MD dropping out of all insurance plans

[Geoff_M]

No, not at all. Nothing is perfect. The issue is whether THIS is better than THAT. Living here, I can tell you with assurance that I find THIS is better.

Perhaps that's the perception to you, but as time moves on, I think you will find that what you're seeing is more of a mirage. As the ER usage story reports, access to primary care doesn't seemed to have changed much (which is where I think the rubber should meet the road in the issue of quality of healthcare). Cost shifting is still happening, though through premiums instead of through provider charging, people are really starting to learn to use the program rules to their advantage... and the state wants to pretend that real costs aren't still really rising that fast. The emerging picture isn't very pretty. But, if you want to subjectively call it "fairer", then be my guest.

 

[Planogirl]

Okay, but then who do you feel should pay for the health care for folks in that situation?

Truthfully, I don't know.

Seriously, this whole healthcare mess is way too complex for anyone to resolve at least at this time. It appears to me that it'll just have to evolve in some way. Apparently, many doctors no longer being part of insurance is one step.

As for "fair", I think that it's likely more fair if the consumer pays the bulk amount. I don't see how that's feasible with costs being so high though.

 

[bicker]

Perhaps that's the perception to you, but as time moves on, I think you will find that what you're seeing is more of a mirage.

That's as easy to say as me saying that, as time moves one, I think you will find that you're mistaken. What's the point of saying such things?

As the ER usage story reports, access to primary care doesn't seemed to have changed much (which is where I think the rubber should meet the road in the issue of quality of healthcare).

So in other words, you're saying your perspective will prevail because the one criteria that you care about will not be served as well as you'd like it to. Well, I look at the entire system - every aspect of it. If all criteria stay the same (even if "the same" means "crappy") except one that improves significantly, then that's a win.

Cost shifting is still happening, though through premiums instead of through provider charging...

"Still happening" implies that you'll only be satisfied with a black-and-white change, from imperfection to absolute perfection. That's unreasonable. A reasonable expectation would be for a small but significant improvement, nothing more.

But, if you want to subjectively call it "fairer", then be my guest.

Explain how it was more fair, before, when a lot of people who could legitimately afford to pay for insurance, according to society's standards, didn't, because they didn't want to, and as a result the rest of us paid for their catastrophic care. I can't imagine how you could possibly defend that assertion.

 

[lillygator]

I work in the contracting area of an insurance company and this is 100% false. Most providers are mailed a fee schedule, review it, and sign the contract with no negotiation, but for those who want to negotiate, the rates are not fixed. Often we see trade offs where a provider will accept much less for a service s/he rarely performs in exchange for more for regular services.

Also, for those concerned about all the doctors dropping insurance, it isn't going to happen. We have doctors beating down our doors trying to get in to our network so for each one who drops insurance, there are 10 more to take his/her place.

exactly, I am in the contracting area on the hospital side and this is how it is done.

 

[ccgirl]

I think its a bit premature to claim that. The "Massachusetts Medical Miracle" has plenty of its own problems, and "cost shifting" is alive and well in The Bay State as it's citizens are quickly learning how to game the system. As a kicker, Massachusetts' ERs are as busy as ever treating non-emergency conditions.

No, not at all. Nothing is perfect. The issue is whether THIS is better than THAT. Living here, I can tell you with assurance that I find THIS is better.

And, of course, it is fairer. Not absolutely 100% fair - again, nothing is - but fairer than how things were, and fairer than how things are where such approaches are not used.

Perhaps that's the perception to you, but as time moves on, I think you will find that what you're seeing is more of a mirage. As the ER usage story reports, access to primary care doesn't seemed to have changed much (which is where I think the rubber should meet the road in the issue of quality of healthcare). Cost shifting is still happening, though through premiums instead of through provider charging, people are really starting to learn to use the program rules to their advantage... and the state wants to pretend that real costs aren't still really rising that fast. The emerging picture isn't very pretty. But, if you want to subjectively call it "fairer", then be my guest.

That's as easy to say as me saying that, as time moves one, I think you will find that you're mistaken. What's the point of saying such things?

So in other words, you're saying your perspective will prevail because the one criteria that you care about will not be served as well as you'd like it to. Well, I look at the entire system - every aspect of it. If all criteria stay the same (even if "the same" means "crappy") except one that improves significantly, then that's a win.

"Still happening" implies that you'll only be satisfied with a black-and-white change, from imperfection to absolute perfection. That's unreasonable. A reasonable expectation would be for a small but significant improvement, nothing more.

Explain how it was more fair, before, when a lot of people who could legitimately afford to pay for insurance, according to society's standards, didn't, because they didn't want to, and as a result the rest of us paid for their catastrophic care. I can't imagine how you could possibly defend that assertion.

exactly, I am in the contracting area on the hospital side and this is how it is done.

I, too, live in Massachusetts and agree the required insurance is far from perfect. I have worked in hospitals and the insurance industry. Just because you are required to have health insurance, does not mean it is commercial. Just investigate how many are on our state run health insurance plans. I think you would be very surprised by the sheer numbers. Also, there are plenty of people presenting themselves at the ER for non life threatening, and life threating conditions without insurance. What happens if you don't have insurance? You get a penalty on your taxes. What happens if you don't work and, therefore, don't pay taxes?

Doctors are dropping Medicaid because they are not getting reimbursed as they should. Medicaid/Medicare keep dropping their reimbursement amounts. Just think, how many pay cuts would you take before you say enough is enough. I don't care how much they make. We all live with what we make. When I was doing reimbursement, it was amazing how much less Medicare/Medicaid was paying compared to Commercial insurers.

Not all doctors take all insurances. This practice is not new. If you really love your doctor you have a choice; pay OOP and get reimbursed later (if available) or change doctors.

As the PP pointed out, doctors can attempt to negotiate their reimbursements. The chances of that happening with a 1 doctor practice as opposed to a 20 doctor practice are very different.

 

[manning]

Him not wanting to bill insurance will reduce the number of doctors available? How? It will make it worse if he is forced to accept insurance because most likely doctors like him will quit practicing forcing those of us who really need people like him to use other resources. He has a tiny office open once a week with another assistant doc and an administrative assistant. If he had to bill insurance he wouldn't be able to deal with the patient load he has now because the overhead would be too much. He provides you with a superbill and it's up to you to send it to your insurance to see if they will cover anything. At least he is an option right now, it is my choice to pay for his services. If I don't wish to pay what he's asking, I'm free to go to anyone else I choose who may or may not be able to help me.

Read up on supply and demand. It is a basic rule of capitalism.

Your list of going to someone else will get smaller, smaller and smaller.

 

[Geoff_M]

Explain how it was more fair, before, when a lot of people who could legitimately afford to pay for insurance, according to society's standards, didn't, because they didn't want to, and as a result the rest of us paid for their catastrophic care. I can't imagine how you could possibly defend that assertion.

I'm not defending anything. Go look at the quote of yours I first highlighted. I said that it's premature to start patting your state on the back with regard to addressing the "fairness" and "injustice". The world you describe and reality (based on media and government reports, and anecdotes provided here) seem to be on divergent paths in this arena. That's what I was saying.

 

[bicker]

I, too, live in Massachusetts and agree the required insurance is far from perfect.

Absolutely. I think anyone who thought we'd be achieving perfection was foolish. A small but significant improvement on one or two metrics was a pretty big stretch.

Doctors are dropping Medicaid because they are not getting reimbursed as they should. Medicaid/Medicare keep dropping their reimbursement amounts. Just think, how many pay cuts would you take before you say enough is enough. I don't care how much they make. We all live with what we make. When I was doing reimbursement, it was amazing how much less Medicare/Medicaid was paying compared to Commercial insurers.

Indeed, and really we're not talking (yet) about the doctors who quit to become cabbies. We're talking about doctors who keep themselves occupied with other patients. It is considered a significant boon in business to be able to pass some less profitable customers off to your competitors, filling in the gap with more profitable customers.

 

[bicker]

The world you describe and reality (based on media and government reports, and anecdotes provided here) seem to be on divergent paths in this arena.

Not at all:

Percent of lower-income population with health care insurance:
2006 = 77%
2009 = 91%

Win!

Percent of adults with chronic health conditions with health care insurance:
2006 = 89%
2009 = 96%

Win!

Percent of racial minorities with health care insurance:
2006 = 83%
2009 = 95%

Win!

And it's not just coverage that has improved:

Percent of population that has had a preventive care visit:

2006 = 71%
2009 = 78%

Percent of population with no unmet health care needs:

2006 = 75%
2009 = 80%


Again, this is not PERFECTION. Again: Perfection is an irrational criteria. This is improvement.

 

[honugirl]

Read up on supply and demand. It is a basic rule of capitalism.

Your list of going to someone else will get smaller, smaller and smaller.

You are correct if I'm going just by people accepting insurance, but I am one that is fine with paying OOP to see someone outside of my insurance plan. By using someone who is actually qualified to treat my disease and is an expert, I save on costs as I'm not using him as often because my disease is well controlled. If I used the endiots on my insurance plan, my disease would be out of control and I'd be seeing them all the time. How does that save anyone any money? The beauty of me going to see someone and paying OOP is that I'm now freeing up space at those who accept insurance for those who refuse to pay OOP for their provider.

 

[Geoff_M]

Again, this is not PERFECTION. Again: Perfection is an irrational criteria. This is improvement.

Fine, ignore the icebergs. All the negative press is just trivial nitpicking. All criticism is due to a lack of perfection, etc.

 

[PaulaSB12]

I know the nhs is not perfect. The treatment my mother is getting is wonderful, they even make sure her appointments dodge my shifts so I can be with her. The taxes are a bit high but at least you don't have to worry about how to pay your gp when you see him.

 

[ccgirl]

Not at all:

Percent of lower-income population with health care insurance:
2006 = 77%
2009 = 91%

Win!

Percent of adults with chronic health conditions with health care insurance:
2006 = 89%
2009 = 96%

Win!

Percent of racial minorities with health care insurance:
2006 = 83%
2009 = 95%

Win!

And it's not just coverage that has improved:

Percent of population that has had a preventive care visit:

2006 = 71%
2009 = 78%

Percent of population with no unmet health care needs:

2006 = 75%
2009 = 80%


Again, this is not PERFECTION. Again: Perfection is an irrational criteria. This is improvement.

Lets be realistic here. The percentage of the population that now has health insurance didn't sign up for one of the commercial insurers. They are on the state run plan which you and I, and the rest of the tax paying citizens pay for. They are on the state run plans that do not reimburse very much at all. They are on the state run plans that doctors are dropping because they are not getting reimbursed. So, while they have health insurance it is going to end up costing the state a lot of money. They will also have a very difficult time finding a primary care doctor. I do not feel Massachusetts should be used as a model. A starting point, maybe, but there is so much work to be done.

 

[palavra]

Okay, but then who do you feel should pay for the health care for folks in that situation?

Our healthcare costs are way out of proportion to what much of the rest of he world pays. I've lived in three other countries on three other continents, and my medical care costs never came close to what I pay in America with insurance. If I could buy an antibiotic OTC in Portugal and South Korea for about $5.00 for a weeks worth, why can't I do that here? Why can't I see a great doctor like I had in Portugal for about $35.00 per office visit? No, that wasn't the insurance co-pay, that was the total cost of the visit. This doctor, btw, correctly diagnoed me with a problem I had had for years that my American doctors had missed.

The other side of the question that you posed is, Are peple going to be dying in droves in America because they can't afford bsic healthcare anymore?

 

[bicker]

Fine, ignore the icebergs.

I'm not ignoring anything. You are apparently ignoring anything that indicates that there is actually some improvement. Do you have some reason why you would prefer to see everything always fail?

All the negative press is just trivial nitpicking. All criticism is due to a lack of perfection, etc.

People will always have something to criticize. The job will never be done. Your expectation that it would be, by anything, is really off-target.

A starting point, maybe, but there is so much work to be done.

Which is consistent with what I've been saying.

Indeed, the most significant barrier to progress is how much mileage people who have a vested interest in nothing getting better have in making everything sound like catastrophe. The denial of improvement is the best tool for fostering a continuation of the decline, which again, some people do benefit from.

 

[Bell30012]

When a doctor is offered take it or leave it, it may not seem like a negotiation but it is. There are indeed at least two options to choose. I think doctors should be allowed to choose what insurance providers they are willing to deal with and the ones that they are not.

If a doctor is making a million dollars a year, so be it. If he/she is making 20 million, so be it. Doctors should not be forced to take just any amount that an insurance company or govt (in medicare/medicaid's cases).

We don't force a convenience store owner to sell Pepsi just because he sells Coke. We don't limit what the store owner can charge for that product or what he/she has to pay the provider.

 

[LaraK]

Indeed, and the folks who have health insurance or pay for medical care out-of-pocket cover the costs for those patients who invoke EMTALA. According to the Centers for Medicare & Medicaid Services, that represented $1,186 per year per family - or $43 billion total - money we pay that goes to cover the emergency care for other people, including both those who cannot afford to pay for health care (which is fair) and those who choose not to (which is not). In Massachusetts, we've very successfully started fixing this injustice, ensuring people who work and make money in the Commonwealth pay their fair share into the system, so that when they find themselves needing care, they're covered.

While it is clear to me that you like a good debate, I'd go back and check the statement you are commenting on. The two people I quoted indicated that ED's could refuse treatment. This is not true.

 

[Friendly Frog]

No, they don't do their own billing, but not all docs just run a practice. Some are also in research and also teach at local med schools. It's a different setup than most are used to. Under his current setup, he can accommodate more patients because his administrative staff is focusing on doing med refills, scheduling testing, answering emails, etc. If they have to shift to spending time billing insurance, then they will spend less time assisting patients. With less time to assist patients, they have to see less or provide a lower level of care.

In the beginning, yes, I did balk at paying OOP to see him, but once I did, it was definitely worth it.

I understand your choosing the doctor who you felt was best for you, regardless of if they file or not...but... the better care is not the result of his refusal to file insurance, it is in spite of his not filing insurance.

Even with your example it is only staff time and care that is possibly affected, not physicians time or his level of care. He could choose to hire more staff to handle the insurance paperwork ( full or part time). Your level of care debate is only relative to adequate administrative staffing not physician time. This is still an economic decision for the physician.

Filing paperwork is certainly the choice of each physician. I choose to support the physicians that provide this service for me. I feel that it is of great benefit to me when I am ill, not to have to deal with filing a lot of insurance paperwork and tracking reimbursements. (I am especially thankful to those who will check to see if I am covered for a certain test or procedure.) To me those are the physicians who are giving me a better level of care and I understand that they have costs associated with this. I thank those physicians who care enough to do this for me by seeking their service and recommending them to others.

 

[Friendly Frog]

We are already paying at a state level for uninsured health care. IMO a national plan with increased membership will result in better cost sharing and improve cost and benefits. It will also add a level of protection and security for all of us.

Don't even get me started on Medicare. Our aging have kept their part of the bargain, paid into the plan and deserve to have the coverage. I consider it a contract that should be honored and that applies to the soon to retire baby boomers who have paid in to the plan for so long.

I will never understand how as a nation we have no problem finding/sending money to other nations/causes but can not find the money to take care of our seniors or citizens who have supported our government for so many years!

Yes, if we don't do something soon many American will die from inadequate health care. It is already happening.

IMO it won't be long before companies will stop offering health care as a benefit anyway, just like they did with retirement plans. It has already happened even with some large profit making companies and others will follow suite sooner or later.

If I was young I sure wouldn't want to count on corporate America to provide health care options in the future. Sadly, without the bargaining power of group plans, or government intervention, only the continuously healthy will keep from being dropped from coverage.

 

[lillygator]

While it is clear to me that you like a good debate, I'd go back and check the statement you are commenting on. The two people I quoted indicated that ED's could refuse treatment. This is not true.

exactly - the name is bicker for a reason...