It is true that there won’t be wholesale conversion to retainer-style medicine; most people can’t afford it now, and even more won’t be able to as the demand for services escalates in the coming years. That doesn’t mean that the rest of the population will just be able to muddle through under the present way of doing business, though. As operating costs squeeze practices even harder than they are now, the ability of practices to tolerate any excess costs and delays to timely payment from third-party payors will be exhausted. This is what will likely break the grip Medicare has on the market, and doctors will be forced to demand payment up front and in excess of the Medicare allowables. That, or close. The doctor may file the claim, but won’t accept or wait for third-party payments. Medicaid patients will be out of luck, as will those insured under low-paying HMOs. As fewer practices provide service while accepting assignment, more patients will be forced farther afield to seek the ever-dwindling numbers of doctors who are able to accept assignment. Appointments will be even more difficult to get. Many practices will close to new patients. Some will have no choice except to go out of business. Doctors who have the resources to retire and who see no prospect of improvement and ever greater financial risk to remaining in practice will bail out. Emergency rooms will be taxed even harder than they are right now as the uninsured and poorly-insured, unable to access care, seek ER treatment, needed or not. Who will want to go into medicine? Many fewer than today, doubtless. Some medical schools, unable to attract quality applicants, will close, just as dental schools did for the same reasons, 15 years ago.

There will likely be a time, not long from now, when we will ask whoever thought the costly compliance requirements like HIPAA and other regulatory deadweight was such a great idea.

The laws of economics will not be harnessed forever by the public’s wishful thinking or by bloated promises of politicians looking for easy votes. Next year, Medicare, in its wisdom, plans to cut reimbursements to doctors another 4.2 percent. It is the heart of folly to think that because our system hasn’t broken yet that it can’t be broken at all.

The third party payor system is disintegrating, Medicare is disappearing, Medicaid is being eaten by State budget cuts….private practice physicians are business people. They have to pay licensening fees, utilities, staff, rent, insurance, etc. None of these entities accept reduced fee schedules, especially on a year to year basis. The physician has a responsibility to provide good care to their patients, be a responsible and moral citizen, provide for their own family and themselves within reason. If the physician wants to charge fee for service, ask for cash up front, write one-to-one contracting with patients, how is this different from writing contracts with individual insurance companies, or more problematic morally than capitated contracting?

in texas we are being squeezed by the board of medical examiners, which is on a ‘witch hunt’called for by the insurance companies, both malpractice and ‘health’ insurance, to bring any maverick physicians who dare to practice outside the control of the mangled-care web to their collective knees. running up the body count of ‘bad’ doctors has provided justification for passage of proposition 12, which greatly limits pain and suffering outlays in malpractice suits, effectively enhancing profit margin hugely for the malpractice carriers. this was sold to the m.d.’s as a malpractice ins premium reduction, but hey, it didnt happen in california, and if it happens here, it will be a hollow token gesture. meanwhile, the state board is flooding the state with foreign med grads, who largely will be at the service of the h.m.o.’s and ON THE CHEAP. the board is in clandestine fashion regulating what an m.d. can charge for his time by misinterpreting the rules to fit the agenda. fee for service and boutique practices are soon to come under scrutiny, and will be found unethical, with no jury of peers, no review before the full board, and no legal recourse beyond a state court who’s ruling can then be nullified by the board. in short, a kangaroo court where one is guilty, period. take a look at the website, tsbme, and weep.