Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
What are the alternatives if health care providers choose to give up medicine? They can take a job in an unrelated field. They can find work in another country--although I doubt they would choose to work in another country with nationalized health care. They can practice and avoid taking the forms of insurance that they don't want to take. The problem with the last alternative is that 90% of all the dollars in health care come from Medicare, Medicaid, other government payment plans, or private insurance. If you want to give up 90% of your potential revenue, you may have a hard time earning a living.
The majority of revenue in my office comes from direct pay. Of the 4 doctors in my group, I am the only one in-network with any medical plans and my income is by far the lowest. I make less than half of what one of the other docs makes. These discount patients are crowding out the cash patients so what should I do?
Quote:
Originally Posted by markg91359
What I suspect we are primarily hearing is simply complaining. Every group in America feels entitled to more than what they are currently getting.
Complaining is one thing, but we are talking about taking it to the next level by "voting with your feet." Physicians are already voting with their feet by getting out of the insurance world and sometimes even moving to different careers.
Quote:
Originally Posted by markg91359
My solution to the medical provider who doesn't want to take Medicare is "go right ahead". However, I think the public would have every right to say that if you refuse Medicare than you have to forgo your right to participate in every other plan including some well paying ones like "Tricare". We might also want to take a look at prohibiting them from participating in private insurance plans as well. I'm not sure if that could be done, but it might be a possibility.
You are very delusional if you think Tricare "pays well." Where on earth did you get that idea? They pay Medicare rates and the bureaucracy is even worse than Medicare.
Quote:
Originally Posted by markg91359
I submit the income of not only physicians, but virtually all medical practitioners is higher than virtually any other profession or occupation. I have a great deal of trouble believing these folks are not making a more than adequate living based on what I observe today and what I have observed over my life.
What you observe misses the most important elements of the big picture. This is the problem with only looking at income....it's only one side of the equation. What does it cost to obtain that income? It takes money to make money. For example, I have to pay about $80,000 each year in loan repayments for my practice. And another $70,000 per year for educational loan repayments. And I spent 12 years after college in training, missing out on the most productive years of retirement savings. This is delayed gratification which requires a higher income later to make it worthwhile. Who would go through all that is required of medical training if they make the same as a plumber? Lastly, there is the question of how much is it worth to sacrifice family time? I spent my Saturday morning today at the hospital taking care of a patient who has no money and will never pay me but he can still sue me. I missed my son's basketball game to go see some deadbeat and I have to go back and do surgery on him tomorrow for free. What other profession does this? My plumber charges an extra fee to come out on the weekend.
Shortage of health care professionals is a common issue - in the US, as well. Medical residency spots are limited and have been for years. It has long been predicted with the advent of the ACA that more people would be seeking health care - and medical provider shortages would become more pronounced.
Clearly, there aren't enough resources in the world to provide adequate health care for all. In other words, the world is overpopulated - so those who are poor or without access - for whatever reason - will die. Some things will never change - no matter where one lives - or under which system.
Be that as it may, all the hoo ha about problems in other systems - US is still down the list on measurable outcomes - especially considering the cost - which, in the US, is outrageous. $15,000/yr++ for family health coverage; $6K-$12k deductibles??? - unless one is fortunate enough to be covered by a generous employer plan - or POOR enough to get their medical care (with quality as a variable) for almost no cost.
You are absolutely correct. The shortage in health care professionals is not isolated to countries with national healthcare - it is a global problem. Maybe with relations with Cuba opening up we can employ some of their doctors to help relieve the crisis here.
Also, I believe that we should change how we deliver healthcare here. Why shouldn't we train and employ medics from the military , nurse practitioners, expand education in healthcare, expand the number of intern and residency positions. Individual states and the Dept. of Health should be reviewing and solving the issue of medical education, medical delivery, and residency. I guess the question is - what is the Dept. of Health and individual states doing to amend this crisis!
IMO the resistance to this will come from the unions and workers who get top quality health insurance at little cost. They won't want to pay the extra money in taxes to get par for the course insurance. I also don't believe our version of national health care will be without deductibles or co payments. I envision more like Medicare 80/20 split with private insurance still being involved if single payer is implemented.
Vermont has looked into universal health and decided against it as the taxes would be prohibitive (I have read about an increase of up to 18% of income just to cover this.) This is from a relatively wealthy, low population state. We have seen how expensive Obamacare policies are to the unsubsidized. just imagine how expensive the premiums will be if we extrapolate this out to the entire population of the US. Then you need to tax everyone to pay for this. Not sure you will get the political support needed as I am not sure the tax will be significantly less than the costs for insurance coverage are now. I am still waiting for my $2500 in savings Obama promised me under Obamacare, lol.
I don't believe Sanders' claim about a 2% payroll tax increase in people and 6% in business being enough to cover the costs associated with the program. Forbes claims it will increase Federal spending by 55%. Even Paul Krugman, a left sided economist isn't for it. He thinks the "haves" will fight to much to not have it succeed that he feels tweeking Obamacare is the better answer. We have already see the "haves" get the Cadillac tax plan delayed. Do you think they will suddenly decide to pay more in taxes than they pay for insurance coverage now? These are usually the left leaning union people, until it affects their wallet.
I don't believe any economist, even Krugman. As one economist noted regarding a position another economist took - "Well he has to make a living." Krugman is most likely a Clinton supporter and ergo feels that tweeking Obamacare is the right way to go (miming Hillary's comment during the last debate) . Anthony Weiner says Bernie is wrong (Anthony Weiner, Champion of Single-Payer Healthcare, Says Bernie Sanders Is Wrong - Mic). Based in fact? Hmm.. He is married to Huma Abedin a Hillary top aide and sometimes referred to as a surrogate daughter. It is always interesting to ferret out relationships that exist that drives news articles, opinion pieces, etc.
I'd have to see the details on both Sander's claim, as well as, Forbes' claim. Both sides have agendas.
BBM~~ from your quote..while a lot of what you said is fairly correct..BUT in such systems, as in Canada..ALL physicians are Private practice ( including mine)..What you suggest is a 3nd tier system....which does exist..but only those who are NOT part of the Universal/Province by province..ala..Out of country types..who have NO standing within the Universal system..so have to pay upfront..(get receipt so can bill Insurance once back home)
In Canada..Most Physicians ( if not all) are part of the system..from walkin-clinics thru to Family Practice onto Experts..referred to by attending FPractice physician/W.I.Clinic MD/ ER physicians ..which is ALL covered ....
Those who have HC Cards..just register..and voila..physician..no matter who you see or where you are..present that card..and they enter bill to system by code in order to get paid within 30 days.....
If out of Province but still in Canada..Provinces have reciprocal recognitions..thus it's seamless...present Ontario HC card to Alberta physician/Hospital/Clinic..and to my knowledge they present that bill to Ontario system..No muss no fuss...
The above could work in USA..IF only ALL States would agree to get on board..instead of declining coverages..all due to Politics..NOTHING TO DO WITH caring for patients..IN fact by denying it..refuses patient care unless they have deep pockets..or if destitute..then ER$$$ more costly !! ...Taxpayer gets on the hook...
My view is that American's HC system is so multi-tiered..that due to political quagmire..many find it difficult to even know what coverage they have within their own state..let alone what's covered OUT OF STATE!! That is Obscuration that creates confusion for the consumer..thus never knows IF SHAFTED!! ..
Anyway..My hopes for you American friends is there's SOMETHING put in place to encircle ALL Americans/States to cooperate in order proper HC gets delivered, cost effective..and Customer knowledge...
Many want to complain about the waiting times etc...BUT there are hundreds of millions who already have waiting periods..including VETS..But compare waiting time to NOT HAVING ACCESS at all just because you can't afford it
I stand corrected. Thanks for informing us about Canada's healthcare system. I'd go for that in lieu of what we currently have!
Medicare for all....fascinating how these discussions assume US doctors are willing to work in such a system. It's much more expensive to become a doctor in the US. Other countries do not require college and they pay for their schooling. More doctors are dropping Medicare every year for a reason...it's charity care. I would worry that Medicare for all would increase the doctor shortage as they leave for other careers. I just dropped Medicare and couldn't be happier.
Perhaps we should change our healthcare education system so that doctors are happy to work within this type of system.
If every doctor opted out of Medicare what would you have to charge to continue your existing income stream? Don't forget - how much of Medicare is paying for the fixed costs in hospitals, clinics, doctors offices? Without it you would most likely have to increase your fees substantially. We all know that there is a price point that when increasing your fees actually results in less income as more and more do without the service provided.
Cigarette taxes come to mind. Once they hit a certain price point, people stopped smoking and it seems to be almost eradicated in the U.S.
I wonder how many high school students would sign up for a program to have their college paid in return for a job paying say $200,000/year as a general physician in the National Healthcare system? No worries about paying college debt, insurance to file, setting up an office, lawsuits (which generally don't happen) - 30 days vacation, ability to transfer to other states, and a retirement plan.
Medicare for all....fascinating how these discussions assume US doctors are willing to work in such a system. It's much more expensive to become a doctor in the US. Other countries do not require college and they pay for their schooling. More doctors are dropping Medicare every year for a reason...it's charity care. I would worry that Medicare for all would increase the doctor shortage as they leave for other careers. I just dropped Medicare and couldn't be happier.
People over 65 are unable to get health insurance. Medicare is it. So I guess you are saying that you will not treat anyone over 65? The only insurance someone over 65 can get is Medicare supplement.
I stand corrected. Thanks for informing us about Canada's healthcare system. I'd go for that in lieu of what we currently have!
Ohhh yeah..I forgot to mention that in Canada..there is no co-pay either when seeing a doctor. That was stopped well over decade and half ago..Yes, some doctor's balked at it initially..But that died down in short order...
One draw back tho is HC card does not cover prescriptions, some treatments. i.e. cosmetic surgery . However is covered if physician files paperwork that deems it NECESSARY i.e. Burn victim, catastrophic trauma's etc.. After retirement..med's get covered but does have a $100.0/ann co-pay...which is applied incrementally with first few prescriptions..so not ALL at once
So most people actually purchase for themselves "Extended Health Insurance" to cover things like Glasses, dental, medications, physio, acupuncture etc...I was fortunate as working @ mostly hospitals first 30+ years, had Blue Cross that covered those things
Insurance Companies often make out like bandits with such policies ..
People over 65 are unable to get health insurance. Medicare is it. So I guess you are saying that you will not treat anyone over 65? The only insurance someone over 65 can get is Medicare supplement.
Your worldview is tainted by the entitlement mentality that is killing our country. Where did I say I will not treat anyone over 65? About 25% of my patients are over 65 and I have new ones every week. Do you see where I am going with this?
Perhaps we should change our healthcare education system so that doctors are happy to work within this type of system.
If every doctor opted out of Medicare what would you have to charge to continue your existing income stream? Don't forget - how much of Medicare is paying for the fixed costs in hospitals, clinics, doctors offices? Without it you would most likely have to increase your fees substantially. We all know that there is a price point that when increasing your fees actually results in less income as more and more do without the service provided.
I think you are misunderstanding the complexities of why doctors are dropping Medicare. It's not just the money. It is the rules, regulations, paperwork, and liabilities that go along with a government program. All this stuff makes it MORE expensive for a doctor to offer healthcare services. What makes you think we would have to increase our fees when dropping Medicare? Getting rid of that bloated middle man makes it much cheaper to offer services and has the opposite effect.
I finally opted out of Medicare because I could no longer afford it in my office. It was just too expensive. Now I have decided (for surgery) to charge Medicare rates but without the MPPR adjustment. My office visits are cheap, in the 100-150 dollar range. Office visits are not a money maker....we only charge a little something to keep the tire kickers away, and the little old ladies who like to go from doctor to doctor just to sit and visit.
A group of us were having a discussion regarding National Healthcare. Many thought that if there was National Healthcare in the United States that would mean the end of private care doctors. This is clearly wrong. In many countries with National Healthcare private doctors still exist. If you don't want to use the National Healthcare system then you can just go to a private doctor and pay for their services, otherwise you could just go to a clinic and see a doctor.
At a minimum, everyone would have healthcare, they wouldn't have any premiums to pay, no co-pays, no prescription drug costs, no deductibles, etc. They would have to pay a bit more in taxes to pay for it, but it would be far less than the premiums, deductibles, co-pays, etc. The money currently used on paying for insurance would be used to purchase other items (education, houses, cars, clothing, etc.) that would stimulate the economy and provide jobs.
Every other western nation has national healthcare (Canada, Sweden, Japan, Denmark, Norway, Europe, Britain, Taiwan, to name a few) except us. Why shouldn't we? Aren't we smart enough to implement something that other nations have? Aren't we worthy enough to get it?
OK, I'll wait for the incoming on this one!!!
I think you're not understanding the math behind all that. Everyone would not pay a bit more in taxes to pay for it. Only taxpayers would pay more. People who are tax-exempt would pay nothing. So the people who do pay tax, will have to pay for their own, plus shoulder the burden for everyone who pays nothing.
If you consider taxing only wage-earners, then the unemployed, disabled, and retired people will pay 0. If you consider taxing only food, then poor people who are on food stamps will pay nothing, and poor people who are not poor enough to qualify for food stamps, but are struggling to make ends meet now, will struggle even more when they have to pay an additional tax for the right to not starve.
If you consider only tax on clothes, well people don't buy clothes often enough to support the health care of the whole nation. Tax on gas - only works for people who drive, and even then - only on people who aren't using electric vehicles. And the ones who are using hybrids get a break.
Tax on alcohol and cigarettes - means smokers and people who enjoy a glass of wine will have to foot the bill for everyone else's health care.
You're mixing geography when you claim that "every other western nation" has national healthcare, and then list countries that are part of the East (Japan and Taiwan), and then include Europe as a country, when it's not.
What you could know, however, is that the tax people pay to support those who don't pay anything, is significant. In Canada, the income tax is approximately 50%, of and much of that goes into socialized health care. In addition, if you need back surgery, you get put on a waiting list and if someone else can afford to pay separately for the space in the hospital, you risk getting bumped down the list in favor of the person paying extra. Most "specialist" procedures involve waiting, even if it's an urgent situation.
In Australia, they coined the term "dole bludgers" to describe people who accept government handouts, which are paid for by working people, and don't have to work at all. The government covers their expenses, and working people pay for it. It's similar to our Welfare system, but you'd combine welfare, section 8 housing, foodstamps, and unemployment insurance, and reap the benefits for a few decades. Raise your kids on it, no worries, the working people will pay for it all.
In order to have truly universal healthcare, you have to fall back away from a capitalistic society and closer to a socialistic society. The USA is not able to handle that. As a nation, we are too immature to embrace socialism. Individually we might be fine with it. But collectively, we are not.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
- unless one is fortunate enough to be covered by a generous employer plan - or POOR enough to get their medical care (with quality as a variable) for almost no cost.
Your worldview is tainted by the entitlement mentality that is killing our country. Where did I say I will not treat anyone over 65? About 25% of my patients are over 65 and I have new ones every week. Do you see where I am going with this?
