Parts Unknown, you have been an outspoken proponent of the reform bill, and a lot of your arguments are certainly well-researched. I am curious what you predict the general impact will be on the medical profession with regards to both practice and compensation.
You occasionally hear old docs wistfully recall the so-called Golden Age of medicine. Ironically, that age was built on a huge new revenue stream called Medicare. Fee for service was king, and providers could get paid vast sums by simply doing whatever they wanted and sending Uncle Sam the bill. Costs also spiraled as technology advanced (largely a byproduct of the Vietnam war). In retrospect it's no wonder that it was shut down so harshly by Congress.
With the current reform I think we're about to enter a Silver Age. The rules aren't going to be as loose as the 70's, but expanded coverage will presumably act to decrease uncompensated care (it was otherwise set to
explode). The trillion bucks they are set to pour into the system is going to go somewhere, and a large chunk of it will end up in our pockets. That's the good news.
The other news is that they are going to shift payment away from procedure-oriented medicine. Personally, I think there are too many specialists performing too many procedures (many of which are of dubious benefit), so I don't see this as an inherently bad thing. There is going to be more financial incentive to go into primary care.
The best way for the specialists to deal with this (and I've been saying this for the past 2 years) is to slash training positions so they can maintain some leverage.
Anyways, the big unknown in all this is Medicare payment. If you want to understand the huge problem with Medicare payment just read the now infamous Atul Gawande article
The Cost Conundrum. The long term survival of Medicare (and medical practice in this country) is going to center around reformulating payment systems.
Best case scenario: we clear more profit by doing what we are supposed to do. Worst case: not so good.
Another upcoming fork in the road has to do with electronic medical records. They could be a huge boon for bettering patient care, reducing administrative headache, increasing payment efficiency and accuracy, and reducing errors and redundancy. Or they could be a complete F-ing disaster.
Gotta run, more rambling later...
