Skip to main content

View Diary: What I Keep Not Hearing About Medicare (182 comments)

Comment Preferences

  •  KSLV - we need to build a surplus of primary care (4+ / 0-)
    Recommended by:
    fayea, mudfud27, Actuary4Change, NWTerriD


    clinicians first. We have a severe shortage of primary care physicians and it will get worse and more people acquire health insurance. I just read an article in a medical journal with just with the advent of the ACA half the primary care physicians won't take new Medicare patients (25% have no Medicare patients) and a shocking number are reducing hours or planning to transition to a concierge practice by 2014 just as new patients come to into the system. If we tried to impost a NHS on physicians today 75% of those over 60 would retire and we have no one to take their place. It takes ten to twelve years post college to train physicians and five years post college to train nurse practitioners and at present they pay those costs themselves. If we want to drive down healthcare costs we need to dramatically increase the number of medical school students and graduate level nurses and change the economics for them.

    Even in the UK there is now a parallel private pay market and the US medical societies are a strong opponent of any NHS type program.  Moving to a Canadian style single payer is the next likely step and like Canada it may start in the states. It would actually be good to have a few states try it and see what works so that a national program could learn from their mistakes.

    "let's talk about that"

    by VClib on Fri Oct 12, 2012 at 04:35:25 PM PDT

    [ Parent ]

    •  Excellent point (5+ / 0-)
      Recommended by:
      VClib, kurt, Actuary4Change, NWTerriD, marina

      I'm a specialist (and we take Medicare) but can easily see how primary care docs have to limit their care of Medicare patients. Reimbursement is so poor that many physicians actually lose money on them.

      Look, if I wanted to get rich I'd have become a banker but that's crazy...

      Squeezing providers for reimbursement has its limits, and there are plenty of people who are, as you correctly point out, getting out of the primary care business altogether in part because they can't afford it.

      A better plan would be to increase reimbursement rates and look for savings elsewhere, such as on pharmaceuticals , imaging, and devices. We need to encourage primary care but instead we're doing the opposite.

      •  mudfud - my primary care physician (1+ / 0-)
        Recommended by:
        Actuary4Change

        stopped taking new Medicare patients five years ago. He does, thankfully, keep his long term patients as they turn 65. Because I am also in the life science business, but not as a clinician or payer, we have very candid conversations about practice economics and technologies. I believe him when he tells me that, even on a marginal cost basis, he loses money on Medicare. Fortunately for me he is not only one of the premier internal medicine diagnosticians in my area, and primary care physician to many other doctors, but feels a real sense of obligation to his aging patient population and continues to see me. I am very lucky.

        "let's talk about that"

        by VClib on Fri Oct 12, 2012 at 06:40:38 PM PDT

        [ Parent ]

    •  An NHS would encourage primary care (2+ / 0-)
      Recommended by:
      Actuary4Change, NWTerriD

      The idea of NHS would be to put the doctors on salary, not on fee-for-service.  Then the disparity between underpaid primaries and overpaid specialists could be reduced.  It's service-based insurance reimbursements that encourage the current mess.

      The US used to have a lot more public care than now.  Before WW II made insurance common, many cities and states had public hospitals offering free care.  That's pretty much gone now, replaced by emergency room unreimbursed care, and by some community health centers (expanded by the ACA) that take insurance but also serve the uninsured.

      •  KSLV - most physicians don't want to be on salary (1+ / 0-)
        Recommended by:
        Actuary4Change

        or have a boss who tells them what hours they have to work. Those that do work for Kaiser, or other similar groups, and there is nothing wrong with that at all. However, most US physicians like being economically independent and have no interest in being a US government employee earning US government employee compensation.  

        "let's talk about that"

        by VClib on Fri Oct 12, 2012 at 07:02:28 PM PDT

        [ Parent ]

        •  May be changing (0+ / 0-)

          Kaiser Permanente has about ten applicants for every opening, at least in NorCal. So that means there are 9 physicians who would like to be in a large group practice for every one who gets a spot in KP.

          •  MP - the 9:1 number is misleading (0+ / 0-)

            I know the Kaiser people well. Every time a physician applies for an available job they are counted as a new applicant, even if the same person has applied 25 times. That being said Kaiser is attracting top flight physicians, particularly young doctors who don't want to take the risks of private practice. Kaiser is the future healthcare model, they actually make more money if they keep you well or they can take care of you on the Internet or by phone. Every time you don't come to see them saves them money, which is the opposite of the fee for service model. The Kaiser physicians have their own corporation who provide services to Kaiser facilities. This structure gives them more autonomy than one might think.

            There is no doubt that healthcare delivery is consolidating. My primary care physician, a top internal medicine practitioner, recently joined one of the mega groups in the SF area. He is in his early 50s, has a full practice and does not take new patients. He has no Medicaid patients, and stopped taking new Medicare patients five years ago, so his payer mix is well above average. With increasing downward pressure on reimbursement he decided to accept a salary for the first time in his professional career. He based his selection of which group to join based on several factors, his autonomy, work schedule, and total compensation. As part of the change he is earning somewhat less, but has reduced his hours trading off free time for less cash. If someone told him he would be working for the US government, he would retire. And that is why the Canadian model is the only transition for us.  

            "let's talk about that"

            by VClib on Sat Oct 13, 2012 at 10:33:57 AM PDT

            [ Parent ]

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site