edit: 8 years 2 months ago by .

Please Log in or Create an account to join the conversation.

More
8 years 2 months ago #80637 by rydys
My practice is about 80% public assistance (medicaid and government subsidized programs). The reimbursements for medicaid are abysmal, not enough to cover my expenses. I recently asked one HMO, with whom I have 1500 patients and have never had an increase in the 6 years I have been with them, for a raise. I was offered a 0.5% increase. It was an insult.

There are many issues with the system, a major one of which is no accountability on the part of the patient. The nature of people is to value what they put effort into. When health care is free, it has no value. I routinely have patients requesting referrals to specialists or expensive tests or medications because it doesn't cost them anything (yes, they will tell me this directly). Many OTC meds are covered, so they want prescriptions for all of them "to have at home, just in case". They come into the office for minutia like a runny nose, sometimes 3-4 times in a week. For some it seems like a social visit, they are bored at home so come up with some reason to come in, just to pass the time.

While I am generalizing about my public assistance population, I do not see these behaviors nearly as often with those who pay for their insurance. They seem to understand the concept of the expense of medicine and the need to keep costs down. They are much more willing to allow me to treat their children, rather than demand specialists and will defer to my judgement rather than push for extra testing "just to be sure". I am sure that this has something to do with the fact that they have to pay for the visits and tests.

I also have many more insurance issues with the PA patients. They do not pay attention to the paperwork for maintaining their coverage, and are regularly terminated. Then they balk at my nerve in asking them to pay for the visit as if I am the "bad guy" denying care to their child. It is amazing how a patient who will be brought in two or three times a week with "urgent" issues can suddenly be fine for several months when asked to pay for the visits.

I do not discriminate in how I treat my patients. As a matter of fact, the only time I look at their insurance is once I decide to prescribe a medication or make a referral, and then only to be sure I do so within the rules of their insurance coverage. I also see many patients for free, because I cannot bring myself to turn them away just because their parents did not file the paperwork in a timely fashion.

The current system is broken and being destroyed at the core. Pay for performance is not fair when I have no control over whether my patients listen to my advice or not. Medicaid reimbursement is already low (peds more than others--I get paid less for the same E&M codes than the internist next door) and being cut further. The cost is rising due to CYA testing and treatment driven by frivolous lawsuits. The cost of medical insurance is going up, the CEOs are making a fortune, and the reimbursements and therefore level of care are going down.

I understand why doctors would discriminate against medicaid patients--They want a good financial return on the money, time and effort they put in to becoming the professionals that they are.

As for myself, I cannot bring myself to do it. To me, a person is a person and I will not look at their insurance status to determine how I will care for them. I do pay the price by working harder and longer than the other MDs in my area, and my income is far below theirs (does not even always cover my bills). Why do I do it? Because this is my passion and I believe that I am making a difference in peoples lives and that makes it worthwhile.

I just hope and pray that I can keep this up and not be forced by the government to change.

Please Log in or Create an account to join the conversation.

More
8 years 2 months ago #80661 by tr_

megboo wrote: See how such awful systems are interchangeable?


No, they aren't. In particular, Medicare has an administrative overhead of something like 2-5%, compared to the whopping 20-30% seen in the private insurance industry. This is because Medicare doesn't expend time, effort, and money trying to figure out how not to pay claims. It just pays the claim. Granted, it doesn't pay *enough* of the claim, but again, this is related to the fact that it carries the bulk of the high-cost patients while private insurance companies cherry-pick the cheap ones.

There's really no "maybe" about it. The insurance business sucks on our end mostly because of the massive regulations that keep good competition from lowering prices and providing better product.


No, the insurance business sucks because insurance is inherently a stupid way to handle a service that is needed by everyone. Insurance is based on risk pooling. It makes sense for fires and natural disasters. It does not make sense for health care.

An unregulated insurance industry would simply go even farther in the current direction of improving profits by reducing product quality (i.e., refusing to insure the ill, and refusing to pay legitimate claims).

Please Log in or Create an account to join the conversation.

More
8 years 2 months ago #80665 by Doc201X

tr_ wrote: It just pays the claim. Granted, it doesn't pay *enough* of the claim, but again, this is related to the fact that it carries the bulk of the high-cost patients while private insurance companies cherry-pick the cheap ones.


Opps!! This point actually has me thinking about how it seems that among Mommd Docs, there aren't too many "Rydys" or Hospitalist around.

And if that's true, then maybe your point is the reason why.

And if that's true, I don't have one ounce of sympathy towards Docs who cherry pick their patient populations. As I see it, this entire mess is likely the fault of cherry picking Docs who sold out for the big bucks to for/work with the insurance company to create this mess in the first place. :mad:

tr_ wrote: An unregulated insurance industry would simply go even farther in the current direction of improving profits by reducing product quality (i.e., refusing to insure the ill, and refusing to pay legitimate claims).


Insurance companies are already doing this. I always have to send paperwork at least twice to get a legitimate claim paid! :mad: :mad:

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

Please Log in or Create an account to join the conversation.

More
8 years 2 months ago #80667 by Doc201X

rydys wrote: My practice is about 80% public assistance (medicaid and government subsidized programs). The reimbursements for medicaid are abysmal, not enough to cover my expenses. I recently asked one HMO, with whom I have 1500 patients and have never had an increase in the 6 years I have been with them, for a raise. I was offered a 0.5% increase. It was an insult.....................................................................................................................
I just hope and pray that I can keep this up and not be forced by the government to change.


Bravo to you Rydys and to Hospitalist too!

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

Please Log in or Create an account to join the conversation.

Moderators: TexasRoseMTaylorefex101
Time to create page: 0.244 seconds
Find us on Facebook!
Find us on Twitter!
Find us on Pinterest!