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View Diary: Durbin takes Social Security off the table (216 comments)

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  •  Your cited survey says Medicaid, not Medicare. (3+ / 0-)

    And the reasons for not taking have nothing to do with the payment system and everything to do with how the state runs the program. But notably, in the article you cite, the doctors who don't want to treat the poor on Medicaid say "we would treat them if you gave us more money!"

    LOL. Well, yeah. I suspect you would!

    I wouldn't worry about it though. That argument is quite meh on the merits. Doctors will treat the sick first and make it pencil out later. If they don't, they shouldn't be doctors in the first place.

    •  That's just unrealistic. Ezra Klein (5+ / 0-)
      Recommended by:
      3goldens, divineorder, VClib, askew, chuckvw

      explained exactly how big provider cuts to Medicare will affect beneficiaries and perhaps increase private insurance costs as well.

      •  Yes, it does mean one less BMW in the driveway. (5+ / 0-)

        They'll have to downgrade to a Honda. Somehow I think they'll muddle through.

        But the idea that this means doctors are going to stop treating sick people is preposterous. If they don't want to accept Medicare or Medicaid, they're going to find themselves with a big problem because ObamaCare is going to start curbing what they get from the private insurers as well.

        Doctors have been living pretty damn good in this country, which pays its doctors far far in excess of what doctors make in other countries.

        They're going to have to shut up and take it. Go to Myrtle Beach instead of Cancun.

        •  No, they are going to treat sick people with (7+ / 0-)

          private insurance.  And (did you read Ezra Klien?) private insurance is going to make up the difference, as it has in the past.

          If there were an overabundance of doctors, and they were hurting for business and needed to take whatever walked in the door, you might be right.  But there's already a shortage, and that shortage is only expected to get worse.  That means that doctors are going to be able to CHOOSE which patients they treat.  And any sane doctor is going to choose to treat as many private insurance patients and as few Medicare/Medicaid patients as possible.  Because that's the clear financial incentive.  

          You already have a significant number of doctors who won't accept new Medicaid patients.   That's because they can fill up their practices just fine with people who pay more, through private insurance.  You're about to add a whole bunch more people with private insurance, which pays much, much better.  And if you add to that cuts in what they get for treating Medicare patients, the financial incentive is to make your practice as much private insurance as possible.  If you can fill your days with private insurance patients (say, 2000 hours a year), what's the incentive to work over and above that to take Medicaid or Medicare patients?  Your return on those extra hours is very small.  

          •  That piece was not from Ezra Klein. (8+ / 0-)

            It is by Sarah Kliff, who is not a policy analyst and is a staff writer who came to the Washington Post from Politico, where she was also a corporate talking points stenographer.

            And low and behold...who does she quote on how bad this will be for providers?

            The providers! How coincidental!

            •  How about the Medicare chief actuary? (2+ / 0-)
              Recommended by:
              VClib, OleHippieChick

              See here for a video of him testifying before Congress.  

              And Here:  "Medicare’s chief actuary has warned repeatedly that Obama’s cuts to the future growth of payments to hospitals are too deep to be absorbed without adverse consequences."

              According to the Medicare chief actuary, significant provider cuts will impact what providers serve Medicare patients, just as it already affects what providers will see Medicaid patients.  He's on video saying precisely that.  

              •  Apples and Oranges. (3+ / 0-)

                What he is talking about is a sharp drop off in the reimbursement rate as result of failing to pass the doc fix. N obody is proposing that. Nobody has ever proposed a sharp 30% cut. That is the reason they keep doing these doc fixes.

                The point is not to keep doc fixing, but have gradual path downward. That is why the proposals center around phasing out fee for service and going to a Mayo Clinic model.

                Yes that does mean certain doctors offices will close. But it wont be a catastrophe and it will be gradual and most doctors will find a way to cope.

                Dont apply the same anaysis to two different things.

                •  bbb - in some areas, including mine (2+ / 0-)
                  Recommended by:
                  OleHippieChick, chuckvw

                  it is getting difficult to find a primary care physician who will accept a new Medicare patient at the current reimbursement rate and it is nearly impossible to find any who will take a new Medicaid patient. There is already a shortage of primary care physicians in the US so the notion that more will stop serving Medicare or Medicaid patients isn't reassuring.

                  "let's talk about that"

                  by VClib on Sun Nov 25, 2012 at 12:17:35 PM PST

                  [ Parent ]

          •  You keep switching between Medicare and (9+ / 0-)

            Medicaid so often I'm not sure where this argument is going.

            Who expresses concern over the physician shortage? Why the doctors of the AMA of course! lol Feeding talking points and quotes to a stenographer.

            Look, the issue of doctor shortage has nothing to do with doctors not being paid enough money. God knows doctors are not poor by any stretch of the imagination. Even crap doctors make six figures.

            The reason we have doctor shortage is because of the high cost of a medical education. And if we fix THAT problem, we will have an abundance of doctors and that will be that.

            Another problem we have is doctors shouldn't be making business decisions of this sort anyway. What insurance to take. If they can't keep up a practice, then they should get a job. Which is how it works everywhere else in the world.

            Doctors should wake up in the morning and think only about healing the sick and getting paid pretty damn good (but not excessively) for doing it. Any doctor who doesn't want to do that shouldn't be one.

            Our health system should keep decisions about how and which insurance pays far from doctors.

            •  The reason is that Medicaid is now (3+ / 0-)
              Recommended by:
              nextstep, Al Fondy, VClib

              stingier than Medicare in provider reimbursements.  As a result, you have the shortage of doctors willing to accept Medicaid patients.  If you cut provider reimbursements for Medicare so that they are closer to Medicaid reimbursements, it's not illogical to assume that providers will treat them the same -- especially given the fact that the number of potential patients with private insurance will INCREASE with the ACA.  

              Of COURSE doctors make business decisions.  All professionals do.  I'm a lawyer and I'm also a small business owner -- a professional practice is a business.  My firm takes some pro bono matters, as part of our professional obligations.  But, aside from that, if we can fill our hours with good clients who pay our standard billing rates, why on earth would we take clients who will pay only, say, only half our rates?  That would be just stupid.  I've worked a lifetime to build up my practice so that my services would be more valuable to people -- that's the whole point.  

              And if doctors who didn't take Medicaid (or potentially Medicare if provider reimbursements were cut) couldn't find other patients, you might have a point.  But you are concurrently going to INCREASE the number of patients with private insurance, which pays much better.  If you were a doctor, and you had 2000 hours of your time a year to fill, which would you fill those hours with?  A doctor would be insane to do anything other than what is best for his/her business.  

              Yes, it would solve the problem if you suddenly had a huge number of new doctors and doctors needed Medicare/Medicaid patients to fill their hours.  But then, of course, you'd get the "top doctors" taking only private insurance patients, and the "bottom of the barrel" or maybe the brand new doctors (those who, for whatever reasons, can't get enough private insurance patients) taking Medicare/Medicaid patients.  And --more importantly, I haven't seen any steps to provide that huge influx, which (if you started now) would take 10 years to see the results.  

              Or maybe if you made all of health care a government function, and took it out of the hands of private business, you'd have a point -- doctors would be paid the same, regardless of who they saw.  But that's about as likely now as my wining that $300 million dollar powerball.  

              As of now, a medical practice is a business.  It's just ludicrous to say doctors shouldn't be concerned about what they are paid for their services.  What business owner is not concerned about that?  

              This is one of my pet peeves about the "progressive" view. Sometimes, it just doesn't recognize the realities of business.  And yes, a medical practice IS a business.  And saying, "they should just help sick people and not be concerned about what they get paid for it"  is just absurd.  Nobody runs a for-profit business that way.  

              •  So, you agree the system is structured (3+ / 0-)

                incorrectly and that the incentives are all wrong. That is exactly why we shouldn't be putting any more money into it.

                The reason some doctors don't take Medicaid has nothing to do with reimbursement rates per se. It has to do with incentives. And you are correct: if you can can just take private clients and have no medicare or medicaid patients, then certainly... you have ever incentive to do so.

                But my point is most people who have medicaid or medicare will get seen by a doctor if they are sick and the doctors will make it pencil out. Now why? Because you've got to be one sick fuck of a doctor not to treat someone who is ill because you arent getting enough scratch out of the deal. And if you are that kind of doctor, people should know that.

                If we impose, they'll find a way to prosper. And still, people still get their Medicaid services and so will people in Medicare once it gets stingier.

                The last folks we should be worried about here is doctors.

                •  They will likely be seen by an emergency room (2+ / 0-)
                  Recommended by:
                  greenbell, VClib

                  if they are really sick.   But as a matter of regular practice, doctors can and will limit how many Medicare patients they see if reimbursements to providers are significantly cut.  They are already doing that with Medicaid, which has reimbursements that are now lower than Medicare.  If you cut Medicare reimbursements, why won't the same thing that is happening in Medicaid happen to Medicare?  In a regular practice, a doctor cannot see every possible patient that wants to see him or her.  There aren't enough hours in a day.  There aren't enough doctors.   See my link to the statements of the Chief Medicare Actuary above, who says exactly that.  

                  I'm not worried about the doctors.  They will fill their practices with all those millions of people who now have private insurance and be just fine.  My concern is for my elderly parents not being able to find a nearby doctor that takes Medicare -- just as people (depending on what state you are in) are already having trouble finding doctors nearby who will accept Medicaid.

                •  The people I worry about (3+ / 0-)
                  Recommended by:
                  greenbell, cslewis, HCKAD

                  are those who will be unable to find primary care using either Medicare or Medicaid without supplemental - for profit - insurance. Many will be unable to afford the latter.

                  This is the tragedy behind ballyhooing a "health care reform" program that is actually a price support program for private insurance.

                  Even before the cuts that are coming... Because we must all feel the pain... And when it gets bad enough we'll go to the emergency room!

                  Those who do not move, do not notice their chains. Rosa Luxemburg

                  by chuckvw on Sun Nov 25, 2012 at 02:38:02 PM PST

                  [ Parent ]

                •  bbb - physicians don't see people who are ill (0+ / 0-)

                  if they are not already a patient. Physicians can exclude Medicare and Medicaid patients and never see them, regardless of the patients need for healthcare. The exception is the emergency room. That is the only place where treatment is mandatory.

                  "let's talk about that"

                  by VClib on Sun Nov 25, 2012 at 05:31:12 PM PST

                  [ Parent ]

          •  I don't know about your insurance (0+ / 0-)

            company, but mine doesn't pay much of anything to doctors. Pretty much in line with what the government (and its subcontracted insurers) pay. That's why people with no insurance have to pay more, and that little problem is endemic. Doctors might find themselves doing better on the bottom line if their renumeration was fair across the board for all their patients.

            Let's face it. There are only so many rich people who can pay out of pocket for expensive medicine (and even they often negotiate). Hence only so many plastic surgeons are needed in any given area of rich people to do those lifts, tucks, nose jobs and implants.

        •  You don't get it. In many places Medicaid almost (2+ / 0-)
          Recommended by:
          Calamity Jean, nextstep

          always pays an amount well below the cost of treatment.  As long as the payments stay below the actual costs then doctors will have to limit the number of Medicaid patients they accept otherwise they will go out of business.

          You have watched Faux News, now lose 2d10 SAN.

          by Throw The Bums Out on Sun Nov 25, 2012 at 11:56:41 AM PST

          [ Parent ]

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