What if the government makes turning down Medicare patients illegal for doctors?

[randombetch]

We just passed a bill that plans on making it illegal for health insurance companies to deny coverage for those with pre-existing conditions. It seems to me that making it illegal to turn down Medicare patients wouldn't be much harder. Is this feasible?

Of course, then doctors would try their best to move out of the poorest neighborhoods with the highest percentages relying on Medicare. And only the doctors who can't find jobs would end up in the poorest neighborhoods, furthering the disparity between the health care quality received by the rich and the poor.

---

Members don't see this ad.

 

[Drrrrrr. Celty]

Hmm well since we can now force health care onto people. It would be just as easy to force it onto the doctors who people see as over paid and greedy. Not to mention the AMA will likely support such legislation....

Seppuku?

 

[randombetch]

Hmm well since we can now force health care onto people. It would be just as easy to force it onto the doctors who people see as over paid and greedy. Not to mention the AMA will likely support such legislation....

Seppuku?

I'm serious though! I'm really starting to reconsider medicine since it looks like we're on a path to socialistic medicine.

 

[circulus vitios]

Move to another country. The UK has socialist medicine but at least it pays well.

 

[Drrrrrr. Celty]

I'm serious though! I'm really starting to reconsider medicine since it looks like we're on a path to socialistic medicine.

Like I said. Have a backup, i've been doing tons of research in what I can do. I'm looking towards criminology or social psychology and then work on books and possibly advertisements or something like what psychologists who work for MTV do when looking for the cool factors.
If you didn't reconsider medicine for a minute at least once then you don't deserve to be in medicine.

 

[MilkmanAl]

You could also go into a field that does procedures Medicare doesn't cover or a field in which Medicare basically doesn't exist (anything peds).

 

[randombetch]

You could also go into a field that does procedures Medicare doesn't cover or a field in which Medicare basically doesn't exist (anything peds).

Aha! Yes, Plastics/Derm FTW.

 

[TexasPhysician]

What if the sky falls?

 

[jturkel]

interesting that this is brought up. The Mayo Clinic in Scottsdale, Arizona is no longer accepting new patients with Medicare. Previous patients who have gone to the clinic/hospital with Medicare will still be able to go there, but no new patients.

 

[BBender716]

interesting that this is brought up. The Mayo Clinic in Scottsdale, Arizona is no longer accepting new patients with Medicare. Previous patients who have gone to the clinic/hospital with Medicare will still be able to go there, but no new patients.

womp wommmppp.

 

[randombetch]

What if the sky falls?

It won't. Illegalizing refusal of Medicare patients very well might though.

 

[Astarael]

I'm not willing to say that legislation to force doctors to accept Medicare patients is impossible, but I think that it would be significantly harder to pass than the recent health care bill. The reason for this is the government has been historically reluctant (or maybe unable) to impinge on personal freedoms. I can think of two recent examples when the government has done so, but they both have extenuating circumstances relating to them. I'll get to that in a minute.

The part of the health care bill that forces insurance companies to cover certain people that they would have dropped otherwise is meant to be imposed on large companies. Although this is removing freedom, I think the government and the people have typically been more willing to do this to large corporations.

As far as recent removals of personal freedom go, you have the Patriot Act and the health care bill itself. The Patriot Act was deemed necessary due to 9/11. The health care bill requiring everyone to have insurance would be seen as helping people, rather than removing freedom. I don't see how either of these arguments fit with removing the ability of a doctor to determine which patients they see. That makes me think that it would be pretty hard for the government to pass the kind of legislature you are worried about, OP.

 

[Siggy]

2 things to think of in terms of the federal government.

1. What power in the consitution gives them the power to require acceptance of medicare? Most of the government health care regulations (HIPAA and EMTALA come to mind) aren't universal federal laws, but medicare regulations. For example, if you don't engage in electronic billing, then you aren't a "covered entity" per HIPAA and do not have to follow HIPAA rules.

2. The federal government does not license physicians. I'd be much more scared that the state governments start requiring physicians to accept medicare. This is much easier to accomplish in a similar vein as the drinking age. It's still a state law requiring acceptance of medicare, it's just the state loses 5-10% of, say, medicade funding if they don't.

 

[GoLytely]

1. What power in the consitution gives them the power to require acceptance of medicare? Most of the government health care regulations (HIPAA and EMTALA come to mind) aren't universal federal laws, but medicare regulations. For example, if you don't engage in electronic billing, then you aren't a "covered entity" per HIPAA and do not have to follow HIPAA rules.
.

I'd love to believe your argument, but nothing in the constitution gives them the power to force people to purchase health insurance under threat of fines and/or jail time either....and that's not stopping them. The courts are even refusing to hear the states' cases.

Although they do have the authority to tax us, which, if we're being honest, is what the healthcare mandate really is.

 

[Cleavername]

You could also go into a field that does procedures Medicare doesn't cover or a field in which Medicare basically doesn't exist (anything peds).

peds?

 

[csmittyB]

peds?

Pediatrics and its subspecialties.

 

[plasmidgreen]

We just passed a bill that plans on making it illegal for health insurance companies to deny coverage for those with pre-existing conditions. It seems to me that making it illegal to turn down Medicare patients wouldn't be much harder. Is this feasible?

Of course, then doctors would try their best to move out of the poorest neighborhoods with the highest percentages relying on Medicare. And only the doctors who can't find jobs would end up in the poorest neighborhoods, furthering the disparity between the health care quality received by the rich and the poor.

Then you might have to treat sick people..............

Become highly specialized if you're that worried about it in the future

 

[randombetch]

I'm not willing to say that legislation to force doctors to accept Medicare patients is impossible, but I think that it would be significantly harder to pass than the recent health care bill. The reason for this is the government has been historically reluctant (or maybe unable) to impinge on personal freedoms. I can think of two recent examples when the government has done so, but they both have extenuating circumstances relating to them. I'll get to that in a minute.

The part of the health care bill that forces insurance companies to cover certain people that they would have dropped otherwise is meant to be imposed on large companies. Although this is removing freedom, I think the government and the people have typically been more willing to do this to large corporations.

As far as recent removals of personal freedom go, you have the Patriot Act and the health care bill itself. The Patriot Act was deemed necessary due to 9/11. The health care bill requiring everyone to have insurance would be seen as helping people, rather than removing freedom. I don't see how either of these arguments fit with removing the ability of a doctor to determine which patients they see. That makes me think that it would be pretty hard for the government to pass the kind of legislature you are worried about, OP.

So you're saying that it was easier to pass the recent bill because it impinged on the freedom of companies instead of individuals? Fine, then let's say that the government proposes a bill that makes it illegal for hospitals/practices to turn down Medicare patients. Pretty much the same thing.

 

[randombetch]

Then you might have to treat sick people..............

Become highly specialized if you're that worried about it in the future

Oh yeah you're right. I forgot that as soon as I get an MD, I lose all my freedom and I am obligated to treat every sick person. Why not make it illegal to charge anything for medical care? We should just force all MD's to treat patients free of charge because then we'd get to treat even more patients! F*** it, let's mandate a new law that requires doctors to PAY patients for treating them! Let's not stop there - let's require all doctors to bi-annually go to Africa and work on treating people there out of our own pockets.

(Forget long term consequences, let's focus on only the current patients doctors would be able to help!)

 

[Astarael]

So you're saying that it was easier to pass the recent bill because it impinged on the freedom of companies instead of individuals? Fine, then let's say that the government proposes a bill that makes it illegal for hospitals/practices to turn down Medicare patients. Pretty much the same thing.

That's the sense that I get, yes. And you're correct that the government could then just legislate that hospitals and practices would have to take Medicare patients. I think it would be harder for them to legislate on practices, since small businesses are often treated differently than corporations. The question then becomes, what difference would it make for a hospital to be required to take Medicare? I don't know enough about this topic to discuss it any further than asking questions at this point.

 

[tennischamp822]

.

 

[oaklandguy]

I could imagine doctor strikes if hospitals were forced to take medicare patients and ended up losing money because of it and had to lower doctor salaries/pay.

 

[Lokhtar]

Haha, the sky is fallllllllllling.

Man, the quicker we get to a single payer the better, so we can stop having these inane debates all the time.

 

[phospho]

I could imagine doctor strikes if hospitals were forced to take medicare patients and ended up losing money because of it and had to lower doctor salaries/pay.

I could be wrong, but I'm pretty sure that physicians are independent contractors... they're never employed by the hospital, which would make it illegal (collusion) if they went on strike...

at least that's what I think I heard....

 

[oaklandguy]

I could be wrong, but I'm pretty sure that physicians are independent contractors... they're never employed by the hospital, which would make it illegal (collusion) if they went on strike...

at least that's what I think I heard....

It depends on the hospital. Most hospitals are the way you described; however, there has been a recent trend, at least in my area, of newer hospitals modeled after the Mayo Clinic which has doctors on salary. These include the Henry Ford Health System as well as many other small hospitals. That being said, due to the majority of hospitals that do have the "outsourcing" of doctors a strike would not really work out. I do tend to like being a patient more at hospitals where the doctors are on salary. They seem more organized and less angry all the time IMO.

 

[gymtanlaundry]

Medicine used to be a sovereign profession, with more autonomy than engineering, law.... Now people are actually discussing the pros and cons of government mandated patient insurance and provider compensation? How far we've come....

Taking medicare under threat of a gun. And some people don't even seem to care!

 

[Lokhtar]

And how far we still have to go

The ones in red don't have government healthcare.

 

[Parts Unknown]

Of course, then doctors would try their best to move out of the poorest neighborhoods with the highest percentages relying on Medicare.

Methinks you have confused Medicare with Medicaid.

Medicare is the program that covers Americans 65+ years of age and a few specific subclasses of disabled individuals. The highest percentages of Medicare recipients will be found in retirement communities.

Medicaid is the program that covers the poor.

 

[gymtanlaundry]

And how far we still have to go

The ones in red don't have government healthcare.

Life expectancy huh?

What about motor vehicle accidents? People drive a hell of a lot in the US. We have cheap gas, bad public transit, large geographic areas.

What about shootings and murders? There is a lot of violence in the US. Work at an urban hospital and you will see it all the time.

Next I bet you will site some statistics on infant mortality, won't you?


And costs?

What about malpractice/liability coverage? Lawyers run the US.

What about research and development? Many of the best medical institutions in the world are located here in the US. Demand for new drugs and therapies.

 

[Lokhtar]

Life expectancy huh?

What about motor vehicle accidents? People drive a hell of a lot in the US. We have cheap gas, bad public transit, large geographic areas.

What about shootings and murders? There is a lot of violence in the US. Work at an urban hospital and you will see it all the time.

Really? Our life expectancy is low because of violence? Care to make a wager on that, if we canceled out violence?

What about malpractice/liability coverage? Lawyers run the US.

Look at costs in states that have malpractice reform. It's better for doctors, and is a good idea, but it doesn't affect the overall spending on healthcare much.

What about research and development? Many of the best medical institutions in the world are located here in the US. Demand for new drugs and therapies.

That's not counted as part of medical costs.

 

[gymtanlaundry]

Really? Our life expectancy is low because of violence? Care to make a wager on that, if we canceled out violence?

Cancel out violence and MVAs and I bet it would be lower, yes. We also share a border with a 3rd world country, and treat their intruders for free under EMTALA. We are also one of the most overweight/obese countries in the world. Is that the HCR system's fault?? Would we REALLY be in better shape if we all had a PCP telling us to lose weight? Give me a break. Even doctors are fat.

The USA is a very unique country- 300 million people and one of the most socioeconomically and culturally diverse. It is comparing apples and oranges.

Look at costs in states that have malpractice reform. It's better for doctors, and is a good idea, but it doesn't affect the overall spending on healthcare much.

Local reform is pretty weaksauce. The defensive mindset is entrenched. Local fixes won't affect national education and training.

That's not counted as part of medical costs.

There are hidden costs everywhere. R&D is one of them.



I'm done talking about this because I don't think you're worth the time.

 

[elektroshok]

Cancel out violence and MVAs and I bet it would be lower, yes. We also share a border with a 3rd world country, and treat their intruders for free under EMTALA. We are also one of the most overweight/obese countries in the world. Is that the HCR system's fault?? Would we REALLY be in better shape if we all had a PCP telling us to lose weight? Give me a break. Even doctors are fat.

The USA is a very unique country- 300 million people and one of the most socioeconomically and culturally diverse. It is comparing apples and oranges.



Local reform is pretty weaksauce. The defensive mindset is entrenched. Local fixes won't affect national education and training.



There are hidden costs everywhere. R&D is one of them.



I'm done talking about this because I don't think you're worth the time.

Good post.

I'm getting sick of people comparing 1-2 aspects of our healthcare system with another country's socialized model.

I think everyone would agree that we need some sort of HCR here - but I also think the majority of America realizes this is NOT the way to it.

Does it surprise anyone that they could not fit in any tort reform or malpractice limititation protecting physicians from frivolous lawsuits? Not me since this bill was written by politicians and lawyers.

I'm also getting sick of the ones for this bill spouting out things like "so you're saying you want to not cover sick kids and drop people from their coverage??" - no, no one is saying that. As sad as those stories are they are the minority. We need to focus on those portions and not the millions uninsured by their own choice or that don't need healthcare.

 

[conrad123]

So...

There are some doctors who hate to deal with NY medicaid so they don't take medicaid patients.

The patients still need medical care, so now these poor folk have to drive an hour and half to the next closest doctor (in this example this is northern, rural NY).

The other doctor is in northern VT, who still has to deal with NY medicaid and it is still a hassle. But the other doctor feels obliged to treat poor, sick patients...so what is the solution?

1. Improve Medicaid re-imbursement.

2. Take away the liscense (or fine) of the doctor who selfishly refuses care to the sick, so that another doctore can pick up the work.

3. Do nothing. Have some doctors look after the well being of the poor and other doctors look after themselves.

My choice would be number 1 followed by number 2.

 

[elektroshok]

2. Take away the liscense (or fine) of the doctor who selfishly refuses care to the sick, so that another doctore can pick up the work.

Why do people think that being a doc equates to being a charity worker?
If you want to be deep in debt and work for less, by all means, go for it.
But it isn't the govt place to impose those regulations on physicians.

 

[Lokhtar]

I love how people say we need HCR, but when asked how else they plan to get 30 million people medical care....it's.....what exactly?

 

[elektroshok]

I love how people say we need HCR, but when asked how else they plan to get 30 million people medical care....it's.....what exactly?

30 million people don't NEED medical care!

That figure includes anyone who has been uninsured for ANY amount of time in the year, as well as people who don't want it, don't need it and people who can afford it but choose to spend their money in other ways.

NO ONE will say that there does not need to be reform for those who legitimately NEED it and can't afford it/access it.

This country is getting so much further away from personal responsibility each day.

We need measures from people not getting dropped or denied for sure, but we also need tort reform like I said and other measures that allow physicians to actually practice medicine how they were trained.

And we need tax credits and health savings accounts. Do you take your car for routine maint and expect your drivers insurance to cover it? No. People should be paying for routine care out of their pockets or health savings accounts - not using insurance.

And then you get a catastrophic policy as well as other measures to help those with chronic conditions (for those people who have no control over these conditions).

Obviously no one here is going to come up with a viable plan on SDN, but the way to reform is not a multi-trillion dollar overhaul and creation of countless new committees and functions all being run by the govt.

When is the last time the govt could run something well, let alone something of this magnitude?

 

[Parts Unknown]

Life expectancy huh?

What about motor vehicle accidents? People drive a hell of a lot in the US. We have cheap gas, bad public transit, large geographic areas.

What about shootings and murders? There is a lot of violence in the US. Work at an urban hospital and you will see it all the time.

Next I bet you will site some statistics on infant mortality, won't you?

I found this handy life expectancy database that can mitigate the factors you listed above. I selected some of the countries from Lokhtar's graph above and looked up life expectancy at age 65 (average number of years remaining if you make it that far):

Japan
M 18
F 23

Australia
M 17
F 21

France
M 17
F 21

Canada
M 17
F 20

USA
M 16
F 20

UK
M 16
F 19

Mexico
M 16
F 18

Poland
M 14
F 18

Slovakia
M 13
F 17

Regardless, our expensive, cobbled together "system" would suck no matter what the personal habits of the patients within it happen to be.

 

[conrad123]

Why do people think that being a doc equates to being a charity worker?
If you want to be deep in debt and work for less, by all means, go for it.
But it isn't the govt place to impose those regulations on physicians.

From the H. Oath:

"I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings"


Agreed the gov't should not have to enforce this...but the medical community should...

 

[Parts Unknown]

30 million people don't NEED medical care!

That figure includes anyone who has been uninsured for ANY amount of time in the year,

This is patently false. The census data that is most frequently cited is based on phone surveys that specifically count only individuals who have been uninsured for the entire calendar year.

Does anyone else find it interesting that the argument went from "there aren't that many uninsured" to "the system can't handle so many newly insured people"?

 

[Parts Unknown]

Why do people think that being a doc equates to being a charity worker?

Increasing insurance rates decreases uncompensated (charity) care, which is why I'm all for adding 32 million people to the rolls of the insured.

This isn't too difficult to understand. If you allow young healthy people to escape paying into the system, that places the burden on older, sicker individuals who cannot possibly afford to shoulder the entire burden. The system eventually breaks and collapses, leaving everyone (including providers) completely F-ed. Solution: pool everyone and make them all pay into the system through their entire lives. This gives insurance a level of stability and predictability that people in other country's take for granted.

I would recommend you peruse some of the fascinating papers recently released by the Urban Institute.

 

[elektroshok]

Increasing insurance rates decreases uncompensated (charity) care, which is why I'm all for adding 32 million people to the rolls of the insured.

This isn't too difficult to understand. If you allow young healthy people to escape paying into the system, that places the burden on older, sicker individuals who cannot possibly afford to shoulder the entire burden. The system eventually breaks and collapses, leaving everyone (including providers) completely F-ed. Solution: pool everyone and make them all pay into the system through their entire lives. This gives insurance a level of stability and predictability that people in other country's take for granted.

I would recommend you peruse some of the fascinating papers recently released by the Urban Institute.

Do you actually think even a portion of the '32mil' uninsured will be paying into this pot? Get real. There is NO incentive to pay in when you can just up and buy a policy when you get sick now that you can't be denied coverage. Those that do pay are going to get stuck with higher premiums, those that cant/dont want to pay will get their bill footed by tax payers...

 

[Szent]

Increasing insurance rates decreases uncompensated (charity) care, which is why I'm all for adding 32 million people to the rolls of the insured.

This isn't too difficult to understand. If you allow young healthy people to escape paying into the system, that places the burden on older, sicker individuals who cannot possibly afford to shoulder the entire burden. The system eventually breaks and collapses, leaving everyone (including providers) completely F-ed. Solution: pool everyone and make them all pay into the system through their entire lives. This gives insurance a level of stability and predictability that people in other country's take for granted.

What your speaking of is a system similar to Social Security. Everyone pays in throughout their lives so that they can receive the same reward in the end. However, social security is going to fail eventually:

By 2016, Social Security will begin paying more in benefits than it collects in payroll taxes, according to the annual report of government trustees; reserves in the form of government i.o.u.'s will be exhausted by 2037, after which incoming taxes will cover three-quarters of benefits.

Article: http://www.nytimes.com/2010/03/23/us/politics/23fiscal.html

Additional point: Might I also add that social security is the biggest ponzi scheme in the US, the majority of the money taken in goes immediately to paying other people. The money not spent immediately is loaned to other areas of the government.

 

[skiddoc]

Do you actually think even a portion of the '32mil' uninsured will be paying into this pot? Get real. There is NO incentive to pay in when you can just up and buy a policy when you get sick now that you can't be denied coverage. Those that do pay are going to get stuck with higher premiums, those that cant/dont want to pay will get their bill footed by tax payers...

Except for the fact that everyone is REQUIRED TO BUY INSURANCE.

 

[dru2002]

Increasing insurance rates decreases uncompensated (charity) care, which is why I'm all for adding 32 million people to the rolls of the insured.

This isn't too difficult to understand. If you allow young healthy people to escape paying into the system, that places the burden on older, sicker individuals who cannot possibly afford to shoulder the entire burden. The system eventually breaks and collapses, leaving everyone (including providers) completely F-ed. Solution: pool everyone and make them all pay into the system through their entire lives. This gives insurance a level of stability and predictability that people in other country's take for granted.

I would recommend you peruse some of the fascinating papers recently released by the Urban Institute.

But those papers would disagree with there worldviews why would they read them? lol

 

[Lokhtar]

We need measures from people not getting dropped or denied for sure, but we also need tort reform like I said and other measures that allow physicians to actually practice medicine how they were trained.

Or....we could just have a single payer.

 

[gymtanlaundry]

I found this handy life expectancy database that can mitigate the factors you listed above. I selected some of the countries from Lokhtar's graph above and looked up life expectancy at age 65 (average number of years remaining if you make it that far):

Japan
M 18
F 23

Australia
M 17
F 21

France
M 17
F 21

Canada
M 17
F 20

USA
M 16
F 20

UK
M 16
F 19

Mexico
M 16
F 18

Poland
M 14
F 18

Slovakia
M 13
F 17

Regardless, our expensive, cobbled together "system" would suck no matter what the personal habits of the patients within it happen to be.

I don't see where they control for the variables I listed- violence, traumatic accidents, MVAs, etc.

I also don't see how they could conceivably control for obesity- which reflects cultural differences between countries, not health care delivery.

 

[username456789]

I don't see where they control for the variables I listed- violence, traumatic accidents, MVAs, etc.

I also don't see how they could conceivably control for obesity- which reflects cultural differences between countries, not health care delivery.

Agreed. People who use life expectancy (and ESPECIALLY idiots who use infant mortality) as some sort of gauge of the quality of our healthcare exhibit such a fundamental lack of understanding on the issue that it's essentially useless to carry on further discussion for fear of actually becoming stupider.

 

[circulus vitios]

And how far we still have to go

The ones in red don't have government healthcare.

Obesity, heart disease, and smoking related deaths will all drop under a single payer system. The per capita spending will also magically cut in half. How? I don't know. But it will.

All of America's health care ailments are in a causative relationship with health care ownership which can be expressed as government-owned = good, privately-owned = bad.

 

[gymtanlaundry]

comparison of most recent intentional homicide rates

I edited out the countries not on the above chart (most of the ones with higher homicide rates than the USA were 3rd world countries)

Mexico 10.0 (homicides per 100,000 people per year)
Turkey 6.23
United States 5.4
Portugal 2.50
Switzerland 2.26
United Kingdom 2.03
New Zealand 2.00
Canada 1.83
France 1.59
Czech 1.33
Slovakia 1.31
Spain 1.20
Australia 1.2
Italy 1.06
Germany 0.88
Denmark 0.88
Austria 0.73
Norway 0.71
Japan 0.44

** Obviously correlation =/= causation. But when you consider the ages of people most commonly killed, 18-25ish, it makes sense that it could skew the data by the 1-2 years needed to make your graph misleading. That combined with the MVAs and trauma.

Also longevity can vary according to inherent factors of ethnicity. sickle cell anemia, etc.

 

[gymtanlaundry]

Obesity, heart disease, and smoking related deaths will all drop under a single payer system.

please....

make it stop.


How? is the single payer going to strap patients onto treadmills? Will they ration food? How exactly does a single payer systerm force people to stop eating, start exercising, stop smoking, and stop killing each other?

You have a government fetish. It's just going too *solve everything*...?

The delusion on display here is simply staggering.