Progressives tout California Health care "success"

[birdog1960]

He likely also got a free ride at UVA, which takes some of the sting out of it. Maybe rich parents as well.

perhaps we need more "free rides" to med school and less promise of future extremely high compensation.

[B-Man]

If You’re on Medicare, the Doctor May Not See You Anymore

By Veronique de Rugy

 

 

The Wall Street Journal reported yesterday that the regulatory cost of complying with Medicare and its payment rate is driving doctors to steer clear of the program’s elderly patients. Here are the numbers:

CMS said

9,539 physicians

who had accepted Medicare opted out of the program in 2012, up from

3,700 in 2009

. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

 

Meanwhile, the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010, according to a survey by the American Academy of Family Physicians of 800 members. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors, up from 3% in 2010.

 

A study in the journal Health Affairs this month found that 33% of primary-care physicians didn’t accept new Medicaid patients in 2010-2011.

As you can see in the following chart, the trend is clear:

 

 

The trend is being driven in part by frustration with the regulatory compliance burden and the fact that “Medicare payment rates that haven’t kept pace with inflation,” and that there is a ”threat of more cuts to come.” This could be made dramatically worse in 2014 because of an automatically scheduled cut to reimbursement rates, though this has always been avoided with legislation that puts it off. Until now, Congress has systematically postponed the cuts, though they’ve also used them as ”savings” to lower the cost of legislation, including Obamacare.

 

 

 

The whole thing is here.

[birdog1960]

The whole thing is here.

operative word is "small"....and that was before parity for medicaid and medicare reimbursement for primary care. things are never quite as simple as people (especially conservatives) believe them to be.

[B-Man]

Darn those obstinate conservatives......................

 

 

July 13, 2013

 

Dear Leader Reid and Leader Pelosi:

 

When you and the President sought our support for the Affordable Care Act (ACA), you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat. Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.

 

Like millions of other Americans, our members are front-line workers in the American economy. We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision.

 

Now this vision has come back to haunt us.

 

Since the ACA was enacted, we have been bringing our deep concerns to the Administration, seeking reasonable regulatory interpretations to the statute that would help prevent the destruction of non-profit health plans. As you both know first-hand, our persuasive arguments have been disregarded and met with a stone wall by the White House and the pertinent agencies. This is especially stinging because other stakeholders have repeatedly received successful interpretations for their respective grievances. Most disconcerting of course is last week’s huge accommodation for the employer community—extending the statutorily mandated “December 31, 2013” deadline for the employer mandate and penalties.

 

Time is running out: Congress wrote this law; we voted for you. We have a problem; you need to fix it. The unintended consequences of the ACA are severe. Perverse incentives are already creating nightmare scenarios:

 

{snip}

 

On behalf of the millions of working men and women we represent and the families they support, we can no longer stand silent in the face of elements of the Affordable Care Act that will destroy the very health and wellbeing of our members along with millions of other hardworking Americans.

 

We believe that there are common-sense corrections that can be made within the existing statute that will allow our members to continue to keep their current health plans and benefits just as you and the President pledged. Unless changes are made, however, that promise is hollow.

 

We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions.

 

We are looking to you to make sure these changes are made.

 

James P. Hoffa

General President

International Brotherhood of Teamsters

 

Joseph Hansen

International President

UFCW

 

D. Taylor

President

UNITE-HERE

 

Months after the president’s reelection, a variety of unions are publicly balking at how the administration plans to implement the landmark law. They warn that unless there are changes, the results could be catastrophic.

 

Union angst over the healthcare law is being matched by some Democrats on Capitol Hill. Senate Finance Committee Chairman Max Baucus (D-Mont.) has said the law’s implementation could be a “train wreck,” while other senior Democrats, including House Minority Whip Steny Hoyer (D-Md.), have expressed reservations.

 

 

 

.

Edited July 31, 2013 by B-Man

[GG]

The coverage problem is a huge, core issue. We write of 150M each year for care that goes unreimbursed because we take everybody who walks in... that doesn't go poof into the air of imaginary finance land, that goes to your insurance company next year to pay for it.. that is a big problem, just mutilple that amount by other 700+ bed facilities around the country by that amount and it get to the mutliple billions extremely fast.

 

We compete now more than every with Private Health Systems, in fact, we have acquired two medical systems in the last 3 years as the consolidation begins... what you wil begin to see if more and more providers leaving a private practice to work at a University Hospital, Large Private Hospital System, or a Self Contained System like Kaiser... but the salaries of MD's are nto all of the sudden going to plummet, especially with more money in the system to pay for services... that doesn't make sense. Yes, you will have concierge practice pop up more, but that had been going on for 10 years if not longer as well... and if MD's think making another 100K in a conceirge practice, wait till you have to be on call 24/7, answer calls on weekend and meet the expectations of wealthy people paying you 10K a year of their money for your ass.... a whole different headache.

 

This is all hype and conjecture right now. The restricted amount of MD's turned out keeps their demand and compensation high, I don't see that changing. Primary Care will be a sore spot, but again, that is nothing new, ask any Internist. Again, in what profession at 30 are you almost guaranteed to make 15-20K a month, and by mid 30's for some who specialize make 30K/ month plus??? Even my lawyer friends aren't pulling that kind of money, nor my buddies who crunch numbers... even my friends on Financial Services near 40 are just starting to pull down decent bucks...

No one claimed that the system is perfect. But instead of fixing the insurance-provider relationship, you blow up the whole thing and hope that single payer will solve everything. Except it wont, because you'll exchange the non-coverage for the small percent of people who absolutely can't get care now for greater scarcity for everyone in the system.

[Alaska Darin]

he had a very good place with nasa. your cynicism http://en.wikipedia...._(contemporary) is showing again.

That's the same NASA that's been cut to the bone but actually increased in bureaucracy? Yeah. Thought so.

 

BTW, you do know the government tried single payer with the military and they found out they couldn't afford it, right? This was in spite of the fact that military patients can't sue for medical malpractice.

[birdog1960]

That's the same NASA that's been cut to the bone but actually increased in bureaucracy? Yeah. Thought so.

 

BTW, you do know the government tried single payer with the military and they found out they couldn't afford it, right? This was in spite of the fact that military patients can't sue for medical malpractice.

the residency is at least 6 years. he was a 3rd year med student at the time. do the math. this was well before the cuts.

 

if i'm not mistaken, all military docs and even VA docs are paid by the same entity, non?

[Doc]

perhaps we need more "free rides" to med school and less promise of future extremely high compensation.

That's one solution. Give free med school education, if not pay people to go. And pay higher wages during residency. And institute tort reform. But none of that was done.

[Alaska Darin]

the residency is at least 6 years. he was a 3rd year med student at the time. do the math. this was well before the cuts.

You do the math - NASA has been cutting the budget for actually work for over a decade now, in favor of the bureaucrats. It's the dirty little not so secret of big brother government.

if i'm not mistaken, all military docs and even VA docs are paid by the same entity, non?

Couldn't tell you and don't really care. I now have reams of paperwork that I have to accomplish to pay for DoD/VA health care through private entities. That's not even close to the single payer model that you liberals keep humping each other over,

[birdog1960]

You do the math - NASA has been cutting the budget for actually work for over a decade now, in favor of the bureaucrats. It's the dirty little not so secret of big brother government.

 

Couldn't tell you and don't really care. I now have reams of paperwork that I have to accomplish to pay for DoD/VA health care through private entities. That's not even close to the single payer model that you liberals keep humping each other over,

you cons just refuse to believe that people actually do noble and extraordinary things for reasons other than financial gain. why is that so difficult for you to accept? or is it that it doesn't neatly fit in your philosophy?yes, va contracts with private entities for some services, largely because the entire us system is currently a hybrid model which therefore loses much of the economy of scale. plenty of examples of successful, efficient, cost effective single payer systems around.

[Doc]

the residency is at least 6 years. he was a 3rd year med student at the time. do the math. this was well before the cuts.

 

if i'm not mistaken, all military docs and even VA docs are paid by the same entity, non?

Wait, I reread your post and you said he finished the neurosurg residency. Meaning you interacted with him during the Dubya years. When the remuneration was still high and even Romneycare wasn't a thought. So his claim that it's not about the money probably wasn't completely accurate (and anyone who says "it's not about the money"...is about the money).

 

You will find that people allegedly like him, who are rare to begin with, will be even rarer when they're facing 4 years of med school bills and 6-8 years of making a resident's salary, and seeing their pay decreased while having sky high malpractice premiums.

[TakeYouToTasker]

you cons just refuse to believe that people actually do noble and extraordinary things for reasons other than financial gain. why is that so difficult for you to accept? or is it that it doesn't neatly fit in your philosophy?yes, va contracts with private entities for some services, largely because the entire us system is currently a hybrid model which therefore loses much of the economy of scale. plenty of examples of successful, efficient, cost effective single payer systems around.

Oh, golly. I'm sorry that I won't just disregard thousands of years of human history, and everything we know to be true about human motivation and incentivization in favor of your new (read "tired and old retread") concept of the emergence of Socialist Utopian Man.

[jjamie12]

you cons just refuse to believe that people actually do noble and extraordinary things for reasons other than financial gain. why is that so difficult for you to accept? or is it that it doesn't neatly fit in your philosophy?

Jesus Effing Christ. NO ONE believes that there are NO "..people who do noble and extraordinary things for reasons other than financial gain".

 

Part of the incentives for people going into medicine is financial. It is YOU who can't accept that when you lower those incentives you will, BY DEFINITION, decrease the incentive for people to go into medicine. Since you refuse to accept that very basic and obvious truism, we can't ever get past that to have the real and important discussions. You're the problem. Not 'them'.

[birdog1960]

Wait, I reread your post and you said he finished the neurosurg residency. Meaning you interacted with him during the Dubya years. When the remuneration was still high and even Romneycare wasn't a thought. So his claim that it's not about the money probably wasn't completely accurate (and anyone who says "it's not about the money"...is about the money).

 

You will find that people allegedly like him, who are rare to begin with, will be even rarer when they're facing 4 years of med school bills and 6-8 years of making a resident's salary, and seeing their pay decreased while having sky high malpractice premiums.

if it were all about the money, why would he even go to med school at all? he wasn't a wet behind the ears 22 yo when starting. pushing 40 when he finished. and all those intervening years at no or little income. from a strictly financial perspective, it probably wasn't a good decision. so, no, it wasn't about the money. and there are more and more nontraditional students making the same decision. i see that as a very good thing. the fact that funding for medical education hasn't significantly changed yet doesn't mean it won't. necessity is the mother of invention, as they say.

[GG]

if it were all about the money, why would he even go to med school at all? he wasn't a wet behind the ears 22 yo when starting. pushing 40 when he finished. and all those intervening years at no or little income. from a strictly financial perspective, it probably wasn't a good decision. so, no, it wasn't about the money. and there are more and more nontraditional students making the same decision. i see that as a very good thing. the fact that funding for medical education hasn't significantly changed yet doesn't mean it won't. necessity is the mother of invention, as they say.

 

And yet again, using a personal anecdote to believe it holds true for the entire sample.

[/dev/null]

Oh, golly. I'm sorry that I won't just disregard thousands of years of human history, and everything we know to be true about human motivation and incentivization in favor of your new (read "tired and old retread") concept of the emergence of Socialist Utopian Man.

 

But it works so well on Star Trek, why wouldn't it work in the real world?

[jjamie12]

if it were all about the money, why would he even go to med school at all?

No one thinks it's ALL about the money. YOU refuse to accept the idea that money is PART OF the incentive to be a doctor. Blindly dismissing the very idea that health care quaility *might* be affected becase of changing incentives ignores everything we know about human nature.

As soon as you admit this very obvious thing, we can all (maybe) start to have the very real discussion about how big of an issue it might be.

[B-Large]

I wish it was a fortune, it's not. Not nearly. I'm almost 37, and I'm less than 1/10 of the way done, and there's a chance I'll reset that goal again, given change.

 

That said, your father's terrible planning has colored your thinking. Your goal should be to make sure you do well enough to never put yourself in his position, not to steal from me, and ruin the medical care quality of the nation, because it makes your feel better and you don't have the balls to watch people suffer the concequences of their own decisions.

 

 

Way to compare apples to oranges. Also, fantastic usage of individual ancedotes to make a non-point.

 

I'm confused, I never mentioned my father. Now if you're talkign about my Ultra Conservative Father-in-Law, who is not my wife's biological parent, ending up broke because he is retarded.... I have no qualms about letting him pull up his bootstraps and continue to entrench.... frankly, my Mother-in-Law is more retarded, and I am fine to watch her go on Medcaid and liquidate every last cent just so I can say "I told you so".... I am wouldn't want to insult their Strong Consertive values by intervening with a family bailout....my wife feels the same way....the irony will be they worked all their lives, foolishy wasted all their money and will be dependent on Social Progams they open and aggressively detest... my guess even as the taxpayers support their every need they will still openly spew about the evil Government...

Edited July 31, 2013 by B-Large

[Doc]

 

if it were all about the money, why would he even go to med school at all? he wasn't a wet behind the ears 22 yo when starting. pushing 40 when he finished. and all those intervening years at no or little income. from a strictly financial perspective, it probably wasn't a good decision. so, no, it wasn't about the money. and there are more and more nontraditional students making the same decision. i see that as a very good thing. the fact that funding for medical education hasn't significantly changed yet doesn't mean it won't. necessity is the mother of invention, as they say.

There were several med students in my class who were older and looking to help people AND make a decent salary. Despite what some may claim, no one is going to out themselves in major debt and delay making any real money until their 30's if they don't see a payoff at the end. You're banking on maybe one in a hundred type of person.

 

Did your med student tell you how much he made with NASA? Versus how much he stood to make as a NS?

Edited July 31, 2013 by Doc

[B-Large]

And yet again, using a personal anecdote to believe it holds true for the entire sample.

 

I am sure when HMO's were introduced the same fear was that there would be disincentives for MD because the third party was calling the shots, I am sure they got over is one they realized teh same amount of money would be made, and the world was not goign to end.

 

I still don't see how having more reimbusement for care in 2014 versus 2013 will make a difference as it pertains to Private Insurance Plans... now if youo want to talk tapered reimbusement from Medicare, we can discuss that... but that is nothing new, payments have been cut before, provider just focus on attracting a better payor mix of private insurance carriers that reimburse a percentage over Medicare. Also, there will be a short-term glut of old people sucking up resources, that will ease after the boomers die off...