Well I read your post, but I really don't think it is correct. Firstly, I use leverage on behalf of my group to our fiscal benefit with payors and vendors all of the time, and politically at times when I feel necessary to do so. In fact, your post is a good demonstration of what I am trying to say - that many believe exactly as you do; we as a group are not effective in influencing change-essentially a resignation of sorts. What I am saying is that is not true - its just a matter of approach. But we agree that there is room for greater efforts.
That's fine. Use all the leverage you want with private insurers in your area. That's really the last bastion physicians have. Even then, historical data has shown that as Medicare reimbursement falls, so falls private insurance reimbursements.
And we're talking about different scales of change. Tell me exactly how you are going to use "leverage on behalf of your group" to influence legislation? Forget federal legislation. How about even state legislation? Just because you can fight tooth and nail with regional insurers doesn't mean you can curb the tides of change in national health care.
Federal Mandate on Payors to see certain class of patients - it in no way is as simple as you are stating - many doctors have a choice to stay in or out of Medicare- and many opt out completely and in growing numbers. Over time, more practice monies are coming from private payors, and less from Medicare. Our office doesn't see Medicaid primaries. Just in the hospital. The mandate itself cannot occur until society doesn't need private practice physicians anymore..that will be a long long time - if ever.
What? Do you know what a mandate is? In Massachusetts, due to the increased number of physicians who did just as you say, it is now state law to see Medicare/Medicaid patients. Failure to comply results in losing your medical license.
The more this (physicians refusing Medicare) happens all over the country, the more likely it is that more states are going to follow suit OR the federal government will issue a national mandate securing Medicare treatment. Efforts to cut costs, especially with the fears of credit crises in the EU, will be continuous and unrelenting.
If you think the government is going to let physicians call the shots on this one, you're deluding yourself.
The requirements on seeing a patient on a plan if you are in network is not - "you just see everyone who calls" - just a limited number. Practices routinely create graphs and when a practice reaches a point of excess demand over excess capacity--the plans with the smaller fee schedules are dropped or patients limited from that plan. The Mayo CLinic does this now for instance. That's just how it is outside of academic medical centers mostly. More people buying insurance is only going to increase this dynamic.
Again, this is private insurers. In fact, what you're describing is probably applicable to a small minority of private practices. Unless you're in a underserved area, where patient demand is greater than provider supply, you probably won't turn down any privately insured patient. In saturated metropolitan and suburban markets, private payors are fought over. I would love to hear how many physician clinics in NYC turn down private payors of any plan.
I agree with you that our President would love to see a government that can call all the shots in health care and all of that - but just wait and see what happens over the next few years - it won't happen. Almost everyone I know with a job and an education is pretty angry about Health Care reform and will vote along the lines of this single issue, which to me is pretty amazing. Younger folks are split evenly, becuase its not a big issue for them yet.
I don't know anyone who is angry about the reform, who isn't a doctor. There are enough people out there who realize that the status quo is not sustainable, financially. It doesn't really matter HOW costs are going to be cut - it only matters that they will be. Physician salaries are going down, regardless. I honestly can't think of a single physician who doesn't concur.
The De-coupling in health care that you speak about is really a movement towards a two-tier system - you know it, I know it- we all do. That's whats happening in my opinion. Folks with decent jobs and some money will have access to better healthcare - and the rest will have access to a basic plan of benefits. I believe the middle class will be losers and will be slowly pushed downward.
Finally on physician supply and demand - a lot of specialties have beeen very smart - and tightly controlled suppply. There are going to be doc shortages in many fields. BTW- anyone see the recent BCBS mailing on their new 2 ribbon system and the 14 targeted specialties? Certainly good for discussion. Ok- off the soapbox ( for now)
There will probably be a two-tier system of some sort, which may function perfectly well.