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  •  You keep switching between Medicare and (9+ / 0-)

    Medicaid so often I'm not sure where this argument is going.

    Who expresses concern over the physician shortage? Why the doctors of the AMA of course! lol Feeding talking points and quotes to a stenographer.

    Look, the issue of doctor shortage has nothing to do with doctors not being paid enough money. God knows doctors are not poor by any stretch of the imagination. Even crap doctors make six figures.

    The reason we have doctor shortage is because of the high cost of a medical education. And if we fix THAT problem, we will have an abundance of doctors and that will be that.

    Another problem we have is doctors shouldn't be making business decisions of this sort anyway. What insurance to take. If they can't keep up a practice, then they should get a job. Which is how it works everywhere else in the world.

    Doctors should wake up in the morning and think only about healing the sick and getting paid pretty damn good (but not excessively) for doing it. Any doctor who doesn't want to do that shouldn't be one.

    Our health system should keep decisions about how and which insurance pays far from doctors.

    •  The reason is that Medicaid is now (3+ / 0-)
      Recommended by:
      nextstep, Al Fondy, VClib

      stingier than Medicare in provider reimbursements.  As a result, you have the shortage of doctors willing to accept Medicaid patients.  If you cut provider reimbursements for Medicare so that they are closer to Medicaid reimbursements, it's not illogical to assume that providers will treat them the same -- especially given the fact that the number of potential patients with private insurance will INCREASE with the ACA.  

      Of COURSE doctors make business decisions.  All professionals do.  I'm a lawyer and I'm also a small business owner -- a professional practice is a business.  My firm takes some pro bono matters, as part of our professional obligations.  But, aside from that, if we can fill our hours with good clients who pay our standard billing rates, why on earth would we take clients who will pay only, say, only half our rates?  That would be just stupid.  I've worked a lifetime to build up my practice so that my services would be more valuable to people -- that's the whole point.  

      And if doctors who didn't take Medicaid (or potentially Medicare if provider reimbursements were cut) couldn't find other patients, you might have a point.  But you are concurrently going to INCREASE the number of patients with private insurance, which pays much better.  If you were a doctor, and you had 2000 hours of your time a year to fill, which would you fill those hours with?  A doctor would be insane to do anything other than what is best for his/her business.  

      Yes, it would solve the problem if you suddenly had a huge number of new doctors and doctors needed Medicare/Medicaid patients to fill their hours.  But then, of course, you'd get the "top doctors" taking only private insurance patients, and the "bottom of the barrel" or maybe the brand new doctors (those who, for whatever reasons, can't get enough private insurance patients) taking Medicare/Medicaid patients.  And --more importantly, I haven't seen any steps to provide that huge influx, which (if you started now) would take 10 years to see the results.  

      Or maybe if you made all of health care a government function, and took it out of the hands of private business, you'd have a point -- doctors would be paid the same, regardless of who they saw.  But that's about as likely now as my wining that $300 million dollar powerball.  

      As of now, a medical practice is a business.  It's just ludicrous to say doctors shouldn't be concerned about what they are paid for their services.  What business owner is not concerned about that?  

      This is one of my pet peeves about the "progressive" view. Sometimes, it just doesn't recognize the realities of business.  And yes, a medical practice IS a business.  And saying, "they should just help sick people and not be concerned about what they get paid for it"  is just absurd.  Nobody runs a for-profit business that way.  

      •  So, you agree the system is structured (3+ / 0-)

        incorrectly and that the incentives are all wrong. That is exactly why we shouldn't be putting any more money into it.

        The reason some doctors don't take Medicaid has nothing to do with reimbursement rates per se. It has to do with incentives. And you are correct: if you can can just take private clients and have no medicare or medicaid patients, then certainly... you have ever incentive to do so.

        But my point is most people who have medicaid or medicare will get seen by a doctor if they are sick and the doctors will make it pencil out. Now why? Because you've got to be one sick fuck of a doctor not to treat someone who is ill because you arent getting enough scratch out of the deal. And if you are that kind of doctor, people should know that.

        If we impose, they'll find a way to prosper. And still, people still get their Medicaid services and so will people in Medicare once it gets stingier.

        The last folks we should be worried about here is doctors.

        •  They will likely be seen by an emergency room (2+ / 0-)
          Recommended by:
          greenbell, VClib

          if they are really sick.   But as a matter of regular practice, doctors can and will limit how many Medicare patients they see if reimbursements to providers are significantly cut.  They are already doing that with Medicaid, which has reimbursements that are now lower than Medicare.  If you cut Medicare reimbursements, why won't the same thing that is happening in Medicaid happen to Medicare?  In a regular practice, a doctor cannot see every possible patient that wants to see him or her.  There aren't enough hours in a day.  There aren't enough doctors.   See my link to the statements of the Chief Medicare Actuary above, who says exactly that.  

          I'm not worried about the doctors.  They will fill their practices with all those millions of people who now have private insurance and be just fine.  My concern is for my elderly parents not being able to find a nearby doctor that takes Medicare -- just as people (depending on what state you are in) are already having trouble finding doctors nearby who will accept Medicaid.

        •  The people I worry about (3+ / 0-)
          Recommended by:
          greenbell, cslewis, HCKAD

          are those who will be unable to find primary care using either Medicare or Medicaid without supplemental - for profit - insurance. Many will be unable to afford the latter.

          This is the tragedy behind ballyhooing a "health care reform" program that is actually a price support program for private insurance.

          Even before the cuts that are coming... Because we must all feel the pain... And when it gets bad enough we'll go to the emergency room!

          Those who do not move, do not notice their chains. Rosa Luxemburg

          by chuckvw on Sun Nov 25, 2012 at 02:38:02 PM PST

          [ Parent ]

        •  bbb - physicians don't see people who are ill (0+ / 0-)

          if they are not already a patient. Physicians can exclude Medicare and Medicaid patients and never see them, regardless of the patients need for healthcare. The exception is the emergency room. That is the only place where treatment is mandatory.

          "let's talk about that"

          by VClib on Sun Nov 25, 2012 at 05:31:12 PM PST

          [ Parent ]

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