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View Diary: Healthcare Reform: What a Week (236 comments)

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  •  I am a physician and I am (14+ / 0-)

    meeting with my Rep tomorrow: Fred Upton (R) from MI-06.  Please give me some pointers, after all I'm just a simple country doc.

    My latest diary: http://www.dailykos.com/...

    But I'm sure I'm missing something.  Thanks.

    "Hope and fear chase each other's tails." --Buddha

    by Grodge on Mon Aug 10, 2009 at 07:21:09 AM PDT

    •  What is your pt mix in terms of insurance? n/t (1+ / 0-)
      Recommended by:
      NogodsnomastersMary
      •  50% medicaid, 40% private, very little Medicare (3+ / 0-)

        OB/gyn... mostly OB in indigent clinic setting

        "Hope and fear chase each other's tails." --Buddha

        by Grodge on Mon Aug 10, 2009 at 07:37:25 AM PDT

        [ Parent ]

        •  how much private pay (0+ / 0-)

          and how much of the MCD is in a MCD HMO? In other words, unless you are a FQHC, what percentage of your accounts receivable have to be written off for indigency each year for those pts who do not make enough to afford healthcare and too much to qualify for MCD?

          •  less than 20% is in 'caid HMO (0+ / 0-)

            and i work for a salary in a large hospital setting.  No way could I run a practice with that much medicaid-- it just does not pay.  100% of community medicaid pregnant pats are in a hospital clinic, and private docs take most of the paying pts.  My salary is subsidized by hosp revenues, and it's a pretty fair salary, ie, comparable with private docs if not higher.

            "Hope and fear chase each other's tails." --Buddha

            by Grodge on Mon Aug 10, 2009 at 08:39:49 AM PDT

            [ Parent ]

            •  therein lies the problem in equating the current (0+ / 0-)

              debate to your current situation; you are insulated from the economics of indigent care. I would take some time to schmooze with some of the other docs who are reasonable who do end up with large numbers of indigent self payers and what sacrifices these pts make on a daily basis about their personal decisions and how much healthcare they can access and the longterm consequences to them on a human level because they do not currently have full access.  

              •  Medicaid covers all pregnant pts (0+ / 0-)

                and has very generous income requirements in MI, so there is virtually nobody that goes without coverage for pregnancy.  I do not consider medicaid "insurance" in the general terminology because it is welfare.

                As for self-payers, there are very few of them in private practices: I know because I was in private practice for 10 years and the private practices in town are virtually immune from that population because the costs are prohibitive.

                I am not "insulated" from the economics of indigent care, and neither are you!  You ARE paying for it whether you know it or not.  My opinion is that a consumption tax could be used to cover the uninsured, but so be it. I see no value added by private insurance companies who really just accept premiums, dole out reimbursement (or refuse payment), but they take 15-20% profit.

                "Hope and fear chase each other's tails." --Buddha

                by Grodge on Mon Aug 10, 2009 at 09:26:20 AM PDT

                [ Parent ]

                •  Perhaps this is a problem of perception (1+ / 0-)
                  Recommended by:
                  entlord1

                  I do not consider medicaid "insurance" in the general terminology because it is welfare.

                  Why isn't Medicaid considered insurance?  Is it because the government is the payor?  What does its being part of a welfare program have to do with whether it's considered "insurance?"  Does a patient with Medicaid receive a different level of care than a patient with "insurance"?

                  If there were a public option in the final health care reform bill, and someone chose the public option but required a subsidy, would you still consider that patient without "insurance?"

                  I'm not trying to be argumentative here, I sincerely do not understand on what basis Medicaid is not considered health insurance.

                  "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

                  by SueDe on Mon Aug 10, 2009 at 10:14:31 AM PDT

                  [ Parent ]

                  •  medicaid is not "insurance" (0+ / 0-)

                    in the usual sense because it's reimbursement is so low that it does not cover overhead.  Physicians that accept 'caid do so at a loss as a public service, or they are subsidized by another source like a nonprofit hospital or Planned parenthood.  So in the usual terminology from a doctor's standpoint, medicaid works differently than Medicare and private insurers.

                    "Hope and fear chase each other's tails." --Buddha

                    by Grodge on Mon Aug 10, 2009 at 11:29:52 AM PDT

                    [ Parent ]

                    •  not if they are an RHC or FQHC (0+ / 0-)

                      and other physicians handle the problem of low Medicaid reimbursement by limiting the number of Medicaid pts. As a matter of fact, most private carriers peg their rates to Medicare's Usual and Customary and there are several private carriers which reimburse at MCD rates  

                  •  To elaborate, (0+ / 0-)

                    this changes the doctor-patient relationship in a fundamental way because the physician's payment has nothing to do with the patient or even the patient's choice.  Since there are only 5 of the 30 docs in town that accept 'caid.  This limits the patient's choice, their access, and this is a fundamental difference.

                    There should be no difference in payment between 'caid and 'care.

                    "Hope and fear chase each other's tails." --Buddha

                    by Grodge on Mon Aug 10, 2009 at 11:32:50 AM PDT

                    [ Parent ]

                    •  And most physicians do not accept all plans (0+ / 0-)

                      or carriers so even having a carrier which is the fourth largest carrier in your area may mean driving 100 miles to find an in network physician. Then of course, you have other carriers which are limiting the number of providers in their panels within a geographic location which also limits choice.

      •  Talk about the bureaucrat, (5+ / 0-)

        at the insurance agencies, that get between you and your patients.
        Use your bedside manner voice.
        Relax, your the curiosity to the other side. They will listen to you because you are an authority figure. They always listen to authority figures.

        Gotta go to Tai-Chi class.  Bye

    •  Think about what your "ask" (1+ / 0-)
      Recommended by:
      Pithy Cherub

      is and get it in early.  Lard your visit with tales of being a simple country doc and what your patients have to go through to get what should be basic care.

      Excellence is to do a common thing in an uncommon way. Booker T. Washington

      by conlakappa on Mon Aug 10, 2009 at 07:39:30 AM PDT

      [ Parent ]

      •  Why bother? You seem to have (0+ / 0-)

        already made up your mind.

        Maybe volunteer to work for a salary instead of fee for service?

        How come I have heard absolutely nothing from the medical community about what they are willing to pitch in to this effort?  Your diary doesn't cover that..

        Laffer may not be correct.  And insurance premiums have indeed skyrocketed over the last decade. But you offer no way to pay for your free healthcare for all with no co-pays or out of pocket expenses.  You offer only derision about critics having no compassion.  And, if you are wrong about over usage what is the downside for you?  Well, none because you'll see increased revenues.

        How about trying to come up with a solution to the rising costs from the provider's side?  No bill before Congress right now does anything to reduce the costs of tests, hospital stays, or your fees.  We need to concentrate on that at least as much as the cost of insuring people against those costs, which is all these bills do... and not very well.

        "Those are my principles, and if you don't like them... well, I have others." - G. Marx

        by Skeptical Bastard on Mon Aug 10, 2009 at 08:16:01 AM PDT

        [ Parent ]

        •  Can't help but have an opinion (1+ / 0-)
          Recommended by:
          QuestionAuthority

          since I've been soaking in this mess for 15 years of practice.  I truly can see both sides of the issue, but I KNOW free market has fatal flaws.

          I come from the point of view that health adds value to the society, and I take issue with the CBO estimate of what the House plan would cost, mainly because they fail to add in all the efficiencies: early detection of disease, healthy workforce, etc...

          The ONLY plan out there that has any provision for cutting costs is Medicare which is run as a trust fund.  This is subverted every year by Congress, but the mandate is to cut costs.  Such a single-payer is a nonstarter.

          It's not about my salary, dude.  I make a fair living and I have no qualms about it.  I do work for a salary, not fee-for-service.  I have other blogs on my website that cover physician contributions for your info... and you are free to look at them.  My commitment is to the community and I won't apologize to people like you for the living I make.

          "Hope and fear chase each other's tails." --Buddha

          by Grodge on Mon Aug 10, 2009 at 08:47:05 AM PDT

          [ Parent ]

          •  My mention of your salary (0+ / 0-)

            was to highlight costs.  Your profit (or salary) is a cost that goes into the total costs of healthcare.

            Proponents of healthcare bills floating thru Congresss always talk about the insurance company profits.  How about your profits?

            Worse, how about the profits of many physicians who have ownership stake in clinics that do the tests they order?  Do you not find even a hint of conflict of interest in that?  Would you agree to outlaw that type of arrangement in any and all healthcare "reform" bills going through Congress?

            We can agree that single-payer is the only real solution to cutting costs.  But short of that, I think physicians and other service providers have to be willing to cut their fees in order for any plan to be a success.  Otherwise, I believe, they are doomed to fail.

            "Those are my principles, and if you don't like them... well, I have others." - G. Marx

            by Skeptical Bastard on Mon Aug 10, 2009 at 09:03:40 AM PDT

            [ Parent ]

            •  I agree and there are laws (0+ / 0-)

              governing clinic assn's owned by doctors, with self-referrals being limited or prohibited.  These are called Stark laws, after Rep Pete Stark from CA and have been on the books and revised for over ten years.

              There are large numbers of physicians who are in favor of single payer, see Physicians for a National Health Plan and other groups.  Physicians are actually an extremely eclectic group that have the complete spectrum of points of view.  Trying to pigeonhole doctors is very hard to do.

              "Hope and fear chase each other's tails." --Buddha

              by Grodge on Mon Aug 10, 2009 at 09:31:20 AM PDT

              [ Parent ]

            •  There are many ways to cut costs (0+ / 0-)

              on the delivery side:

              - Ditch fee for service payments to doctors and pay them a set amount per patient - Reduce the payment for tests, particularly high tech tests (MRI, CAT scans, etc).  The rest of the world pays a fraction of what the U.S. pays for these tests.  An MRI is $10 in Japan. - Mandate that hospitals enact patient safety regulations.  More deaths were attributable to lax safety standards in U.S. hospitals last year than were attributable to auto accidents.  (See the current investigation of patient safety by Hearst Newspapers.)  Enforceable safety regulations would also reduce infections and mistakes in drug distribution occuring in hospitals - Negotiate down prices of prescription drugs with drug companies.  U.S. patients shouldn't have to pay more for their prescriptions than anyone else in the industrialized world.

              "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

              by SueDe on Mon Aug 10, 2009 at 10:53:28 AM PDT

              [ Parent ]

    •  What to know (0+ / 0-)

      As a practicing family doc I am well aware there are problems through out the system, but the main one is the incredible administrative waste in the multiple insurance companies who charge outrageous premiums deductibles and copays exclude many sick and needy people and consume gobs of my time. That's why single payer is the answer. Go to www.pnhp.org for data and info and by all means join up at PNHP. Jeoffry Gordon, MD

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