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.
