I think I recall whopper mentioning in another thread that if you do at least 3 years of internal medicine as a resident, or do a fellowship in C-L then it becomes easier to get reimbursements from insurance companies for so-called non-psych services. Do any of you think, given how things may unfold, it will be more worthwhile to do 3 years of IM during residency or do a fellowship as a way of preparing for whatever cards the insurance companies may be waiting to play (at least more so than before)?
The amount of money you'd lose by doing 3 extra years of residency would not be made up by a nominal increase in reimbursement. Don't do that. One year of C-L...maybe, although I kind of doubt even that. Do it if you love it.
I'm less sure about the insurance companies continuing to be all-powerful forever. People are already very, very fed up with insurance companies (denying claims for pretty much any reason, not covering things they said they would, fine print, etc, etc). In my area, I know of about a dozen primary care docs (this is a small town) who are going to cash-only retainer type practices this year. $75-125/month per person. Done.
As this continues to happen, you'll see more and more people dropping their insurance coverage, or moving to very high deductible plans. Then, they'll all be looking for ways to avoid using their insurance, the insurance companies will feel the belt tighten, and no one will care. Sell your insurance stock now people.
Now, government-run healthcare is another matter. I predict vast Medicare reimbursement restructuring, because they can't keep paying the absurd amounts they're paying for hip replacements. ER visits for non-emergencies will HAVE to be forcibly curbed, or we'll go bankrupt. EMTALA will be repealed or heavily modified to deal with that problem. They'll eventually go to a Single Payor system, making the insurance companies obsolete, and this single payor system will actually reimburse primary care, and psych fairly well (probably enough to make our $200k/year salaries), because the value of psychiatric care is being recognized by national and international healthcare organizations. Malpractice reform will also HAVE to happen as part of this package.
What we'll be left with is a two-tiered system. Gov't run healthcare for the poor/lower middle class and a private, cash-based, high-deductible "insurance" system for the richer half.
Now. The other option is that NONE (or few) of these things will happen. If our leaders fail to actually get anything meaningful done in the cost-cutting area, we're all kinda screwed. Our credit rating is jeopardized. We're running out of money fast. We can't keep upping our own credit limit forever. We have an educational system in crisis and dangerously poorly funded. We have a healthcare bubble that will explode without intervention. We have the housing bubble which, kind of popped, but like PCOS, others cysts have arisen. We have high racial tensions in many parts of the country. We have high class tensions in many parts of the country. Add in tensions between republicans and democrats, christians and muslims, christians and atheists, america and the middle east, america and china, north korea, and iran. Tension between the police and the public, the list goes on and on. This is starting to look like a George R.R. Martin novel.
If all these things were to come to a head at the same time, the result could look very, very nasty. Greece x 1000. WW3? Civil War 2? All of these at once? It could be very, very bad. I know it sounds a little paranoid, and I hope it's just some schizophreniform ranting, but our financial situation really is that bad. If it's not fixed, we could be in serious trouble, and I'm not sure the country can psychologically handle "serious trouble" right now.
I'd prefer the two-tiered system myself, seeing as how I don't own any guns.
