How does the new health care bill change civ med, compared to mil med?

[MDV]

I know it's probably a tough question to answer, but I don't understand much about health care reform. My basic understanding is that the U.S. now has near-universal coverage.

I know military medicine has been compared unfavorably to civilian medicine, but how does this new bill change things? The thread "I Thought I Was Going To Get Out of Military Medicine" sounds like they are more similar now.

I'm concerned because I'm considering doing the Army HPSP. Don't worry, I'm not an idealistic sheep that is easily persuaded by a recruiter. I'm glad SDN has provided me with a clear view of the bad aspects of military medicine. But now, it seems like some of these bad aspects are now part of civilian medicine.

I would appreciate any further information/insight into this matter. Thank you for reading.

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[grotto]

Nothing is going to change until we wake up one day and say "uh oh, we out of money," civil society breaks down, and people start going all Lord of the Flies. It will probably take that type of scenario (ironically predicted today by many on the right) to see any change in this country's military budget.

Although, on a good note, the military might be the last place that you can practice as a primary care physician and make a decent buck (i.e. over 100k/ year).

 

[Perrotfish]

I know it's probably a tough question to answer, but I don't understand much about health care reform. My basic understanding is that the U.S. now has near-universal coverage.

I know military medicine has been compared unfavorably to civilian medicine, but how does this new bill change things? The thread "I Thought I Was Going To Get Out of Military Medicine" sounds like they are more similar now.

I'm concerned because I'm considering doing the Army HPSP. Don't worry, I'm not an idealistic sheep that is easily persuaded by a recruiter. I'm glad SDN has provided me with a clear view of the bad aspects of military medicine. But now, it seems like some of these bad aspects are now part of civilian medicine.

I would appreciate any further information/insight into this matter. Thank you for reading.

Short term this bill doesn't change anything for docs on the civilian side. Private health care still exists and people still need to buy it. A lot of what were previous non-payers are now on Medicaid (which is the major expense of the bill), you can no longer be turned down for prexisting conditions, and if you're healthy you have to buy insuranse or you pay a fine. As of right now the governmennt doesn't manage care any more than before, and you don't even need to accept Medicaid if you don't want to. For that matter you're still free to operate on a cash system if that's what you'd prefer.

Long term people are worried that cost overruns on this bill are going to force the governmet to cut physician salaries and further socialize the system in an attempt to make the budget work. Long way off, though.

 

[IlDestriero]

Short term this bill doesn't change anything for docs on the civilian side. Private health care still exists and people still need to buy it. A lot of what were previous non-payers are now on Medicaid (which is the major expense of the bill), you can no longer be turned down for prexisting conditions, and if you're healthy you have to buy insuranse or you pay a fine. As of right now the governmennt doesn't manage care any more than before, and you don't even need to accept Medicaid if you don't want to. For that matter you're still free to operate on a cash system if that's what you'd prefer.

Long term people are worried that cost overruns on this bill are going to force the governmet to cut physician salaries and further socialize the system in an attempt to make the budget work. Long way off, though.

That little Medicaid accounting group can recommend cutting physician fees, facility fees, etc. Starting as soon as they can put the group together to brainstorm savings ideas. Private insurance will immediately follow up with similar cuts. Revenue will than decline. Military med is not immune, as they will stop offering the 50k multiyear bonuses. Insurance companies have to carry all kinds of expensive patients that they used to not have to worry about. As they cannot operate on an endless deficit spending plan, payments for services will further decline toward Medicaid rates and at the same time premiums will increase signficantly. Eventually, right on time, the govt will return to rescue healthcare with a government plan, as the for profit insurance system will rapidly become unsustainable. It will also cost far more than planned, so the new govt system will be needed to rescue the country from the spiraling out of control healthcare spending. Perfectly executed plan B. We will be there in 10 years. More spending ourselves out of trouble.
People think I'm joking when I say I'll finish my career overseas, or in Canada. The jokes on them I'm afraid.

 

[sethco]

I am getting out in about 35 days or so, and let's just say (with this bill passing) I will not be burning any bridges

 

[Ziehl-Neelsen]

Short term this bill doesn't change anything for docs on the civilian side. Private health care still exists and people still need to buy it. A lot of what were previous non-payers are now on Medicaid (which is the major expense of the bill), you can no longer be turned down for prexisting conditions, and if you're healthy you have to buy insuranse or you pay a fine. As of right now the governmennt doesn't manage care any more than before, and you don't even need to accept Medicaid if you don't want to. For that matter you're still free to operate on a cash system if that's what you'd prefer.

Long term people are worried that cost overruns on this bill are going to force the governmet to cut physician salaries and further socialize the system in an attempt to make the budget work. Long way off, though.

Balderdash. This bill has insidious, far-reaching effects for civilian doctors in certain specialties, but these effects are buried in the language of the bill regarding the changes the government will make to medicare beginning in 2014.

Least among these effects are the stipulations that medicare fee reates for subspecialists and diverted to primary care subspecialties.

The gamechanger is the mandate to bundle payments (as a cost saving measure) to hospitals for medicare patients in 2014 i.e. physicians who contract with hospitals to cover certain services will not be able to bill medicare directly for those patients; instead, medicare will bundle a large payment to the hospital for general services rendered that will be divided by the hospital to the services/individuals that administered care. The obvious implication is that certain specialties become golden geese for the hospital. Specialties that bring patients in the door of the hospital (surgery, heme/onc, cardiology, etc.) are the specialties that hospitals need to keep happy to make money. Consultative specialties that serve patients once admitted to the hospital (pathology and the laboratory, ID, rads, PCLS, and even ancillary allied health fields like nutrition, OT, and PT) are of no use to a hospital because they do nothing to get a patient in the door. Who do you think will get the fat contracts from the hospital? The rest will be left out in the cold.

Choose your specialty wisely. If you love a consultative field of medicine that requires you to be based at a hospital, prepare to watch other specialists take home the sweet contract while you constantly fight hospital administrators for your specialties fair share of the pie. It's looking to me like the military is the only place where I can practice good collaborative medicine with my peers for the good of the patient and not be hacked off that the surgeon who consulted me is not actively trying to screw me out of a greater share of my income.