When Doctors Opt Out.

[Perchoutofwater]

WSJ:

By MARC SIEGEL

 

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

 

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

 

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

 

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

 

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

 

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

 

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

 

I wouldn't want to be a patient when that happens.

[Ursa Majoris]

WSJ:

 

 

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

 

The more I think about this whole Medicare / Medicaid and private insurance deal, the more it diverges from Social Security, a simple problem to solve (given the political will). This isn't simple, it's insoluble.

 

The bottom line is that unless we are willing to spend to infinity minus one on Medicare and Medicaid, there will have to be rationing, it's as easy as that. People WILL die a few months before they otherwise would have if millions more had been spent. The sooner we all face up to the reality of an aging population and the massive annual increases in medical costs, the better.

[Perchoutofwater]

I think the majority of this problem is in fact caused by the government. It is caused by our porous borders, and by medicare and medicaid not paying a reasonable amount. If you look at it, those of us that have insurance are paying for the freeloading illegals, and the semi-freeloading medicare / medicaid crowd. You know the government will set a minimum wage, but then won't pay a fair rate for medical costs. So the hospitals have to charge crazy amounts to make up for what isn't being paid for by illegals and by the government.

[Ursa Majoris]

I think the majority of this problem is in fact caused by the government. It is caused by our porous borders, and by medicare and medicaid not paying a reasonable amount. If you look at it, those of us that have insurance are paying for the freeloading illegals, and the semi-freeloading medicare / medicaid crowd. You know the government will set a minimum wage, but then won't pay a fair rate for medical costs. So the hospitals have to charge crazy amounts to make up for what isn't being paid for by illegals and by the government.

But where does the government get the money? As you've pointed out ad infinitum, it is from us, so unless you want to pay increased tax, how will the government pay increased amounts to doctors?

 

The "illegals" argument is a total non-starter. The amounts involved are miniscule.

 

The problem is a simple one of entitlement beginning at an increasing timespan before death, plus an increasing number of beneficiaries. It is simple math.

[Scooby]

Last month I took my 3 yr old to the ER for stitches on a Tuesday evening...the place was crawling with people of all ages with minor ailments...things you would go to a regular clinic for, nevertheless a redneck couple had their young daughter in there for a sore throat, she was bouncing around, happy, and seemed not to be real bothered by this illness. I actually overheard the mom tell her to "act sick." A hospital rep came by and asked for her insurance..she said she had none, but just applied for medicaid which had not yet been approved. He said the fee would be $300, and she said just "bill me." The doctor came in, prescribed the girl some antibiotics, said she could go to school the next day. Then the mom asked for a doctor's excuse so she herself could get out of work the next day, since she had to spend the evening in the er caring for her sick girl. He politely refused. I eavesdropped, yes, but it's hard not to with curtain walls. crazy stuff!

[Perchoutofwater]

But where does the government get the money? As you've pointed out ad infinitum, it is from us, so unless you want to pay increased tax, how will the government pay increased amounts to doctors?

 

The "illegals" argument is a total non-starter. The amounts involved are miniscule.

 

The problem is a simple one of entitlement beginning at an increasing timespan before death, plus an increasing number of beneficiaries. It is simple math.

 

The illegals argument might be miniscule where you live, but go to a Texas, new Mexico, Arizona, or California hospital and tell me it is miniscule. If government would do what it is supposed to, an protect our borders, and quit doing stuff it was never intended to do we wouldn't be in half the mess we are in now.

 

I'd be willing to bet there are more people today that can not afford medical care than there were wen medicare and medicaid were started, and I think that is at least partially the result of these "entitlement" programs.

[westvirginia]

The illegals argument might be miniscule where you live, but go to a Texas, new Mexico, Arizona, or California hospital and tell me it is miniscule. If government would do what it is supposed to, an protect our borders, and quit doing stuff it was never intended to do we wouldn't be in half the mess we are in now.

 

I'd be willing to bet there are more people today that can not afford medical care than there were wen medicare and medicaid were started, and I think that is at least partially the result of these "entitlement" programs.

 

It's awful here in GA too.

[yo mama]

Step 1: eliminate the minimum income level required to file a federal income tax return. People who wouldn't owe tax would NOT have to pay any, but they would be required file an informational return under penalty of perjury showing the numbers, their SS#, address, etc.

 

Step 2: limit receipt of medical/medicare benefits to those who are in compliance with their federal income tax reporting requirements.

 

I know this wouldn't be a stand-alone solution, but it would help address the issue of prioritizing who is most deserving of limited resources. And I can't imagine any rational objection to showing preference to those who are in compliance with/paying into "the system" over those who aren't. An exception would be required for minors, obviously. But at least it would help Josh Gordon out career criminals, tax cheats, illegal aliens, and help prevent fraud.

Edited April 20, 2009 by yo mama

[Perchoutofwater]

Step 1: eliminate the minimum income level required to file a federal income tax return. People who wouldn't owe tax would NOT have to pay any, but they would be required file an informational return under penalty of perjury showing the numbers, their SS#, address, etc.

 

Step 2: limit receipt of medical/medicare benefits to those who are in compliance with their federal income tax reporting requirements.

 

I know this wouldn't be a stand-alone solution, but it would help address the issue of prioritizing who is most deserving of limited resources. And I can't imagine any rational objection to showing preference to those who are in compliance with/paying into "the system" over those who aren't. An exception would be required for minors, obviously. But at least it would help Josh Gordon out career criminals, tax cheats, illegal aliens, and help prevent fraud.

 

Better idea, go to a sales tax instead of an income tax, then everyone is paying, and you don't have to deny anyone.

[yo mama]

Better idea, go to a sales tax instead of an income tax, then everyone is paying, and you don't have to deny anyone.

The hidden benefit of limiting receipt of benefits to a filing requirement is that you can effectively deny a myriad of services to those are aren't in compliance. And I want to be able to deny entitlement benefits to some people.

[Perchoutofwater]

The hidden benefit of limiting receipt of benefits to a filing requirement is that you can effectively deny a myriad of services to those are aren't in compliance. And I want to be able to deny entitlement benefits to some people.

 

Why are you such a racist?

[yo mama]

Why are you such a racist?

Must have been the decade I spent in Texas.

[muck]

I spoke with a HSA insurance guy a week or so ago.

 

He said that 99.9% of the issues are due to the fact that we, as a nation, are addicted to the $20 copay.

 

If we did away with the cheap co-pays, people would not bombard the system for minor ailments or discomforts ... insurance costs would drop ... medical practicioners would not be so crazed by every moran out there ... etc ...

 

I think he's probably right. Do away with the cheap co-pays and insurance costs fall in line.

 

If you can get a HSA plan for you and your employees and you don't, it appears to me that you're contributing to the problem ... not helping to solve it.

[Scooby]

I'm all for the sales tax, but what about the sick and infirmed, young and old that can't get out of bed, and therefore aren't hitting the stores and spending? Don't mind my tax dollars going to them at all, but how would you work them in under the sales tax system?

[Perchoutofwater]

I'm all for the sales tax, but what about the sick and infirmed, young and old that can't get out of bed, and therefore aren't hitting the stores and spending? Don't mind my tax dollars going to them at all, but how would you work them in under the sales tax system?

 

If they can't get out of bed to spend they can't very well get out of bed and earn either can they?

[Ursa Majoris]

The illegals argument might be miniscule where you live, but go to a Texas, new Mexico, Arizona, or California hospital and tell me it is miniscule. If government would do what it is supposed to, an protect our borders, and quit doing stuff it was never intended to do we wouldn't be in half the mess we are in now.

 

I'd be willing to bet there are more people today that can not afford medical care than there were wen medicare and medicaid were started, and I think that is at least partially the result of these "entitlement" programs.

 

 

It's awful here in GA too.

This is typical squawk radio head-in-the-sand thinking. If we just get rid of the illegals, all will be rainbows and fluffy bunnies. Well, it won't. The current Medicare entitlement starts too early and is unsustainable over the expected lifespan of an increasingly large population segment.

 

Again, this is simple math - you don't need to go on the usual scapegoat hunt.

 

Disclaimer - I believe illegals should be on a plane out within 24 hours, so please don't try and pin that liberal nonsense on me. But you are missing the much larger issue in your hunt for an easy target.

[Perchoutofwater]

This is typical squawk radio head-in-the-sand thinking. If we just get rid of the illegals, all will be rainbows and fluffy bunnies. Well, it won't. The current Medicare entitlement starts too early and is unsustainable over the expected lifespan of an increasingly large population segment.

 

Again, this is simple math - you don't need to go on the usual scapegoat hunt.

 

Disclaimer - I believe illegals should be on a plane out within 24 hours, so please don't try and pin that liberal nonsense on me. But you are missing the much larger issue in your hunt for an easy target.

 

Ursa, I agree with you regarding the age if you are going to keep the program which I would contend never should have been stated. Now we are probably past the point of no return and stuck with it. (BTW that is what scares me about Obama's hugh spending increases, that we will get stuck with another medicare, or ss).

 

Problem is regardless of age, if you go into an emergency room with an emergency they have to treat you whether you can pay them or not. And unless you've held your kid in your arms for 4 hours in an ER waiting room to get her head stitched up while a waiting room full of Mexicans are in there to take using ER docs as primary care physicians to check on their flu symptoms, don't talk to me about squawk radio head in the sand thinking. Unless you've been in an ER waiting room in a state that borders Mexico you have no idea how many illegals there are. I'm sure it isn't a problem for you because Mexicans don't like the snow.

[yo mama]

The current Medicare entitlement starts too early and is unsustainable over the expected lifespan of an increasingly large population segment.

 

Again, this is simple math - you don't need to go on the usual scapegoat hunt.

If only there was a way to convert old people into energy. We'd call it Soylent Green Technology: fix medicare, social security, and reduce our dependence on foreign oil!

[Perchoutofwater]

If only there was a way to convert old people into energy. We'd call it Soylent Green Technology: fix medicare, social security, and reduce our dependence on foreign oil!

 

Fat burns, we could probably get something from the heat produced from burning flesh.

[TimC]

2 big issues are the problem...

 

As Muck said, the $20.00 co-pay is garbage. We should have health insurance like car insurance. You pay the doctor visits and they pay the major stuff. Of course, if you are sicker, you pay more...just like a bad driver with car insurance.

 

Second, Canadians will tell you that America spends far too much time and effort trying to keep the old and feeble alive an extra month. America spends every penny it can to save some 95-year old person about to drop....even sometimes opting for surgery. Surgery on an old person is basically a death sentence in most cases, but at least they are still trying for some unknown reason. America really should embrace euthenasia to end a person's life peacefully and gracefully. We treat our animals better when the inevitable time to die comes. It's sad really. As much as I hated to put my dog down, I wish I could've done the same for my Grandparents when it was their time. They were too proud in life to suffer away the last month...and so will I be.

[detlef]

I spoke with a HSA insurance guy a week or so ago.

 

He said that 99.9% of the issues are due to the fact that we, as a nation, are addicted to the $20 copay.

 

If we did away with the cheap co-pays, people would not bombard the system for minor ailments or discomforts ... insurance costs would drop ... medical practicioners would not be so crazed by every moran out there ... etc ...

 

I think he's probably right. Do away with the cheap co-pays and insurance costs fall in line.

 

If you can get a HSA plan for you and your employees and you don't, it appears to me that you're contributing to the problem ... not helping to solve it.

I agree with this. Health Insurance should be a safety net, not something that you feel duty to bound to get your money's worth out of. People are addicted to cheap and free things so they'll put up with hell to get them. It really makes no sense to subject yourself to the hours of annoyance just to have some piddly issue looked at but people will because it's only a $25 co-pay.

 

Then there's the BS drugs. Drugs for cukfing everything. That has to cost a bloody fortune because, as someone who lives in an area dominated by <<who knew there was a filter for farma>>, I know they're making mad jack and it has to come from somewhere.

 

Sure illegals can't help but I don't think they're the big deal. As someone who employs many Latino immigrants, I can say that it's like pulling effing teeth to get them to go to the doctor under any circumstances. If one gets hurt at work we practically have to forcibly take him to the clinic. Then, the next day, they show up with some crazy folk remedy anyway. I can't imagine that this is the same mentality that is overtaxing our system.

 

I understand that it's much easier to point the finger at the outsiders and blame it on them but, the day you rounded them all up and shipped them off, and then found the problem was a whopping 2% better, it would dawn on you that it's the tax paying, McDonalds eating, pill popping, sedentary, hypochondriac legal US citizens who are trashing this whole thing.

Edited April 20, 2009 by detlef

[detlef]

2 big issues are the problem...

 

As Muck said, the $20.00 co-pay is garbage. We should have health insurance like car insurance. You pay the doctor visits and they pay the major stuff. Of course, if you are sicker, you pay more...just like a bad driver with car insurance.

 

Second, Canadians will tell you that America spends far too much time and effort trying to keep the old and feeble alive an extra month. America spends every penny it can to save some 95-year old person about to drop....even sometimes opting for surgery. Surgery on an old person is basically a death sentence in most cases, but at least they are still trying for some unknown reason. America really should embrace euthenasia to end a person's life peacefully and gracefully. We treat our animals better when the inevitable time to die comes. It's sad really. As much as I hated to put my dog down, I wish I could've done the same for my Grandparents when it was their time. They were too proud in life to suffer away the last month...and so will I be.

I meant to echo this as well because it's true. We simply can't handle the truth. We want to think that "everything in our power will be done to fix this, or stop that, or save gramps." It's just not reasonable but being the guy who says, "Listen, we can pay millions more but it's just not worth it considering the minute improvement we'll make," is assuring he won't get elected because he must be a heartless a-hole. Regardless, it's true about everything and regardless of where you draw the line. At some point, you're not doing "everything you can", so not stop at a realistic spot?

[The Holy Roller]

Last month I took my 3 yr old to the ER for stitches on a Tuesday evening...the place was crawling with people of all ages with minor ailments...things you would go to a regular clinic for, nevertheless a redneck couple had their young daughter in there for a sore throat, she was bouncing around, happy, and seemed not to be real bothered by this illness. I actually overheard the mom tell her to "act sick." A hospital rep came by and asked for her insurance..she said she had none, but just applied for medicaid which had not yet been approved. He said the fee would be $300, and she said just "bill me." The doctor came in, prescribed the girl some antibiotics, said she could go to school the next day. Then the mom asked for a doctor's excuse so she herself could get out of work the next day, since she had to spend the evening in the er caring for her sick girl. He politely refused. I eavesdropped, yes, but it's hard not to with curtain walls. crazy stuff!

 

 

Redneck, Mexican, "colored", kike, wop, dago, slope...aren't we all deserving of free healthcare.

[Perchoutofwater]

2 big issues are the problem...

 

As Muck said, the $20.00 co-pay is garbage. We should have health insurance like car insurance. You pay the doctor visits and they pay the major stuff. Of course, if you are sicker, you pay more...just like a bad driver with car insurance.

 

Second, Canadians will tell you that America spends far too much time and effort trying to keep the old and feeble alive an extra month. America spends every penny it can to save some 95-year old person about to drop....even sometimes opting for surgery. Surgery on an old person is basically a death sentence in most cases, but at least they are still trying for some unknown reason. America really should embrace euthenasia to end a person's life peacefully and gracefully. We treat our animals better when the inevitable time to die comes. It's sad really. As much as I hated to put my dog down, I wish I could've done the same for my Grandparents when it was their time. They were too proud in life to suffer away the last month...and so will I be.

 

I agree with you, on both points.

Edited April 21, 2009 by Perchoutofwater

[Scooby]

what do you suggest we do with Down's syndrome patients?