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CreativeDominant -> RE: BUt who determines what is affordable? (7/10/2009 7:07:04 AM)
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ORIGINAL: rulemylife
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ORIGINAL: CreativeDominant
Yes, there are other studies that show where gov't control will be more stringent. They will set up panels that will ration care, panels that will decide the necessity of a procedure, panels that decide when you should be well which...when confronted...they will be vague about exactly what guidelines they are following but they sure aren't any you ever learned in school.
Care to share any of those studies or am I just to accept that they exist and that's enough? They exist. I read one or another of them about 1x/week. You want to see them...look them up.
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Their idea is to set up something similar to Medicare. Being a provider who has dealt with Medicare for 26 years tells me in no uncertain terms do I want the government involved in my regular patient's health care.
And does that have to do with the quality of care your patient receives or more to do with the quality and timeliness of your compensation? Given that I've had some of my Medicare patients since about 15-20 years before they were on Medicare, I'd say that the quality of care that I give the patients remains the same, whether they are on Medicare or not. What doesn't remain the same is the payment level. I receive, on average, 5 - 10 bucks less per patient once they are on Medicare. My waiting time goes up to anywhere from 3 mos - 6 mos vs. immediately for cash patients and 2 - 3 mos for regular insurance. The amount of paperwork for this reduced sum is increased by at least twofold. So, to answer your question, it has to do with the ineffective bureaucratic machine that Medicar e is. Tell me, would you like to wait 3 - 6 months for your work check? Would you like to have to prove that the work you did was necessary?
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Someone on here asked why doctors should be insulated from the competition for patients based on providing a service at a lower cost. Good and bad question. On the bad question side, doctors are forced to compete...many insurance companies set a price for procedures that they will pay for. Any amount charged that is higher than that is the patient's responsibility OR, in some cases where the doctor is a part of that insurance network, is not allowed. If the doctor wants to build a patient base or other circumstances force him to work where he is, he has the choice of entering into these network agreements even if they do not pay him what he thinks he is worth. He is always entitled to try and make it without that umbrella by charging a higher fee than what the insurance companies will pay him but a lower fee than what other providers charge. I charge less than what one of the other chiropractic doctors around here charges and more than the other one does. I charge less because I don't have the overhead that the doctor who charges more does, not because I think they are better. I charge more than the other one does because, even though he has the same equipment, I've been at it 15 yrs longer and have post-graduate certification. If a patient wants to pay the higher fee because the doctor is not in the network or because they feel the doctor is worth it, then that is their option and their choice. People like to say that everyone is entitled to decent health care. While I agree that no one should be subjected to a criminal standard of care, the idea that everyone deserves the best is a socialistic, utopian view. If you want a Mercedes rather than a Chevrolet, expect to pay a higher price. If you want a world-renowned cardiologist rather than the specialist in your city that is covered under your health plan, expect to pay more.
Good question side...if there are doctors like me who charge less than what the insurance companies are willing to pay...and there are plenty of us...why don't the insurance companies go with those of us with lower rates?
Well, I guess that pretty much answers my previous question.
While I realize doctors have to make a living like everyone else, I think your opposition to government health care is easily summed up by what you wrote above.
You are worried it will affect your bottom line, regardless of how it might help your patients.
What I wrote above is that, on average, I charge less than many other doctors and charge more than some do. As a matter of fact, I do care about my bottom line...just as anyone who is working for themselves does. Many people may love their jobs but I seriously doubt that you will find anyone who would happily accept a pay cut while being expected to work longer hours. Someone who will accept a pay cut while their own expenses go up...expenses such as malpractice insurance, licensing fees, inspection fees, any sort of fee that the state government can think of to impose since...in our state anyway...they are forbidden to raise our taxes without going to the people and giving them the chance to vote on it first. So the government sets a fee...like they have now for vehicle registration...which is basically a new tax on anyone who drives. 10 years ago, before my divorce, I had 4 women working for me on clerical and technical assistant duties. When my practice went down after the divorce, I had to get rid of these people. Now...10 years later...my practice is back up to almost the same level as it was before the divorce yet now, I could only afford to hire one of these people back. Why? Because Medicare reimbursement has gone down. Because I have recognized that other people are hurting in terms of their employment status more than I am and have kept my fees the same for the last 5 years. But that same holding of fees has not occurred within medicare, within the medical malpractice insurance industry, within state licensing agencies.
Something that people who advocate having something that someone else pay for always love to bring in is "the humanity"...tell me, why should I accept a lower fee to work on a lawyer who drives up to my office in his Porsche Boxster? Why should I accept a lower fee to work on a woman who walks into my office wearing leather pants, after getting out of her 40,000 dollar truck, because she's got 5 kids but no father in sight and is receiving Medicaid, WIC, and all the other government bennies? Because the government has determined that it bematter of fact, I do care about my bottom line...just as anyone else who is working does. People st knows how to handle costs and their best way is always to decrease payments to the providers while at the same time, bloating the numbers of people who work for Medicare...or any other government agency? Lawyers serve humanity too...tell you what, let's put them on a fee schedule based on what the government says they are worth. Do you really think that would ever happen? No. Because trial lawyers, especially those who love to sue for "damages" are some of the biggest contributors to politicians.
As for your snide comments about what sort of quality of care I provide to my patients...all I can say is that I've been in practice in the same small town for 26 years. Some of my patients became mine when my father died 24 years ago and some of my patients are people who first came to me 26 years ago. My very first patient is still my patient 26 years later and is happy with what I've done for her through the years. My practice has survived a vengeful ex-wife, a 7 year drought that affected many of my farmers and ranchers, and the cyclic nature of the beef, sugar, and oil industries. So I must do something right, eh?
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