Dr Gerrard

10+ Year Member
7+ Year Member
Feb 16, 2009
1,044
1
Status
Medical Student
but wouldn't making sure everyone has insurance raise salaries of doctors by increasing profit to hospitals?

I know many patients hospitals currently see are uninsured. Wouldn't giving them insurance actually ensure that they get more of a return?

Also, is simply forcing everyone who does not have healthcare (maybe 25%) to buy it and expanding medicaid to cover those that don't not a good enough plan?
 

apumic

Oracle of the Sheet
10+ Year Member
7+ Year Member
Jan 1, 2007
3,924
7
Denver, CO
Status
Medical Student
but wouldn't making sure everyone has insurance raise salaries of doctors by increasing profit to hospitals?

I know many patients hospitals currently see are uninsured. Wouldn't giving them insurance actually ensure that they get more of a return?

Also, is simply forcing everyone who does not have healthcare (maybe 25%) to buy it and expanding medicaid to cover those that don't not a good enough plan?

Yes and no... Docs do see a lot of uninsured px; however, one of the recently proposed reform bills gave only 105% of medicare's fee schedule. Considering physicians generally shoot for 120-130% of medicare, having all our px only paying at 105% would be a huge loss. As it is, for some operations, docs actually write off medicare patients as a loss b/c it pays so poorly. If all patients were causing a loss of profit, doctors would not be able to maintain their practices and healthcare would go broke.
 

TopSecret

Removed
Jul 14, 2009
1,095
4
949, 310
Status
Attending Physician
How will it be paid for? If it means increasing the tax rate on the upper income tax brackets, then in effect doctors will be providing many services for free because whatever is gained will be taken away by the IRS.

Also, insurance is not the same thing as access to health care.

It's a complicated issue and one that will be debated for a long time.
 

mvenus929

10+ Year Member
Jul 6, 2006
6,833
1,617
Status
Fellow [Any Field]
The hospital I work for is non-profit, which means that when we actually make a profit, it is dispersed among the employees. We employ something like 2000 people, and our 'shared comp' for this half of the year (Jan-Jun) is almost $800, per person.

My supervisor was talking about it today with us, and basically said that we do worse for shared comp during the winter, because we see so many more medicare/medicaid patients. They don't generate profit, and often result in the hospital operating at a loss. We rely on the private health insurance to give us profit.
 

J ROD

Watch my TAN walk!!
Lifetime Donor
10+ Year Member
Aug 1, 2005
58,237
1,974
working on my tan......
Status
Resident [Any Field]
Simply the way it is structured, any federally backed plan does not make enough money and will drive down profit not to mention the loss from increased taxes.

The only way I see it works is if the federal government decides to provide enough profit to make it work for the docs to have a prosperous business.
 

ygree001

10+ Year Member
Nov 18, 2008
304
0
Status
Resident [Any Field]
Simply the way it is structured, any federally backed plan does not make enough money and will drive down profit not to mention the loss from increased taxes.

The only way I see it works is if the federal government decides to provide enough profit to make it work for the docs to have a prosperous business.
But of course it's those rich doctors driving up the cost of health care. I know this one who has a BIG HOUSE and a BOAT! For shame!
 

Poliscidoc

7+ Year Member
Jul 28, 2009
1,783
77
Status
Resident [Any Field]
At the Private Urgent Care office I worked at.. We didn't see people with Medicare or Medicaid. If you have those or no insurance and still want to be seen its 152.50 just to see a doctor. They stopped taking them and the next year there total profits rose GREATLY...
 

MDtobe31311

Class of 2014!
10+ Year Member
7+ Year Member
Feb 2, 2008
169
0
Status
Medical Student
I think the US should have major tax cuts for physicians. Well, at least primary care physicians
 

red10

7+ Year Member
Jun 2, 2009
1,429
23
Status
Medical Student
i wish everyone was required to have insurance. I don't care if people get the Safe Auto equivalent of health care so long as they understand that they're going to get what they pay for and the rest has to come out of pocket, not for free.
 

NickNaylor

Thank You for Smoking
Lifetime Donor
10+ Year Member
May 22, 2008
16,807
7,602
Deep in the heart of Texas
Status
Attending Physician
In short, no, that's not how it works. The money doesn't just materialize. SOMEONE's paying for it. Whether that be everyone via the government in taxes or everyone via private insurers in increased premiums, that money is coming from somewhere.

I think almost everyone supports some form of universal coverage. The problem is how to efficiently deploy such a system without bankrupting everyone involved. Maybe it's not possible. The person that figures it out deserves to never work again.
 

Charles_Carmichael

Moderator Emeritus
10+ Year Member
7+ Year Member
May 11, 2008
4,078
41
Status
Non-Student
but wouldn't making sure everyone has insurance raise salaries of doctors by increasing profit to hospitals?

I know many patients hospitals currently see are uninsured. Wouldn't giving them insurance actually ensure that they get more of a return?

Also, is simply forcing everyone who does not have healthcare (maybe 25%) to buy it and expanding medicaid to cover those that don't not a good enough plan?
That's really not true. Everyone has access to medical care (EMTALA). Insurance and access to medical care are two different things.

Also, if the government provided insurance plan goes through, the reimbursements are going to go down. Since the govt plan will be cheaper, private insurance will have a hard time competing with the govt (who would want to pay more for insurance when you can get the same thing from the govt for cheaper?). Lower reimbursements + relatively same cost of overhead = a sizeable cut in take home pay.
 

red10

7+ Year Member
Jun 2, 2009
1,429
23
Status
Medical Student
That's really not true. Everyone has access to medical care (EMTALA). Insurance and access to medical care are two different things.

Also, if the government provided insurance plan goes through, the reimbursements are going to go down. Since the govt plan will be cheaper, private insurance will have a hard time competing with the govt (who would want to pay more for insurance when you can get the same thing from the govt for cheaper?). Lower reimbursements + relatively same cost of overhead = a sizeable cut in take home pay.
I don't think people would automatically jump over to the govt insurance plan. The government inefficiency +lack of clarity on pretty much everything would mean a lot of people would keep their private insurance at least until they figured out if the govt actually knew what they were doing.
Even if the govt does a good job and can offer lower costs, the insurance companies will find some way to offer better service (just imagine trying to get in touch with your govt insurance agent...) or more specific coverage. They'll do something to make people think the extra $$ is worth it
 
Jul 22, 2009
330
0
Status
Pre-Medical
I don't think people would automatically jump over to the govt insurance plan. The government inefficiency +lack of clarity on pretty much everything would mean a lot of people would keep their private insurance at least until they figured out if the govt actually knew what they were doing.
Even if the govt does a good job and can offer lower costs, the insurance companies will find some way to offer better service (just imagine trying to get in touch with your govt insurance agent...) or more specific coverage. They'll do something to make people think the extra $$ is worth it
Didn't they announce that a public option was off the table? Or is there fine print somewhere I didn't read that says otherwise?
 

ygree001

10+ Year Member
Nov 18, 2008
304
0
Status
Resident [Any Field]
I don't think people would automatically jump over to the govt insurance plan. The government inefficiency +lack of clarity on pretty much everything would mean a lot of people would keep their private insurance at least until they figured out if the govt actually knew what they were doing.
Even if the govt does a good job and can offer lower costs, the insurance companies will find some way to offer better service (just imagine trying to get in touch with your govt insurance agent...) or more specific coverage. They'll do something to make people think the extra $$ is worth it
It will be very hard/much more expensive to get your own. Employers will save money by not offering coverage. If you don't want the public plan you will have to go private, which is expensive. Plus, insurance companies will lose a ton of money and pass some of that on, making private plans even more expensive.
 

Poliscidoc

7+ Year Member
Jul 28, 2009
1,783
77
Status
Resident [Any Field]
Is anyone else afraid of possible pay cuts... being cut by the Obama proposed plan?
 

nabeel76

Senior Member
10+ Year Member
7+ Year Member
Nov 10, 2004
660
4
Status
Also, if the government provided insurance plan goes through, the reimbursements are going to go down. Since the govt plan will be cheaper, private insurance will have a hard time competing with the govt (who would want to pay more for insurance when you can get the same thing from the govt for cheaper?). Lower reimbursements + relatively same cost of overhead = a sizeable cut in take home pay.
I haven't really had much time to read up on the new proposals set forth by the Obama plan but based on your statement, just thinking out loud here, if the government were to come out with a cheaper plan that makes it hard for private insurance companies to compete, essentially putting the private companies out of business. Then wouldn't you end up with a 1 payer system in which the goverment is soley responsible for not only the funding but the delivery of every citizens healthcare needs and expenses? And if their rates are cheap enough to force the private companies to leave the market then wouldn't that put a serious strain on government funds which could possibly drive the debt rate into oblivion?

I could be wrong but I don't think its in the best interest of the government to bankrupt or drive off the private insurance companies as that will definitely be taking on more than they can chew. Therefore I highly doubt something that drastic is going to come out of this plan. But if you know something that I don't do share as I haven't really been following the field lately.
 

Parts Unknown

Fork tender
Jun 26, 2009
1,515
3
Status
Attending Physician
Didn't they announce that a public option was off the table? Or is there fine print somewhere I didn't read that says otherwise?
Four days ago the Senate Finance Committee announced they were dropping two elements from its bill (there are multiple):

1. Requirement for large corporations to offer employee insurance
2. The public option

Unless there is a dramatic and unexpected shift in the political landscape, the public option is as dead as fried chicken. It has been for awhile. It does not now, nor has it ever, had the Congressional votes necessary for passage. The only reason to be discussing it these days is as a thought experiment.
 

Parts Unknown

Fork tender
Jun 26, 2009
1,515
3
Status
Attending Physician
Yes and no... Docs do see a lot of uninsured px; however, one of the recently proposed reform bills gave only 105% of medicare's fee schedule. Considering physicians generally shoot for 120-130% of medicare, having all our px only paying at 105% would be a huge loss.
Perhaps one of us misunderstands the OPs question. I read it as this:

Currently a generic doctor sees four types of patients:
1. Privately insured
2. Publicly insured (Medicare, Medicaid)
3. Uninsured but pays out of pocket
4. Uninsured charity

In theory, an insurance mandate would eliminate 3 and 4. Paying out of pocket is actually good for revenue, as those poor sods have to pay for what is billed, not what is pre-negotiated through a third party. But those instances are relatively rare (except for some huge referral centers like Mayo and MD Anderson). Eliminating charity care, on the other hand, would be a huge boon to revenue. After all, what's worse than collecting 0%?
 

not so calm now

10+ Year Member
Oct 8, 2007
602
1
Status
Attending Physician
At the Private Urgent Care office I worked at.. We didn't see people with Medicare or Medicaid. If you have those or no insurance and still want to be seen its 152.50 just to see a doctor. They stopped taking them and the next year there total profits rose GREATLY...
I've heard of doctor's offices doing this, and I think this is crap. Were I to discover my doctor doing this I would switch. I undersand that reimbursement rates are much lower (in fact, where I work, medicare reimburses about $22/hour what private insurance reimburses about $85), but refusing to see them just seems ridiculous. I can understand not actively advertising for these patients, but refusing to take them??
 

red10

7+ Year Member
Jun 2, 2009
1,429
23
Status
Medical Student
I've heard of doctor's offices doing this, and I think this is crap. Were I to discover my doctor doing this I would switch. I undersand that reimbursement rates are much lower (in fact, where I work, medicare reimburses about $22/hour what private insurance reimburses about $85), but refusing to see them just seems ridiculous. I can understand not actively advertising for these patients, but refusing to take them??
Slightly off topic but my bf's dad is a plastic surgeon and he's seen people try to use their medicaid to get plastic surgery, like boob jobs not reconstruction. He laughed them on out of his office
 

Dr Oops

10+ Year Member
Feb 13, 2009
470
1
Status
Medical Student
I've heard of doctor's offices doing this, and I think this is crap. Were I to discover my doctor doing this I would switch. I undersand that reimbursement rates are much lower (in fact, where I work, medicare reimburses about $22/hour what private insurance reimburses about $85), but refusing to see them just seems ridiculous. I can understand not actively advertising for these patients, but refusing to take them??

Many doctors are forced to limit the amount of medicare patients they see. Not because of malice or greed, but because they often times lose money on these patients. This not only cuts into the physicians bottom line, but it also makes it harder to pay his overhead (i.e. administrative staff, nursing staff, building fees).
 

nontrdgsbuiucmd

10+ Year Member
Mar 28, 2008
998
3
my own little world
Status
Medical Student
Perhaps one of us misunderstands the OPs question. I read it as this:

Currently a generic doctor sees four types of patients:
1. Privately insured
2. Publicly insured (Medicare, Medicaid)
3. Uninsured but pays out of pocket
4. Uninsured charity

In theory, an insurance mandate would eliminate 3 and 4. Paying out of pocket is actually good for revenue, as those poor sods have to pay for what is billed, not what is pre-negotiated through a third party. But those instances are relatively rare (except for some huge referral centers like Mayo and MD Anderson). Eliminating charity care, on the other hand, would be a huge boon to revenue. After all, what's worse than collecting 0%?
great thread & great points raised above! Lots of this comes down to economics and studying why things are the way that they are now, as well as how we can change incentives going forward.

re: those who are now uninsured -- I'd read a good article on this, point was that those who "choose" to be uninsured, do so for a handful of reasons; top on that list is that other expenses are more important than buying health insurance. If we mandate that a family buy health insurance, and the cost of this prevents them from purchasing food/clothing/bare necessities, that seems bad.

I'd consider this option intriguing (all conditions to be monitored by the gov't): what if those with no insurance, in return for exercising 5x per week, not smoking or drinking, actively bringing their weight to "approved" levels, not skydiving, riding a motorcycle, bungee-jumping, or doing "high-risk" activities, eating fruits and vegetables several times per day, etc, were "given" stripped down health insurance that covered basic necessities. Would people agree to give up some basic freedoms in return for health insurance?

regarding medicare rates, & the post above -- when you run a company, one basic calculation you have to do is determining what it costs you to run different aspects of your business to ensure they cover expenses. If you're McDonalds, what's the cost of staff, rent, equipment, and supplies per day divided by the cost per burger, and is this less than the selling price of the burger? I hope so! If not, you're losing money for every burger sold, and you'd make more money by selling less food.

This type of calculation is necessary to prevent bouncing employee paychecks, rent, etc. It truly is not an optional exercise. A physician needs to have someone who can do this on staff or on retainer (like an accountant). I'd contend the basic requirement for any physician to provide any benefit to a patient is to keep the doors open. If seeing more than 30% medicare/medicaid patients at current reimbursement rates would shut that physician's practice down, he or she has a duty to bring in the patient mix that will allow sufficient revenue to keep the practice running.

Another question is what level of compensation is appropriate -- it may seem "kind" to take care of any patient, regardless of ability to pay. But extend this out onto an annual pay basis -- if physicians were paid less than, say, teachers, would top notch candidates go into medicine given the sacrifices required of them to do so? If the average intellectual capabilities of applicants to med school decreased due to lower pay than other fields, how would this impact the health of the population? This stuff seems pretty complicated, and it's all tied together in one way or another.
 

bamtuba

10+ Year Member
Jul 6, 2006
1,899
3
Status
Medical Student
SOMEONE has to pay for EVERYTHING.

The ultimate reason for our current economic woes, insurance problems, credit/debt issues, etc. is that for too long our society has forgotten that you must pay for that which you receive.

The ONLY REAL solution? Providers request REASONABLE reimbursements. People only use the system WHEN THEY REALLY NEED IT. People pay for those services THEMSELVES. Drug companies charge REASONABLE rates for drugs, etc.

Those that need the services and can not pay, like it or not, must depend upon the kindness of those willing to help by providing services in free clinics, etc. This is likely why altruism (whether possible or not) is a sought-after commodity during the application process. This sucks. True. But the other solution of forcing people to pay until they can be bled no more makes EVERYONE poor except a select few. Like it or not, we don't really have it much better today. Maybe we would if people would stop traveling to freakin' third-world countries to look for those great "I helped people in poverty" experiences and started helping AT HOME! (not knocking the people, but rather the idea that one must go far away to make an impact/really learn what its like to live in absolute poverty and help those in need of care)

This will not happen and we can not fix the system through more government intervention via insurance or by telling people who have gotten rich at the expense of the system that they can no longer be greedy.

Oh, this also applies to college education, credit cards, and the housing market as well. Like any system of government, its really only as good as the people governing are wise.

It used to be the American "DREAM" to own a home because you either earned the money or you didn't.

Things may not have been "fair" but neither are things today.

We dug a hole. We will pay for it. Sooner or later.

Oh well.
 

MegaProjectile

10+ Year Member
Feb 10, 2009
912
1
Status
Medical Student
Having a single-payor system will destroy healthcare and close many doctor's offices. The medicare pay is TOO LOW, the paper work is terrifying and the wait to get paid is ridiculous. I strongly support having a public option and keeping private insurances. It keeps a nice mix while saving lives too. Either one or the other is too extreme.

Also the way health care is run in this country is wack. MRIs are golden tickets in a lot of medical practices leading to massive self-referrals and ballooning the health care deficit.
Also, cardiology became an business enterprise when stenting was discovered. Capitalism and profit incentives has led to innovative technologies but has only led to increase in cost. Until we remove the incentive to "cash-in", healthcare cost will continue to grow.