Vote No for the Medicare-Based Public Plan

[RussianJoo]

Hi guys just received an email from the ASA asking us to vote email or call our state senators to reject the Medicare-Based Public Plan. you can do this easily by going to this link and simply filling out your personal info it only takes a minute to send the email.. http://capwiz.com/asa/issues/alert/?alertid=13441936&type=CO

or you can call the capital switchboard at 202-224-3121 and ask for the offices of your U.S. Senators.

So please help out your own profession it's free and only takes a minute or less.


thank you.

For more info I am sure you can check out the ASA website.

---

Members don't see this ad.

 

[Gimlet]

Already done! I thought the pre-written message on the capwiz page could have done a bit better job emphasizing some points, so I reworded it a little before sending.

Thanks for posting it on here. Residents, don't forget to forward it to your colleagues!

Hi guys just received an email from the ASA asking us to vote email or call our state senators to reject the Medicare-Based Public Plan. you can do this easily by going to this link and simply filling out your personal info it only takes a minute to send the email.. http://capwiz.com/asa/issues/alert/?alertid=13441936&type=CO

or you can call the capital switchboard at 202-224-3121 and ask for the offices of your U.S. Senators.

So please help out your own profession it's free and only takes a minute or less.


thank you.

For more info I am sure you can check out the ASA website.

 

[Octagonecology]

Can you guys briefly state why your against it?

 

[mcgreen]

Can you guys briefly state why your against it?

the Senate Finance Committee and Senate Committee on Health, Education, Labor & Pensions (HELP) -- are reported to be considering mandatory physician participation in the public plan option.
Urge your Senators to reject any public plan option based on Medicare, and to allow physicians to voluntarily participate. -ASA

Currently Physician are allowed to choose whether they want participate in Medicare and how much of their practice is Medicare. By changing the Law the government is forcing them to take Medicare which often pays far less than private insurance.

This is a dangerous step toward Canadian style Socialized medicine where it is illegal to privately pay for medical care. Unlike the English system where there are private physicians and hospitals for the wealthy who do not want to endure the poor quality care, rationing and long waits that characterizes Socialized medicine.

 

[RussianJoo]

I just hope the spam filter doesn't pick up all these emails that our senators are going to get.. cause that would really suck.

 

[mcgreen]

I just hope the spam filter doesn't pick up all these emails that our senators are going to get.. cause that would really suck.

If you want to make your voice count, Pick up the phone and call them, but don't waste your time with the official numbers on their web site. You will just get voice mail and it will be deleted just like your email. Try to get the staff's real phone numbers and call them. Google your US congressman's official presses releases and call the numbers on the press release. You will get a real person since politicians always have time for the press. Alternatively Google the staff member's names and then try to get their contact info.

 

[GoodmanBrown]

This is a dangerous step toward Canadian style Socialized medicine where it is illegal to privately pay for medical care. Unlike the English system where there are private physicians and hospitals for the wealthy who do not want to endure the poor quality care, rationing and long waits that characterizes Socialized medicine.

I'm not necessarily for or against Obama's plan, but the statement above is completely false. Canada has private physicians and hospitals. It is not illegal to see a private doctor or visit a private hospital.

Second, your last sense sounds like some sort of Red-baiting propaganda from the McCarthy era. Tone it down a touch and maybe people can have an intelligent debate.

Oh, wait. This is the Anesthesiology forum...

The sky is falling! The sky is falling! Obama is the devil come to take us all!!!

 

[mcgreen]

I'm not necessarily for or against Obama's plan, but the statement above is completely false. Canada has private physicians and hospitals. It is not illegal to see a private doctor or visit a private hospital.

Second, your last sense sounds like some sort of Red-baiting propaganda from the McCarthy era. Tone it down a touch and maybe people can have an intelligent debate.

Oh, wait. This is the Anesthesiology forum...

The sky is falling! The sky is falling! Obama is the devil come to take us all!!!

Gordon Brown, Leader of the Labour Party ?

Does anybody believe Obama's new "public" health-insurance plan isn't really a bridge to single-payer government-run health care? And does anyone think this plan won't produce a government gatekeeper that will allocate health services and control prices and therefore crowd-out the private-insurance doctor/hospital system?

In Canada, If the public plan covers everything you could ever need, then it does not give one any choice of seeing a private doctors and getting private medical care if you are not allowed to provide services coved by the public plan.

Contrary to widespread public belief, it has been suggested that the public administration criterion does not prohibit private health care insurance.(8) Six provinces (Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island and Quebec) have, nonetheless, expressly prohibited private insurance from covering services insured under the provincial plan, in order to achieve the single public insurer model for health care. In those provinces, private health care insurance is only complementary to the public plans. Three of the four other provinces that permit private insurance coverage of provincially insured health services have economic disincentives that discourage physicians from opting out of public health care insurance plans; this, in turn, reduces the need for private insurance. In Nova Scotia, a physician who has opted out of the provincial plan is prohibited from charging fees that exceed the compensation provided by the public plan. In New Brunswick and Saskatchewan, an opted-out physician cannot be reimbursed by the provincial plan. Newfoundland and Labrador is the only province that both allows private insurance to cover services insured under its provincial health care insurance plan and does not use other means to discourage physicians from opting out of the public plan.(9) As a result of provincial (not federal) legislation in most provinces, there is no parallel, private insurance sector that competes with public insurance for the funding of health services covered under the Canada Health Act.
The accessibility criterion is another principle of the Canada Health Act which, supported by the user charge and extra-billing provisions, expressly restricts private funding for publicly insured health services. In order to receive the full CHT cash contribution to which they are entitled, provinces may not require that individuals make a financial contribution in order to obtain services covered under provincial health care insurance plans.(10) Provinces that allow user charges and extra-billing are subject to mandatory dollar-for-dollar deductions from federal CHT transfers. Between 1994-1995 and 2003-2004, financial penalties totalling almost $9 million were deducted from federal transfers to the provinces that permitted user charges and extra-billing.(11)-PRIVATE HEALTH CARE FUNDING AND DELIVERY UNDER THE CANADA HEALTH ACT

 

[jwk]

I'm not necessarily for or against Obama's plan, but the statement above is completely false. Canada has private physicians and hospitals. It is not illegal to see a private doctor or visit a private hospital.

Second, your last sense sounds like some sort of Red-baiting propaganda from the McCarthy era. Tone it down a touch and maybe people can have an intelligent debate.

Oh, wait. This is the Anesthesiology forum...

The sky is falling! The sky is falling! Obama is the devil come to take us all!!!

Clearly clueless.

 

[Jeff05]

you are absolutely wrong. it is most definitely illegal to opt out in the majority of provinces in canada. that's why so many canadians are coming down to the states for prompt care. do your homework. i'm including a reference (one of MANY).

as far as the sky is falling - it is. not just for us, but for many productive upper middle class citizens of the USA. i won't rehash the well trampled arguments, but if you love giving away all of your money for the "common good" - you're in the right place. once you actually WORK in this field (medicine) and see how pitifully we are compensated for some of the MOST extensively educated specialized stressful labor (ever), you'll change your tune.

or maybe you won't. then, i salute you, and invite you to donate 60% of your borguasie profits to the people. but, if it's ok with you, i'll keep some of mine.

it's a shame that we never learn from our mistakes. this time it's gonna be different! right?


http://www.cmaj.ca/cgi/content/full...STINDEX=0&volume=164&issue=6&journalcode=cmaj

I'm not necessarily for or against Obama's plan, but the statement above is completely false. Canada has private physicians and hospitals. It is not illegal to see a private doctor or visit a private hospital.

Second, your last sense sounds like some sort of Red-baiting propaganda from the McCarthy era. Tone it down a touch and maybe people can have an intelligent debate.

Oh, wait. This is the Anesthesiology forum...

The sky is falling! The sky is falling! Obama is the devil come to take us all!!!

 

[GoodmanBrown]

you are absolutely wrong. it is most definitely illegal to opt out in the majority of provinces in canada. that's why so many canadians are coming down to the states for prompt care. do your homework. i'm including a reference (one of MANY).

Jeff05, your reference was from 2001. In 2005, the Canadian Supreme Court ruled that Quebec couldn't prohibit private physicians from billing their patients for healthcare already covered by Canadian Medicare. That ruling still stands, though, as in the U.S., it takes time to see how judiciary rulings actuallly affect the way things run. Admittedly, there's still staunch opposition to privately funded healthcare in the provincial governments.

I'm not saying that Canada's healthcare system doesn't have problems. McGreen's reference is more up to date, and gives some details (including those in his post) that I didn't have a full understanding of. (And I'm sure still don't.)

However, I'm still not convinced that Canada's healthcare system is the the end of the world. It provides a lot of folks with good, baseline coverage which has been shown repeatedly to improve the overall health of a population. I'll readily agree that Canadians don't get ortho surgery nearly as quickly as Americans have the privilege of getting. I'll also openly admit that the most cutting-edge cancer treatments are probably not being given in Canada.

As for compensation and taxes overall, I just don't know how I feel about that. Yes, doctors work hard, and yes, they certainly trained a hella-long time to do what they do. Props to them for that. I hope to do the same one day. But other people work hard too, and don't make nearly as much money. Most PhD folks take almost the same amount of time for schooling. I have a friend who expects to work 6 years on her anthropology PhD because you have to spend a year or two on some archeological site before coming back and writing your dissertation. So, she'll be in school almost as long as an internist. When she comes out, she's looking at tops 80-90K for a professorship (providing she can find one). Then she has to crank out a good amount of research for a good while to ensure she can keep her job.

All in all, I think docs have it pretty good here and in Canada. You can say you deserve more and are being abused by the system, but I have a hard time believing it. I guess I'll see personally in a few years and maybe my story will change. I doubt it though.

 

[RabbMD]

To med students. Currently medicare sets rates based almost exclusively on special interest lobbying. The rates for anesthesia units nation wide run around $20/unit. In most states the medicaid rates are even worse, ir $13-$15/unit. The rates from private insurance companies run around $50-60/unit. This translates into for doing the exact same case and getting 150% more payment for a private insurance case versus a medicare case. Now, I do not know of any job where the only way you get paid is accept whatever the government mandates you accept. Enlighten me of any of which you know.

However, I have no trust in the government to suddenly increase their payments for anesthesia services once they establish a legalized monopoly. In fact if you want to cut some health care costs one sure fire way to do it is to create a legalized monopoly, and then drive DOWN the costs you pay to your suppliers (doctors). In normal business if a company cuts the rates it will pay to their suppliers, the suppliers just search around for another customer. That is their right, and that is what sets the market prices for their products. However, once you legislate away their right to search for other companies, then you are in essesnce giving them one choice only. That choice is either quit the field entirely, or accept whatever payment we (the government in this case) decides to give you.

I would love to see government come in and set the rates attourneys could charge for setting up wills, negotiating divorces, going through probate. Then make it so that the attournies have to accept the government rates. Imagine the outcry.

 

[pseudoknot]

I find it hilarious that you people have so much faith in markets and competition, and believe despite evidence to the contrary that government run healthcare is always less efficient and lower quality--and yet you don't think your wonderful private insurance plans will be able to outcompete the terrible, incompetent government. The only discussion currently is whether to have a public OPTION alongside the private market, no mandates, no tax subsidies.

 

[seinfeld]

Decreased Compensation + increased cost of education + increased mandates = less physicians = less access to care. This is regardless the specialty you practice.

The shame about medicare is that in fact its overhead is the least among insurers. Its interesting that most Private insurers can pay physicians better and still make their shareholders happy and have double the overhead expenses.

 

[pillowhead]

As for compensation and taxes overall, I just don't know how I feel about that. Yes, doctors work hard, and yes, they certainly trained a hella-long time to do what they do. Props to them for that. I hope to do the same one day. But other people work hard too, and don't make nearly as much money. Most PhD folks take almost the same amount of time for schooling. I have a friend who expects to work 6 years on her anthropology PhD because you have to spend a year or two on some archeological site before coming back and writing your dissertation. So, she'll be in school almost as long as an internist. When she comes out, she's looking at tops 80-90K for a professorship (providing she can find one). Then she has to crank out a good amount of research for a good while to ensure she can keep her job.

You really will not get it until you start residency. I used to think along the same lines, too, even through medical school. My husband is finishing his PhD in the sciences, and I know he works hard. But the stress level of having to finish your own dissertation vs. being yanked out of bed at 3:45am after laid down to finally sleep at 3:30am after deciding you would rather sleep than eat (even though you hadn't eaten since before noon that day because you were so busy) with a pregnant patient who came in with no prenatal care and is at 9cm with two previous c-sections with unknown scars (meaning a vaginal birth is life threatening and five other children meaning this kid is coming and coming quick) and a horrible looking airway so general anesthesia leaves you quivering in your boots. And if something goes wrong, you still open to a mulit-million dollar lawsuit even though this patient won't pay you anything for your work. This EXACT thing happened to me two nights ago.

Then do the above every third night for two months straight which means you never even have an actual weekend off. You'll start taking Pepcid all the time for gastritis (this coming from someone that never even took a Tums before residency) and argue with your family all the time from sheer exhaustion. While your friends of a similar age are buying houses and having kids, you'll still be renting and be grateful you can (just about) take care of a dog (IF you're married) and hoping your eggs make it to the end of residency (if you're female). And you'll have hundreds of thousands to dollars of debt to boot which the PhD student definitely doesn't have (any decent PhD student at a real university in real field of study should be totally self-funded).

So I would argue, all of the above is just a little more stressful and quite frankly a little more important than having to "crank out a good amount of research for a good while to ensure she can keep her job." Again, no disrespect to the academics and PhDs out there...my husband is one and plans on remaining in academics for the rest of his life. Because after a few years, he'll pull in about $100,000 and have basically have weeks of summer, winter, and spring vacation every year while showing up to work at 9am everyday and pulling an all nighter before a paper is due a few times a year. Most the professors in his department spend every summer abroad "teaching" some BS undergrad course so they can travel all the time on the university's dime. Sounds pretty good to me.

(Disclaimer: I usually love my work and love what I do. But I can't stand this BS of other people claiming that other professions work just as hard as doctors do. They DO NOT. Even IF they put in the same number of hours (and generally, they DO NOT) the stress level is nowhere near the same when you are acutely responsible for someone's life or two lives as in OB. Except maybe military seals and folks of that ilk. I'm sure they have us beat.

 

[Octagonecology]

even though this patient won't pay you anything for your work.

This is where I get confused. With the public option insurance program, in cases like the above you would get paid for your work, even if it is at the Medicare re-imbursement level.

Wouldn't you prefer to get that as opposed to nothing at all?

 

[periopdoc]

As for compensation and taxes overall, I just don't know how I feel about that...

I have a friend who expects to work 6 years on her anthropology PhD... So, she'll be in school almost as long as an internist. When she comes out, she's looking at tops 80-90K for a professorship (providing she can find one). Then she has to crank out a good amount of research for a good while to ensure she can keep her job.

When your friend screws up it sets back our understanding of an ancient civilization. When the internist screws up, somebody dies several years earlier than he should have. And you aren't sure that the internist should be paid just 20-30 k more????

- pod

 

[BLADEMDA]

This is where I get confused. With the public option insurance program, in cases like the above you would get paid for your work, even if it is at the Medicare re-imbursement level.

Wouldn't you prefer to get that as opposed to nothing at all?

Here is the answer:

It depends on the practice.

Many of you did well in math. So, scenario one is a practice where 50% of patients have private insurance at $60 per unit. 20% of patients have HMO at $50 per unit. 20% more have Medicare at $20 per unit. 5% have Medicaid at $13 per unit while the remaining 5% have no insurance at all.

If you are a partner in scenario one do you want a single payer system at $20 per unit? Plus, what makes you think the government will keep paying $20 per unit indefinitely? $13 per unit is more likely.

As for Public/private plans existing side by side that is pure political B.S. Many, if not most, patients will leave their private plans if the government plan saves them money while access remains the same.

 

[periopdoc]

I find it hilarious that you people have so much faith in markets and competition ... and yet you don't think your wonderful private insurance plans will be able to outcompete the terrible, incompetent government.

I have every faith that the private system can outcompete the government on a level playing field. However, when the government legislates an uneven field it can force unprofitability onto even the most lean private insurance. No one can compete with a governmental monopoly.

The only discussion currently is whether to have a public OPTION alongside the private market, no mandates, no tax subsidies.

And where is the OPTION for physicians to not provide care if the government continues to pay an unprofitable rate? Lets be honest, the ultimate goal of this administration, for good or for bad, is a single payor system. This "current discussion" about "a public option" is just political gamesmanship to debate a single payor system without openly using the single payor vocabulary. If necessary, the administration will accept a "public option" as a mechanism to further develop a governmental monopoly and drive insurance out of the market, but keep in mind the goal is a single payor system.

Mandating participation of physicians into providing care for an increased population of unsustainably underpaying patients will only hurt health care overall. It is not profitable to provide care to medicare patients, in many cases we lose money by providing care for them. In the current system, medicare patients are indirectly subsidized by the monies that are collected from private insurance patients. If/ when you reduce the pool of private insurance patients, you reduce the ability of systems to absorb the cost of the medicare patient. Ultimately, you end up in a situation where it is impossible to profitably provide care unless governmental payment increase substantially.

- pod

 

[ProRealDoc]

Here is the answer:

It depends on the practice.

Many of you did well in math. So, scenario one is a practice where 50% of patients have private insurance at $60 per unit. 20% of patients have HMO at $50 per unit. 20% more have Medicare at $20 per unit. 5% have Medicaid at $13 per unit while the remaining 5% have no insurance at all.

If you are a partner in scenario one do you want a single payer system at $20 per unit? Plus, what makes you think the government will keep paying $20 per unit indefinitely? $13 per unit is more likely.

As for Public/private plans existing side by side that is pure political B.S. Many, if not most, patients will leave their private plans if the government plan saves them money while access remains the same.

Therein lies the crux of the issue. The govt will ensure it provides a much cheaper alternative to health insurance than any current private company can. Walmart, anyone?

 

[RussianJoo]

that's great lots of discussion on this thread.. i just hope all of you remembered to send the email to your senator.

 

[ProRealDoc]

May 29 (Bloomberg) -- Senator Edward Kennedy, chairman of a Senate panel drafting a health-care overhaul, is circulating a plan that would require everyone to have insurance and would create a government program to compete with private insurers, said people familiar with the plan.
The proposal would pay health-care providers participating in a public plan 10 percent more than they would get under Medicare, according a summary provided by the people.
Kennedy, a Massachusetts Democrat and chairman of the Health, Education, Labor and Pensions Committee, said in an op- ed piece yesterday in the Boston Globe that a key way to expand health-care coverage to the 46 million uninsured Americans is through a new program run by the U.S. government.
"An important foundation of our legislation is the following principle: If you like the coverage you have now, you keep it," Kennedy wrote. "But if you don't have health insurance or don't like the insurance you have, our bill will give you new, more affordable options."
Kennedy's plan would require employers to provide health insurance or pay a subsidy to help support the public plan, according to the summary. It would set a federal standard for Medicaid, the federal program for the poor, to cover people who earn up to 150 percent of the poverty level. States currently set their own standards for coverage.
CHIP Program
The Kennedy proposal expands the Children's Health Insurance program to cover people up to age 26, from age 18 under the current plan, according to the summary. It also outlined the creation of a "Medical Advisory Council," a body like the Federal Reserve that would help set minimum benefits for a public plan.
Kennedy's proposals might go further than another plan being drafted by Senate Finance Committee Chairman Max Baucus. Baucus, a Montana Democrat, has said he is weighing whether to include a government-run program in a measure and, if so, how it might be structured to attract Republican votes and industry support.
Baucus spokeswoman Erin Shields said in an e-mail yesterday that he is "working very closely" with Kennedy's panel and that Baucus is "confident they will be able to reach agreement on one package before it is considered by the full Senate this summer."
Kennedy's panel yesterday released a preliminary schedule for considering his legislation, with work to begin June 16.
‘Moving Target'
"These dates are a moving target," Anthony Coley, a Kennedy spokesman, said yesterday. Coley declined to comment on Kennedy's proposals, saying the senator's words in the Boston Globe article "speak for themselves."
Kennedy last week joined 27 other Senate Democrats in co- authoring a resolution calling for creation of a "public option" of government-run health insurance. Others included Senator Richard Durbin of Illinois, the No. 2 Democratic leader in the chamber, and Senator Charles Schumer of New York, the third-ranking Democratic leader.
Some insurance companies, including Hartford, Connecticut- based Aetna Inc., argue that private corporations would be at a disadvantage under a plan that would, in effect, extend Medicare, the U.S. government health plan for the elderly and disabled, to more people. Aetna says it pays an extra $89 billion a year to providers to make up for "underpayments" from patients covered by existing government programs.
Split the Parties
The issue has the potential to split the political parties in this year's debate over one of President Barack Obama's top domestic priorities. His budget request for 2010 sets aside $634 billion over 10 years to pay for a health-care overhaul.
In a telephone conference call yesterday with volunteer supporters, Obama said it is vital that Congress act this year or the opportunity for broad-based changes will slip away.

"I think the status quo is unacceptable and that we've got to get it done this year," Obama said during the call arranged by the Democratic National Committee. "If we don't get it done this year we're not going to get it done."
Nancy LeaMond, executive vice president of the AARP retirees' lobby, said her group's efforts to build "political will and trust across ideological lines" to pass a health-care overhaul "have led up to this moment -- it's time to get it done."
Senator Charles Grassley of Iowa, the finance panel's top Republican, opposes including a government-run program.
Senator Jon Kyl of Arizona, the No. 2 Senate Republican leader and a member of the finance committee, this week said inclusion of any public program also would lose his support.
Computer ‘Gateways'
In his Boston Globe article, Kennedy said he wanted to let the uninsured and others purchase affordable coverage at group rates through computer "gateways" that would allow comparison shopping. He said he favored barring insurers from excluding coverage for pre-existing conditions and from placing "other restrictions" on consumers. Kennedy said he would back some measures of effectiveness for medical procedures and products to boost efficiency in health care.

 

[Coastie]

So, Obama's plan isn't to revamp healthcare by diminishing bureaucracy or eliminating the string of middle-men which separate the physician-patient relationship, it's to create a gov't run-taxpayer subsidized program which adds multiple layers of bureaucracy to an already overladen system?

In other words, why create a need for personal responsibility amongst the populace for their own healthcare needs when you can steal from peter to pay paul? Who needs to make decisions and tough choices when the government can do it for you? How do we pay for such a utopia?

Simple: tax the most productive members of society to subsidize the laziness and poor choices of the lower members of society. If you're in the lower bracket, why work hard, why make wise decisions, and why sacrifice when everything you need to remain comfortable is handed to you via government theft in the name of "the greater good"?

Liberty at it's finest, folks. Get the gov't more involved in our lives, and reap the benefits. All hail Chairman Maobama.

May 29 (Bloomberg) -- Senator Edward Kennedy, chairman of a Senate panel drafting a health-care overhaul, is circulating a plan that would require everyone to have insurance and would create a government program to compete with private insurers, said people familiar with the plan.
The proposal would pay health-care providers participating in a public plan 10 percent more than they would get under Medicare, according a summary provided by the people.
Kennedy, a Massachusetts Democrat and chairman of the Health, Education, Labor and Pensions Committee, said in an op- ed piece yesterday in the Boston Globe that a key way to expand health-care coverage to the 46 million uninsured Americans is through a new program run by the U.S. government.
"An important foundation of our legislation is the following principle: If you like the coverage you have now, you keep it," Kennedy wrote. "But if you don't have health insurance or don't like the insurance you have, our bill will give you new, more affordable options."
Kennedy's plan would require employers to provide health insurance or pay a subsidy to help support the public plan, according to the summary. It would set a federal standard for Medicaid, the federal program for the poor, to cover people who earn up to 150 percent of the poverty level. States currently set their own standards for coverage.
CHIP Program
The Kennedy proposal expands the Children's Health Insurance program to cover people up to age 26, from age 18 under the current plan, according to the summary. It also outlined the creation of a "Medical Advisory Council," a body like the Federal Reserve that would help set minimum benefits for a public plan.
Kennedy's proposals might go further than another plan being drafted by Senate Finance Committee Chairman Max Baucus. Baucus, a Montana Democrat, has said he is weighing whether to include a government-run program in a measure and, if so, how it might be structured to attract Republican votes and industry support.
Baucus spokeswoman Erin Shields said in an e-mail yesterday that he is "working very closely" with Kennedy's panel and that Baucus is "confident they will be able to reach agreement on one package before it is considered by the full Senate this summer."
Kennedy's panel yesterday released a preliminary schedule for considering his legislation, with work to begin June 16.
‘Moving Target'
"These dates are a moving target," Anthony Coley, a Kennedy spokesman, said yesterday. Coley declined to comment on Kennedy's proposals, saying the senator's words in the Boston Globe article "speak for themselves."
Kennedy last week joined 27 other Senate Democrats in co- authoring a resolution calling for creation of a "public option" of government-run health insurance. Others included Senator Richard Durbin of Illinois, the No. 2 Democratic leader in the chamber, and Senator Charles Schumer of New York, the third-ranking Democratic leader.
Some insurance companies, including Hartford, Connecticut- based Aetna Inc., argue that private corporations would be at a disadvantage under a plan that would, in effect, extend Medicare, the U.S. government health plan for the elderly and disabled, to more people. Aetna says it pays an extra $89 billion a year to providers to make up for "underpayments" from patients covered by existing government programs.
Split the Parties
The issue has the potential to split the political parties in this year's debate over one of President Barack Obama's top domestic priorities. His budget request for 2010 sets aside $634 billion over 10 years to pay for a health-care overhaul.
In a telephone conference call yesterday with volunteer supporters, Obama said it is vital that Congress act this year or the opportunity for broad-based changes will slip away.

"I think the status quo is unacceptable and that we've got to get it done this year," Obama said during the call arranged by the Democratic National Committee. "If we don't get it done this year we're not going to get it done."
Nancy LeaMond, executive vice president of the AARP retirees' lobby, said her group's efforts to build "political will and trust across ideological lines" to pass a health-care overhaul "have led up to this moment -- it's time to get it done."
Senator Charles Grassley of Iowa, the finance panel's top Republican, opposes including a government-run program.
Senator Jon Kyl of Arizona, the No. 2 Senate Republican leader and a member of the finance committee, this week said inclusion of any public program also would lose his support.
Computer ‘Gateways'
In his Boston Globe article, Kennedy said he wanted to let the uninsured and others purchase affordable coverage at group rates through computer "gateways" that would allow comparison shopping. He said he favored barring insurers from excluding coverage for pre-existing conditions and from placing "other restrictions" on consumers. Kennedy said he would back some measures of effectiveness for medical procedures and products to boost efficiency in health care.

 

[Deanmonster]

at what point are we "ethically" allowed to strike? Obviously not yet, but if things continue in the single payer direction, we will eventually simply be government employees and our ethical standpoint of putting the patient's welfare above our own will no longer hold true. At that point isn't the government obligated to keep its employees (us) happy to take care of its people?

 

[sweetalkr]

at what point are we "ethically" allowed to strike? Obviously not yet, but if things continue in the single payer direction, we will eventually simply be government employees and our ethical standpoint of putting the patient's welfare above our own will no longer hold true. At that point isn't the government obligated to keep its employees (us) happy to take care of its people?

strike? LOL. i love your enthusiasm bro, but only 15% of your colleagues have the ballz to donate to the ASAPAC. that requires a pen, check, and a stamp to fight for our cause. a strike would draw 15 people, and half of those would be the spouses of the 8 anesthesia personell on strike. and one person's spouse would divorce them for striking!

 

[ProRealDoc]

at what point are we "ethically" allowed to strike? Obviously not yet, but if things continue in the single payer direction, we will eventually simply be government employees and our ethical standpoint of putting the patient's welfare above our own will no longer hold true. At that point isn't the government obligated to keep its employees (us) happy to take care of its people?[/QUOTE]

No but if you don't like it you could start a revolutionary war.

 

[TheTickets]

Can we really start a war?!

 

[pseudoknot]

Can we really start a war?!

Surely sedition violates the SDN terms of service, right???

 

[racerx]

strike? LOL. i love your enthusiasm bro, but only 15% of your colleagues have the ballz to donate to the ASAPAC. that requires a pen, check, and a stamp to fight for our cause.

It doesn't even take that anymore! I just donated online. It took me 2 minutes and my bank card.

 

[kmurp]

"Many of you did well in math. So, scenario one is a practice where 50% of patients have private insurance at $60 per unit. 20% of patients have HMO at $50 per unit. 20% more have Medicare at $20 per unit. 5% have Medicaid at $13 per unit while the remaining 5% have no insurance at all."


God, I wish that we had as good a payor mix as that...

 

[tennisnr]

I'm a soon to be 4th year trying to figure all this out. I'm interested in Anes but some of this stuff is scaring me.

couple questions I have:

1) If medicare pays 33% of private insurance why hasn't private insurance lowered it's reimbursements seeing that they don't need to keep paying as much as they are?

2) The whole concern right now seems to be the mandatory physician participation. But currently according to AAMC careers in medicine 48% of our payer mix is private and 42% is already medicare/medicaid, 10% uninsured. If in the long run the govt runs private insurance companies out of business (which seems unlikely and seems like they don't entirely want to do that) and you have more ppl moving to govt insurance you get a payer mix of 80% govt (10% which came from uninsured and is a benefit), 20% private....yes it will decrease the avg private anes salary from 314k (which is one of the higher ones) drops to 215K (which isn't terrible, but yes it is a pay cut for working the same amt)... unless the time based reimbursement model changes. But again the 80% medicare pie seems unlikely...

3) If anyone has anything to add please message me or reply as I'm only a 4th yr that's not in the field yet trying to figure things out.

Thanks

 

[Leverage]

I'm a soon to be 4th year trying to figure all this out. I'm interested in Anes but some of this stuff is scaring me.

couple questions I have:

1) If medicare pays 33% of private insurance why hasn't private insurance lowered it's reimbursements seeing that they don't need to keep paying as much as they are?

2) The whole concern right now seems to be the mandatory physician participation. But currently according to AAMC careers in medicine 48% of our payer mix is private and 42% is already medicare/medicaid, 10% uninsured. If in the long run the govt runs private insurance companies out of business (which seems unlikely and seems like they don't entirely want to do that) and you have more ppl moving to govt insurance you get a payer mix of 80% govt (10% which came from uninsured and is a benefit), 20% private....yes it will decrease the avg private anes salary from 314k (which is one of the higher ones) drops to 215K (which isn't terrible, but yes it is a pay cut for working the same amt)... unless the time based reimbursement model changes. But again the 80% medicare pie seems unlikely...

3) If anyone has anything to add please message me or reply as I'm only a 4th yr that's not in the field yet trying to figure things out.

Thanks

This debate is going on in nearly every field in medicine. It is far from unique to anesthesia. Why wouldn't the govt cut reimbursement to all doctors in all fields?

Going into another feild will help very little. Best case senerio you might see primary care reimbursment increase but I doubt it. More likely, all feilds come down to primary care level or less.

Bottom line- I wouldn't even have this as a factor in applying to which every feild you enjoy...But I would be considering this if I was thinking about the good old MCAT and applying to medical school (debt load). I havn't done the math but i imagine soon it might not be very smart to go to medical school with debt you generate and with income falling. Anyone done the math on this??

 

[McPoyle]

I feel like this puts people like me in a precarious situation. I will be an M1 this August, OOS tuition will leave me with roughly 210-220k in medical school debt in addition to ~70k combined for the wife and I's undergrad. While this seems like a staggering amount of debt to me, especially for something that has no tangible value if things go poorly, I can't "sell" my degree as I could my house for instance, when put in context of compensation packages I see thrown around I feel this is a manageable amount and surely worth it if the specialty provides a satisfying career and lifestyle.

With that said, as I approach beginning medical school this summer, I feel that on some level I am gambling on the hope that things I hear you all lobbying vehemently against do not transpire... Although I did see a glimmer of hope the other day in an article stating that Obama's healthcare "plan" neccessitated being done beofre the end of the year or even he felt it would never get done. Any thoughts on this?

Also, do you think that fellowship training (CCM for instance) would buffer individuals against the effects of the impending "change"?

 

[cleansocks]

Widespread medicare will cut healthcare costs by reducing physician salaries. However, physician salaries amount to less than 2% of total healthcare costs, while administrative costs amount to over 30% (http://content.nejm.org/cgi/content/short/349/8/768). Reducing these costs through insurance company regulation, tort reform, and FDA approval reform would be much more productive than moving towards an expensive mass medicare system that only serves to reduce part of 2% of the cost of healthcare.

Additionally, medicine is an extremely difficult job that requires the best and the brightest; removing incentives for these individuals to go into healthcare will be detrimental to our system. Additionally, paying anyone with such immense responsibilities an amount that encourages them to practice volume- rather than quality-based medicine will reduce the quality of healthcare to those who receive it. Mediocre care and mismanagement will prevail.

Additionally, while private insurance is currently excessively expensive, it does provide 2 major benefits. 1. It forces competition among insurance carriers and among hospitals towards the goal of patient satisfaction, and 2. It allows for the private sector to fund US R&D of healthcare technology and pharmacology (something the government will never do). Regulation rather than elimination of private insurance will allow us to reduce costs while maintaining these benefits that are truly unique to the US system.

Therefore, please do not endorse expanding and strengthening medicare when more effective and less detrimental solutions exist. Instead, encourage tort reform to reduce extremely costly defensive medicine, private insurance regulation rather than extinction, and FDA approval process reform such that the expensive R&D that occurs in this country is not geared towards useless, expensive pharmacology or technology.

 

[pseudoknot]

Widespread medicare will cut healthcare costs by reducing physician salaries. However, physician salaries amount to less than 2% of total healthcare costs, while administrative costs amount to over 30% (http://content.nejm.org/cgi/content/short/349/8/768).

Physician salaries amount to over 20% of US healthcare spending. See this report:
http://www.kff.org/insurance/upload/7670_02.pdf

Also, the idea of a public system is not to reduce physician salaries, it is to reduce administrative costs, which are substantially lower in Medicare and the Canadian system than they are in private systems (see the link that you posted, which was advocating a public healthcare system).

In fact, there is no reason to assume that a public option in the proposed reform would have reimbursement as low as medicare's.

 

[cleansocks]

Physician salaries amount to over 20% of US healthcare spending. See this report:
http://www.kff.org/insurance/upload/7670_02.pdf

Also, the idea of a public system is not to reduce physician salaries, it is to reduce administrative costs, which are substantially lower in Medicare and the Canadian system than they are in private systems (see the link that you posted, which was advocating a public healthcare system).

In fact, there is no reason to assume that a public option in the proposed reform would have reimbursement as low as medicare's.

Physician/clinical services do not equal physician salaries; in fact physician salaries amount to a very small portion of physician/clinical services (ie. 10% of that 21.4%, or 2% of total healthcare costs - the major costs of physician/clinical services are SG&A and legal). This is what I have learned in my own experience, at least. But I was curious and some articles cite that physician salaries can amount to as much as 50% of physician/clinical services' income statements' operating costs, so that would be 10% of total healthcare costs.

Perhaps it is not its purpose, and it would certainly reduce administrative costs, which would be very useful and important, but a public system would also reduce physician salaries substantially towards levels akin to every other public healthcare system on earth, with the consequences that I mentioned earlier (mediocre care, mismanagement by a volume-based practice and a growing % of mid-levels), not to mention the other consequences (no more funding for tech/pharma, no more competition for patients by hospitals, plans).

 

[Leverage]

I feel like this puts people like me in a precarious situation. I will be an M1 this August, OOS tuition will leave me with roughly 210-220k in medical school debt in addition to ~70k combined for the wife and I's undergrad. While this seems like a staggering amount of debt to me, especially for something that has no tangible value if things go poorly, I can't "sell" my degree as I could my house for instance, when put in context of compensation packages I see thrown around I feel this is a manageable amount and surely worth it if the specialty provides a satisfying career and lifestyle.

With that said, as I approach beginning medical school this summer, I feel that on some level I am gambling on the hope that things I hear you all lobbying vehemently against do not transpire... Although I did see a glimmer of hope the other day in an article stating that Obama's healthcare "plan" neccessitated being done beofre the end of the year or even he felt it would never get done. Any thoughts on this?

Also, do you think that fellowship training (CCM for instance) would buffer individuals against the effects of the impending "change"?[/QUOTE]

Not a chance

 

[RabbMD]

Physician salaries amount to over 20% of US healthcare spending. See this report:
http://www.kff.org/insurance/upload/7670_02.pdf

Also, the idea of a public system is not to reduce physician salaries, it is to reduce administrative costs, which are substantially lower in Medicare and the Canadian system than they are in private systems (see the link that you posted, which was advocating a public healthcare system).

In fact, there is no reason to assume that a public option in the proposed reform would have reimbursement as low as medicare's.

So anesthesiologists that currently receive payments from medicare equal to only 36% of what they receive from private insurers are supposed to just jump for joy at the idea of the creation of universal medicare? Find a lawyer who would voluntarily sign up for a government mandated 64% pay decrease and I will take my medicine as well. Most people do not disagree that health care has sustainability issues, we are just arguing on this anesthesiology forum three things:

1). Doctor salaries are a very small part of health care costs (2-20% depending on how you define it is the money that actually goes to doctors LLPs, S corporations, ect to pay all their staff and overhead or what actually goes into their pockets after expenses).

2). Anesthesiologists are likely to be disproportionally hit by changes to a medicare based plan because currently there is a drastic split between medicare ($20/unit) and private insurance companies ($50-60$/unit) in what they pay for anesthesia services.

3). Any creation of a federal public option will over time through legal right to arbitrarily set payment rates and legally refuse non-participation of anesthesiologists with their arbitrary rates be able to undercut private insurance companies rates charged to to the public and create a defacto monopoly. This is regardless of how "efficient" the government payer is because they can legally just keep ratcheting down their costs by incrementally decreasing physician reimbursement.

If you disagree with any of these points or conclusions please state how?

 

[pseudoknot]

creation of universal medicare

That is not what is being proposed. That is a straw man argument.

 

[RabbMD]

That is not what is being proposed. That is a straw man argument.

So I am assuming that you disagree with the assertion that creation of an open to the entire public medicare based system would eventually lead to a single payer run by the government?

I think it will based on the following logical steps. If you see flaws in them feel free to point them out.

1). The only reason to create an open access medicare based plan (ie open medicare to anyone) is to lower the costs of premiums to the business world. This would allow employers to switch from bluecross XYZ to medicare XYZ health plan and realize cost savings. The only other reason to expand medicare would be to covered those currently uninsired. Our current funding of medicare faces a significant shortfall without raising taxes. Without getting more employers to pay into medicare where would these additional funds come from?

2). Once medicare starts lowering costs to employers they will get more market share as long as they provide approximately the same level and quantity of service. By requiring participation, they ensure the same service providers. More market share means more bargaining power, plus as stated above they could require health care providers to participate at whatever rates they deign to pay providers. Once they reach a critical mass of say 90% market share, they would have a defacto monopoly on payment to providers. The only protection we have against monopolies is the court system, how would the courts decide against a government monopoly?

3). Once they have monopoly power, what is to prevent them from further cutting payments to providers? One could assume the government is good and looks out for the interest of all people and would not do something underhanded like that, but the fact that 45% of american currently pays less than or equal to $0 in income tax is not evidence that to me supports that hypothesis. Diversification states it is not good to put all of one's eggs in one basket, and trusting in a government health monopoly to efficeintly and adaquately price fix for services is not something I trust.

So I oppose the initial step as described above, establishment of a medicare based publically available plan with required doctor participation.

 

[pseudoknot]

So I oppose the initial step as described above, establishment of a medicare based publically available plan with required doctor participation.

Again, I don't think that the current plans for a public program include that it is "based on medicare" (it has been discussed that payments would have to be substantially higher and not based on the flawed SGR method), nor marketed solely to employers, nor that it would have required participation by anyone. These are all things that one can legitimately take issue with (and lobby against), but they are not inherent to the creation of a public plan.

 

[RabbMD]

And if you look at the title of this thread it is just based on lobbying against a medicare based public plan. That is a real option being discussed in committee. That is what people here are posting about.

 

[Frank Rizzo]

VAMC = a not so small scale gov't 'public-plan' for vets. A model of efficiency!

 

[JHopRevisit]

Something we can all agree on:

Today, the AMA, the insurance industry, the pharma trade group, and a few other organizations released some more BS "we're behind reform until sh** really hits the fan" letters.

There is one interesting part, however. The headline topic of the insurance industry's part of the plan involves simplifying billing and administration for us and patients. It's about damn time. They sound vaguely serious about simplifying things for us:
For the summary: http://blogs.wsj.com/health/2009/06/01/health-cost-control-docs-hospitals-insurers-labor-industry/
For the actual document: http://www.ama-assn.org/ama1/pub/upload/mm/31/stakeholders-to-obama.pdf

If you're already gonna bother your congressman, for or against the public plan, at least throw in a shout out about how necessary this is.