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View Diary: Take Social Security off the table (159 comments)

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  •  Not all of us providers are Rs (19+ / 0-)

    I'm a Ph.D.-level speech-language pathologist.

    I can tell you straight up that both Medicare and Medicaid have been 'sticking it' to us for several years now.

    We continue to take Medicare because we have to if we want to take any private insurance.

    Medicaid reimbursement rates in the state where I work are so bad that it's laughable. I think we're currently reimbursed $16 for a therapy session.

    As bad as Medicare and Medicaid reimbursement rates are at least the 2 government insurers pay.

    As a field, we have about a 75% reject rate on claims because the policies are written such that insurers don't have to pay if we (the clinicians or physicians) can't link the communication problem directly back to accident, illness, or injury. Basically, that lets private insurers off the hook for paying for developmental (read kid) therapy at all.

    •  Never met a broke doctor yet. (4+ / 0-)
      Recommended by:
      AoT, megisi, jrooth, evangeline135

      Not even once.

      Sorry, if somebody is gonna be on the chopping block, it ought to be you. Not a factory worker or poor minorities.

      But I'd be fully in favor of jacking up taxes if we could get that passed by doing nothing. Unfortunately, we have a reelected president  (who doesnt need us anymore) who is sharpening his meat axe. Somebody is gonna lose limbs.

      •  Not on our side then, goddamnit (5+ / 0-)

        Who says he doesn't need us anymore?  He's looking at four years of twiddling his thumbs right now, with the little people he could do anything.

        Fatalism is one thing, generalizations another.  I'm truly surprised, surely you know a great many physicians are superb liberals, democrats and human beings.  They have educations I dream about, and their immediate compassion and action can be immensely powerful, far more than my puny keystrokes can do.

        [looks at you] Surprising.

        •  I do. And they all could give up some $$$ and (4+ / 0-)

          still be alright. But the fact is the vast majority of physician advocacy groups in Washington are heavily republican.

          But the president, lets face it, is in a very strong position. Not only over Republicans, but over Democrats too.

          If you saw that memo about what he was willing to give up last year, you should be far more concerned about what he's going to do now that he doesn't need to respond to the electorate.

      •  I understand where you're coming from but... (4+ / 0-)

        Physicians leave school with hundreds of thousands of dollars in student loan debt. As for me, I just paid off my student loans from my Master's degree after 15 years this past March. Fortunately, there is enough of a shortage of Ph.D.s that I didn't have to pay for that degree.

        At $16 per therapy session from Medicaid, I couldn't afford to keep the doors open if I were running a private practice. If I were running a private practice, I couldn't bill for seeing patients in groups. That's just not an option with Medicare, Medicaid, or the private insurers. If I tried it, they'd shut me down. Group therapy is only an option in the school districts.

        Most people are enrolled in speech-language therapy for 1-3 years depending on the disorder type and the severity. We generally see clients 1-2 per week. Any less than that and they might as well not come at all.

        To give you some idea of the overhead we face, one of the standard language tests we use for kids costs $515 for the ages 5-8 version. The score forms are $60 for 25 forms. A frequently used artic test is $200 and the forms are $55 for 25. I frequently use a literacy test that is $800 for the picture plates and $90 for 25 forms. One form per individual and those original forms better be in the file. That doesn't include all of the other consumables I'd need - gloves, tongue depressors, anti-bacterial wipes so your kid doesn't get sick from the kid before him, games, iPads to run therapy apps, etc. Nor does it even begin to cover the costs of malpractice insurance premiums - even in my field.

        •  Primary Care Physicians (7+ / 0-)

          are often very stressed these days too.  They can't bring in the income of specialists and the insurance companies and the hospitals are squeezing them like crazy.   Many are retiring early, at least early compared to the age physicians liked to retire when they enjoyed the job.  Finding providers is going to become a problem for Medicare patients.

        •  That's why we should fund Medical School, like (0+ / 0-)

          they do elsewhere.

          If we at least subsidized malpractice and enacted some sensible tort reform, then doctors could live well on a lot less income...

          So much more civilized that way.

          Purging predominantly minority voters and requiring them to present IDs to vote in the face of VIRTUALLY NON-EXISTENT VOTER FRAUD is RACISM! I hereby declare all consenting Republicans RACISTS until they stand up and object to these practices!

          by Words In Action on Wed Nov 14, 2012 at 06:20:15 AM PST

          [ Parent ]

      •  Doctors on chopping block? (2+ / 0-)
        Recommended by:
        Liberaljentaps, helpImdrowning

        You clearly don't understand what entails becoming a doctor or how BUSINESSMEN have absolutely ruined my dad's previous group practice.

        It's expensive to become a doctor and even more so if you had to borrow for your education. My dad's colleague still hasn't finished paying off her student debts. She's in her 50's now.
        You pay to take expensive tests - USMLE, COMLEX.
        You have to get a BS degree, minimum, to apply for med school (fees, fees, fees).
        You also receive a bare bones salary when you are a resident and work a ton of overtime and on calls (40k).
        "Administrators" with "business degrees" decided that doctors should be paid less in my dad's former workplace. They didn't make any cheaper to be seen by my dad. In fact, they just justified their pay increases.

        Go talk to today's med students. Ask them if they want to be in primary care. Hell no they don't. You wonder why they want to become specialists? Because they need the money to pay off their debts and specialists can pretty much charge as they like. Primary care, not so much. OBGYN? Forget it, malpractice insurance is too high and parents will sue the doctor for outcomes that truly are, acts of God, or their bad habits. Yes there are bad doctors out there, but the good doctors won't mention them by name.

        My father treats California prisoners now (lawsuits galore from ambulance chasers - but the state pays for his legal defense in full). He threw his physician pride away to earn more money and make sure I had ZEE-RO debt when I graduated from college. He would be more than happy to treat regular people as long as it paid his bills and allowed him to save for his retirement. Not much different than the goals of the patients he has treated now, huh?

        He has also given medicines away, whenever he could, to help seniors manage the cost of their prescription. He knew business people were greedy, but his hands were more or less tied when it came to controlling the cost of healthcare.

        Why hello there reality, how are you doing?

        by Future Gazer on Tue Nov 13, 2012 at 03:59:33 PM PST

        [ Parent ]

      •  Do we want medicine to become an aristocracy? (3+ / 0-)

        Because that's where it's heading.  Medical school is hugely expensive, such that a good chunk of the people who attend do so on their parents' wealth.  The rest of them have hundreds of thousands of dollars of debt when they leave.

        Bad enough that undergraduate admissions are often largely need-based (i.e., your parents don't have money, you don't get in unless you're a star; if they do, you do, even if you're a mediocrity).  I don't want the person operating on me, reading my pathology, and choosing my course of treatment to be a dimwit on a trust fund legacy career.

        Medical care is too expensive?  Support medical school reform.  Go after for-profit (or "not-for-profit") hospitals that overcharge.  Go after unnecessary testing.  Support preventative care (which saves money) and universal care (which saves money and lives).

        Blaming the doctors is short-sighted and counter-productive.

        © cai Visit to join the fight against global warming.

        by cai on Tue Nov 13, 2012 at 04:15:56 PM PST

        [ Parent ]

    •  Couple years back, there was a comparison (3+ / 0-)
      Recommended by:
      AuroraDawn, cai, evangeline135

      for common treatments, of the doctor payments for private insurance, medicare, and Canadian healthcare, posted to this very websote.

      Medicare paid about twice what the Canadian system did, per procedure.

      So, while there may be specific areas where our doctors are underpaid by Medicare, I find it hard to believe this is the case across the healthcare system.

      Non enim propter gloriam, diuicias aut honores pugnamus set propter libertatem solummodo quam Nemo bonus nisi simul cum vita amittit. -Declaration of Arbroath

      by Robobagpiper on Tue Nov 13, 2012 at 01:23:50 PM PST

      [ Parent ]

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