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Under a single-payer, government run universal healthcare program in America, would patients get to keep their doctors, this is a serious question.
If it was "medicare for all", a large percentage of practices would go out of business, as they would not be able to afford their overhead.
Medicare pays physicians much less than commercial insurance. We all see medicare as a community service; however, if ALL pts were "medicare patients", a very large percentage of practices simply could not afford to remain open.
I used to have a practice in the Midwest in which I made over $1 million per year. I am now in East TN, where nearly all the patients are medicare. I am paid a salary of $250K per year, yet the clinic loses about $25K per month (gee- exactly what they pay me). Thus, the clinic loses money every year.
I am going back to the Midwest this year, as I can get an annual guarantee of $750K without hassling with the payers and wondering if the clinic will remain open doing the exact same work with the same number of patients per day. What I am seeing here is what "medicare for all" would be like, and it aint pretty.
This has been going on full tilt since the last 1970's (Nixon started the HMO craze)....so 95% of doctors have always been under such a system.
In fact, in our state (MA), most Docs like the existing (universal) system because they can just be doctors instead of being accountants. It takes a vast load off their shoulders.
I think you are somewhat giving people the wrong impression. Most people in Mass. have private insurance, not government-run. If you are lower income, you might have to use the state health connector to get a subsidy. We have a Tufts Health Care plan and one of my doctors dumped it last year so I have to pay the bill myself just to see him.
Nothing in your link indicates the doctors are not billing the government for actual medical exams performed. I’m fairly confident they are.
I assume the fees charged are for the services provided other than medical exams. Why do I say that? Because I read through their fee schedule describing services provided: Fee Schedule | Provital Health & Wellness Center
These other services, such as massage therapist, nutritionists, fitness experts, are not generally covered by the government health plan, except in a hospital setting.
If it was "medicare for all", a large percentage of practices would go out of business, as they would not be able to afford their overhead.
Medicare pays physicians much less than commercial insurance. We all see medicare as a community service; however, if ALL pts were "medicare patients", a very large percentage of practices simply could not afford to remain open.
This is a reality that many people are unaware of and/or won't care about. The system where my husband works must make 2x Medicare rate just to break even. Most hospitals and practices lose money on Medicare/Medicaid, and make up the shortfall with commercial insurance. One of the reasons so many rural hospitals are going under is because they don't have the payer mix to offset their high Medicare/Medicaid population.
So, if we move to Medicare for All, you will see hospitals and practices close, and the remainder cut, cut, cut expenses (and services) wherever they can, starting with labor/jobs, and then on down the line. And the argument that Medicare for All will slash expenses and overhead because it will streamline the process and free up staff to do other things? I don't believe that for a minute. We've already seen the opposite is true courtesy of ACA mandated EMR's.
This doesn't mean I think the existing system should remain in place with no changes, because there's plenty of room for improvement over what we have now, that's for sure.
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Quote:
Originally Posted by ottomobeale
Not nearly enough details in OP.
I favor one paid for by a payroll tax WITH copays and deductibles and private institutions.
Others favor no pay and paid for by income tax.
A NHS style system?
Swiss style system?
Canadian style system?
Exactly - there are lots of different universal health care systems, the US should examine all the options before any system is even suggested.
An NHS type system would be very difficult to impliment in the US (and is probablt not right for the US), whilst a system such as that in Australia or the Netherlands would be far easier to impliment and would still allow a good deal of private input.
Yes, unless your doctor is willing to work for free, he has no choice except to bill the single payer. Single payer means single payer, not more than one payor.
Not all universal healthcare systems are single payor though.
As I mentioned earlier, some doctors are going concierge medicine. Mine surveyed her patients a year after ACA took effect and transitioned over to concierge medicine a couple of years ago. She does not accept any government insurance, nor private insurance. Patients pay an annual fee and all visits are free as well as some standard testing. When I go for an appointment she takes her time, my last visit was a good thirty minutes one on one with her.
Nothing in your link indicates the doctors are not billing the government for actual medical exams performed. I’m fairly confident they are.
^^^^^ And I never asserted that the doctors are not billing the government for actual medical exams performed. That isn't the primary issue/point re concierge practices, and it wouldn't even occur to me to bring that up. The primary points are access and time, both of which are discussed in the link.
Quote:
I assume the fees charged are for the services provided other than medical exams. Why do I say that? Because I read through their fee schedule describing services provided: Fee Schedule | Provital Health & Wellness Center
These other services, such as massage therapist, nutritionists, fitness experts, are not generally covered by the government health plan, except in a hospital setting.
Again, how the tab/fees get paid/divvied up isn't a primary driver of the appeal of a concierge practice....and 'access to' and 'time avail to address concerns' with providers are primary drivers of such appeal. My link describes some of the appeal of Provital and like practices, and your link (their site), to Provital's credit (IMO), further enhances that appeal. The hospital physician and health policy researcher interviewed toward the end of my link obviously doesn't like that concierge/boutique practices exist, and thinks the onus is on the provincial and federal governments to close the loopholes.
Under a single-payer, government run universal healthcare program in America, would patients get to keep their doctors, this is a serious question.
depends on if the doctor choses to say in business...depends on the type of singlepayer
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