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

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  •  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

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      •  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

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          •  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

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            •  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

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              •  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

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              •  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.

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