Yesterday while I was out and about I ran into a doctor that I know casually. He is a general practitioner who is in favor of the law that was signed today. His list of reasons included:
Medicare is losing money by not paying for wellness exams. By paying for these exams they can find things at an earlier stage when it is both easier to treat and less expensive. Ok, I think we can all agree this is a good thing. But, it didn’t take almost 3,000 pages to accomplish this.
His bottom line will increase. As a person in favor of capitalism I am ok with that. He writes off tens of thousands of dollars that he is never paid for. Here we have a bit of a disagreement. When I was sick my issues were not really my treatments, but my prescription costs. I didn’t understand that had I called the pharmaceutical company they could have helped me work out a more reasonable rate. I also must be a complete idiot, as I paid back every dime of debt. Apparently most people can’t be bothered. I made arrangements to pay an affordable amount every month. It took me years, but it was paid. I don’t understand why people don’t pay their debts. I know firsthand that if you work with the doctors, they will work with you. Now, I am not saying there are times that people just can't do it. That absolutely happens. Again, we can put in safety nets for this.
He told me that he is forced to increase the costs of the insured to cover the under-payments for services from Medicare. Medicare is scheduled to be decreased, not increased. This problem will still exist and may actually get worse as the baby boomers hit retirement age.
I asked him if I came into his office and paid cash in full at the time of visit would this decrease his costs. He said that it would require less administrative time which would lower his overhead costs. So I asked doesn’t it stand to reason that if we move away from insurance dependence instead of increasing it costs would be lowered? He said that would lower staff costs. He currently has five people who do nothing but fill out paperwork for insurance companies. This has been proven to lower costs at Safeway, Whole Foods, and the state employees of Indiana. I have a similar plan. I have a high deductible that is supplemented by a HSA. Once my HSA runs out I then use my insurance. This has been very cost effective for me. Almost all HSA’s will now pay doctors directly, so they will be paid the same way that they are right now by conventional insurance.
My final questions were to ask him if he accepted Medicaid. He does not. So we are increasing the role of Medicaid into the healthcare system, who is going to treat them? What we have done is given people access to insurance. This will not translate to improved health. For improved health wouldn’t they actually have to have access to a doctor? His response was that it is not perfect. Really?
Lastly, and there is no way around this, if I am wrong, so what? My bad, I’ll take responsibility for it, and the country will be better off. If he is wrong, what then? The most innovative medical care in the world could be destroyed. Who is going to be responsible for that?
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6 comments:
Interesting... as I'm sure you know, this person is one of the few MD's who actually believes good things are to come from this bill.
I don't know enough about Medicare to say and I'm not sure what programs like AARP's Medicare Advantage help with. My insurance covers "wellness exams" and I know that's not all too common. Today on Rush's show his insurance lady called and said that will be one of the major killers of the insurance industry - the requirement set forth by this legislation.
Medicaid is going to be the big crusher. That's where most of the "preexisting condition" people are likely to end up, I think... and I know today local news reports were that Arizona's balanced budget for this year is now in deficit, because the state had cut some of its SCHIPP recipients that the feds now are requiring to be eligible, at the expense of the state.
There's a lot of confusion to this bill, and it's going to take a long time to really see the cost / benefit analysis. Unfortunately, the 'Rats front loaded all the good stuff to help them, and after 2012 is when the bad news really starts to show.
Fascinating convo - thanks for sharing.
Sol:
They are gutting Medicare Advantage. They say that the program is too cost prohibitive. This is where AARP is going to step in. They are in a position to make BILLIONS of dollars. They have become barely more than an insurance broker. They will sell plans that will take the place of Medicare Advantage, but will be more expensive to the seniors.
My mom has a policy that she has had for decades. It was from my dad who passed away 20 years ago. She uses as a wrap around policy now. So for her, this is going to make no difference as long as Medicare doesn't gut it's payments.
Think about what kind of medical care we would have now if this was introduced years ago. Young people wouldn't be as keen to go into medicine, there would be less doctors, more demand with all the people with their Medicaid cards, and you have to wonder if all the advancements that have been made in the last 50 years - would have happened.
Sure there are good points. But the good things could definitely been done without the bad things and the huge power grab. Ugh!!
There are plenty of docs who dread Obamacare. And the immediate Medicare cuts to come. And the steady/high malpractice premiums. And paying back their student loans with lower reimbursement. Being a doctor is becoming more and more a thankless job.
I had a doctor's appointment on Monday and brought the legislation up with my doctor, as well. As a typical, liberal Rhode Islander, the only thing she doesn't like about the bill is that concessions were made to insurance and pharmaceutical companies. I wonder how she'll feel about this legislation when the reality of it, and it's impact on her practice, kick in over the next four years?
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